Cervical Cancer and HPV: What Every Woman Should Know About Screening

TL;DR: Nearly all cervical cancer is caused by HPV, a very common virus. The HPV vaccine can prevent most cases, and regular Pap smears can catch precancerous changes early, when they're easily treated. This is one cancer we can actually eliminate, but only if women have access to screening and vaccination.

Here is something that should make you feel hopeful: cervical cancer is one of the most preventable and treatable cancers in the world. We know what causes it. We have a vaccine that can stop it before it starts. And we have a simple screening test that catches it early.

Yet cervical cancer still kills more than 340,000 women every year, most of them in low- and middle-income countries. The difference between those who survive and those who don't almost always comes down to access, access to information, to vaccination, and to screening.

This post gives you all three.

What Is Cervical Cancer?

Cervical cancer is cancer that starts in the cervix, the narrow lower part of the uterus (womb) that connects to the vagina. Think of the cervix as the opening of the uterus.

Cervical cancer usually develops slowly over many years. It begins with precancerous changes (abnormal cells that are not cancer yet but could become cancer if left untreated). This is actually good news, because it means there is a long window of time to catch and treat these changes before they ever become cancer.

How HPV Causes Cervical Cancer

Almost all cervical cancer, more than 95% of cases, is caused by a virus called HPV (human papillomavirus). HPV is the most common sexually transmitted infection in the world. Most sexually active people will get at least one type of HPV at some point in their lives.

Here's what's important to understand:

• There are over 200 types of HPV. Most of them are harmless and go away on their own.
• About 14 types are considered "high-risk" because they can cause cancer. HPV types 16 and 18 are responsible for roughly 70% of all cervical cancers.
• HPV is spread through skin-to-skin sexual contact, including vaginal, anal, and oral sex. You don't need to have penetrative sex to get it.
• Most HPV infections clear on their own within one to two years, thanks to your immune system. You may never know you had it.
• The problem is when a high-risk HPV infection doesn't clear. If it persists for years, it can cause cells in the cervix to change and eventually become cancerous.

HPV can also cause genital warts (from low-risk types like HPV 6 and 11), as well as cancers of the vulva, vagina, anus, and throat. For more on sexually transmitted infections, see our guide to STI symptoms, prevention, and treatment.

The HPV Vaccine: Prevention Before Infection

The HPV vaccine is one of the greatest tools we have against cervical cancer. It works by teaching your immune system to fight off the HPV types that cause most cancers and genital warts.

Who Should Get It?

• The ideal age is 9 to 14 years, before a person becomes sexually active and is exposed to HPV.
• Catch-up vaccination is recommended up to age 26 for anyone who wasn't vaccinated earlier.
• Adults aged 27 to 45 may still benefit if they haven't been previously vaccinated. Talk to your doctor about whether it makes sense for you.
• Both girls and boys should be vaccinated. Vaccinating boys helps protect them from HPV-related cancers and also reduces transmission to their future partners.

How Effective Is It?

Very. The HPV vaccine prevents more than 90% of HPV-related cancers when given before exposure to the virus. Countries like Australia, which introduced widespread HPV vaccination programs early, have seen dramatic drops in cervical cancer rates and are on track to become the first country to effectively eliminate the disease.

Is It Safe?

Yes. The HPV vaccine has been extensively studied and is endorsed by the World Health Organization, the CDC, and major medical bodies worldwide. Hundreds of millions of doses have been given. Side effects are typically mild, soreness at the injection site, mild fever, or a headache.

How Many Doses?

• If starting before age 15: Two doses, six to twelve months apart.
• If starting at 15 or older: Three doses over six months.

The Pap Smear: How Screening Works

A Pap smear (also called a Pap test or cervical screening) is a simple procedure that checks for abnormal cells on your cervix. It can detect precancerous changes long before they become cancer.

What Happens During a Pap Smear?

1. You lie on an exam table with your feet in stirrups.
2. Your doctor gently inserts a speculum (a smooth, duck-bill-shaped instrument) into your vagina to hold it open.
3. Using a small brush or spatula, they collect a sample of cells from your cervix.
4. The sample is sent to a lab for examination under a microscope.

The whole thing takes a few minutes. It can feel slightly uncomfortable or cause mild pressure, but it shouldn't be painful. If it hurts, let your healthcare provider know, they can adjust.

What About HPV Testing?

An HPV test checks for the presence of high-risk HPV types in your cervical cells. It can be done at the same time as a Pap smear (this is called co-testing), or on its own. In many countries, HPV testing is now the preferred primary screening method because it's more sensitive, it can detect high-risk HPV before any cell changes appear.

How Often Should You Get Screened?

Screening guidelines vary slightly by country and organization, but here are the widely accepted recommendations:

Important: Even if you've been vaccinated against HPV, you still need regular screening. The vaccine doesn't cover all high-risk HPV types.

For a full overview of which health screenings you need at every age, see our women's health screening checklist.

What Do Abnormal Results Mean?

An abnormal Pap smear does not mean you have cancer. It means some cells on your cervix look different from normal. This is common, and most of the time it's nothing serious.

