Cervical Cancer

Sex and Gender-based Analysis of this topic

Despite cervical cancer having a strong causal relationship with human papilloma virus (HPV), in the wake of growing concern about the environment and its impact on human health it is important to approach environmental risks as co-factors worthy of investigation [1]. Two chemicals - trichloroethyle (TCE) and tetrachloroethyle (PCE) - have potential links to cervical cancer and a developing body of research indicates that environmental exposure to chemicals could heighten risk of cervical cancer [2]. Certain groups of women may be especially vulnerable to these environmental risk factors in occupational and domestic settings, as well as in the general ambient environment [2]. 
Sex Issues
Cervical cancer is the third most common cancer in women during child-bearing years (20-49) [3]. While infertility can be a side effect of cancer treatment, environmental exposures heighten the risk of cervical cancer add additional reproductive concerns [3-4]. Women’s bodies can be sites for the transference of toxicants. This is illustrated by the case of diethylstilbestrol (DES), a synthetic estrogen that is a risk factor for cervical cancer and that has been shown to transfer from mother to daughter prenatally, potentially causing structural damage of the reproductive organs and increasing the daughter’s chance of developing cervical cancer [5]. 
Gender Issues
Gendered occupational settings, social roles, and domestic responsibilities can significantly influence degree of exposure to two related chlorinated solvents with researched associations with cervical cancer: trichloroethylene (TCE) and tetrachloroethylene (PCE) [6-7].  

TCE has a history of use in an occupational setting as a drycleaning solvent and as spot treatment in the textile industry [5]. In domestic settings, cleaners and degreasers can contain TCE and further exposure through polluted indoor air can come from dissolved samples inhaled through vapors in a context such as showering [6, 8]. PCE is also a solvent used in drycleaning as a stain remover [7]. Although use of PCE in drycleaning has decreased significantly in Canada, one of the primary sectors through which workplace exposures to PCE occur is the personal and household services sector [7]. 

The textiles, personal, and household services sectors are traditionally staffed by a significant number of women; in many countries, after agriculture, the textile sector is the largest employer of women [6, 7, 9]. In British Columbia, women in the personal service sector, which includes drycleaning, make up 56% of the workforce, a number considerably higher than women’s share of total employment (47%) [10]. Studies also confirm high mortality rates for drycleaning employees from cancers, including cervical cancer [11].  

Across Canada, women spend considerably more time than men on unpaid work such as cleaning and home maintenance, which put women at greater risk of chemical exposure [12]. Often responsible for laundering, women may have elevated risk of second-hand exposure from carcinogens brought into the house on clothing [13].
There is a positive correlation between rates of cervical cancer mortality and chemical and agricultural industry employment [14]. Establishing risk is further confounded by risk factors and vulnerabilities such as lifestyle, health, disability, age, race, and/or socio-economic status [15] [16].  

Of people who develop or die from workplace-related cancers, a disproportionate number are low-income, have limited education, and are part of a minority or “underserved” group. Mobility is threatened by a sense of limited employment opportunities, lack of access to knowledge, or not being able to risk losing a source of income [13]. 

First Nations groups are an example of intersecting vulnerabilities influenced by environmental exposures. Pollution is a particular risk in both occupational and domestic settings given the proximity of industrial plants to many First Nations communities, as well as Northern communities’ exposure to pollution originating from industry in southern regions of North America [17]. First Nations have different risks of cancers than non-First Nations [18]. Although overall rates of cancer for First Nations people are lower than the general population, an Ontario study (the Canadian province with the greatest number of First Nations people) indicated that rates of cervical cancer for First Nations women in the province are significantly higher as compared to the provincial population as a whole [18-19].  Analyses suggests that these differing rates could be credited to a combination of genes, attitudes towards preventative measures, lifestyle, and sociocultural factors, including environmental factors [18]. 
Establishing links between exposure to environmental factors and cervical cancer is difficult due to confounding factors diluting the perception of risk [20]. This is further challenged by a lack of longitudinal studies, a lack of complete knowledge about long-term effects of chemicals, and a lack of research pertaining specifically to women, female cancers, and the workplace risks [14]. 

In addition to the need for improved measures to access hard-to-reach or hard-to-service populations for screening, more data is required isolating the causal factors linked to environmental exposure, in particular among those populations where cervical cancer rates are highest. While the education of girls and young women about cervical cancer risk now focuses largely on the role of HPV, the importance of regular Pap tests, and the HPV vaccine(s), additional efforts to include information about chemical exposures and the relationship to cancer are needed [21]. Though some information about women’s vulnerabilities to exposures within certain occupations exists, more research is crucial to highlight the interplay between these and other exposures across a broad range of environments (air, water, dust), settings (home, work), and concentrations.
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