Here's what the different results can mean:

• ASCUS (atypical squamous cells of undetermined significance), Some cells look slightly unusual but it's unclear why. This is the most common abnormal result. Your doctor may recommend an HPV test or a repeat Pap in a year.
• LSIL (low-grade squamous intraepithelial lesion), Mild cell changes, usually caused by HPV. These often resolve on their own. Your doctor will likely monitor you.
• HSIL (high-grade squamous intraepithelial lesion), More significant cell changes that have a higher chance of progressing to cancer if untreated. Further testing and treatment are usually recommended.
• AGC (atypical glandular cells), Unusual changes in glandular cells. This requires further evaluation.

If your results are abnormal, the next step is usually a colposcopy (kol-POS-kuh-pee), a procedure where your doctor uses a special magnifying instrument to look closely at your cervix. They may also take a small tissue sample (a biopsy) for further testing.

Treatment for Precancerous Changes

If precancerous cells are found, treatment is straightforward and highly effective. The goal is to remove or destroy the abnormal cells before they can become cancer. Options include:

• Cryotherapy, Freezing the abnormal cells with cold gas. Quick, done in a clinic, no anesthesia needed.
• LEEP (loop electrosurgical excision procedure), A thin wire loop heated by electric current is used to remove the abnormal tissue. This is one of the most common treatments.
• Cone biopsy, A cone-shaped piece of tissue containing the abnormal cells is surgically removed. This is used when changes are more extensive.
• Laser therapy, A focused beam of light destroys the abnormal cells.

These treatments have cure rates above 90% for precancerous changes. Recovery is usually quick, and most women go on to have normal Pap smears afterward.

Cervical Cancer in Africa: A Preventable Crisis

Cervical cancer tells a story of global inequality. While rates have dropped significantly in high-income countries thanks to vaccination and screening, Africa carries a disproportionate burden.

The Numbers

• Sub-Saharan Africa has some of the highest cervical cancer rates in the world.
• In countries like Malawi, Zambia, Zimbabwe, and Tanzania, cervical cancer is the most common cancer in women.
• An estimated 80% of cervical cancer deaths occur in low- and middle-income countries.
• In much of Africa, fewer than 10% of women have ever had a cervical screening test.

Why Are Rates So High?

• Limited screening programs, Many countries lack the infrastructure for widespread Pap smear or HPV testing.
• Low HPV vaccination coverage, While some African countries have introduced the HPV vaccine, coverage remains low due to cost, supply issues, and vaccine hesitancy.
• Late diagnosis, Without screening, cancer is often detected at advanced stages when treatment options are limited.
• HIV co-infection, Women living with HIV (human immunodeficiency virus) are six times more likely to develop cervical cancer because their weakened immune systems are less able to clear HPV infections. Sub-Saharan Africa has the highest HIV rates globally.
• Shortage of trained healthcare workers, Especially in rural areas.

The WHO Elimination Strategy

In 2020, the World Health Organization launched a global strategy to eliminate cervical cancer as a public health problem. The targets for every country by 2030 are:

• 90% of girls fully vaccinated with the HPV vaccine by age 15
• 70% of women screened with a high-performance test by age 35 and again by age 45
• 90% of women identified with cervical disease receive treatment

This is ambitious, but achievable. Countries like Rwanda have already shown what's possible, they reached over 90% HPV vaccination coverage in girls through a national school-based program.

Reducing Your Risk

You can significantly lower your risk of cervical cancer:

• Get the HPV vaccine if you haven't already, and vaccinate your children.
• Get screened regularly, Pap smears and HPV tests save lives.
• Practice safer sex, Condoms reduce (but don't eliminate) HPV transmission. See our guide to contraception methods for more on protection options.
• Don't smoke, Smoking weakens your immune system's ability to clear HPV infections and doubles your risk of cervical cancer.
• Manage HIV, If you're living with HIV, staying on antiretroviral therapy (ART) helps maintain your immune system and reduces your cervical cancer risk. More frequent screening is recommended.

Why Early Detection Saves Lives

When cervical cancer is caught at the earliest stage, the five-year survival rate is above 90%. When caught late, that number drops dramatically. The difference is screening.

A Pap smear takes a few minutes. It's not the most comfortable experience, but it could save your life. If you've been putting off your screening, consider this your reminder to book it.

Cervical cancer is one of the few cancers we have the tools to eliminate entirely. The vaccine exists. The screening exists. The treatments for precancerous changes work. What's needed now is for every woman to have access to them, and to use them.

You deserve that.

References

1. World Health Organization. "Cervical Cancer." who.int
2. World Health Organization. "Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem." who.int
3. CDC. "HPV Vaccination." cdc.gov
4. CDC. "Cervical Cancer Screening." cdc.gov
5. ACOG. "Cervical Cancer Screening." acog.org
6. Cancer Research UK. "About Cervical Cancer." cancerresearchuk.org
7. PMC. "Cervical Cancer in Sub-Saharan Africa." pmc.ncbi.nlm.nih.gov
8. The Lancet Global Health. "HPV Vaccination in Sub-Saharan Africa." thelancet.com

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