Cervical cancer is a disease that develops when cells in the cervix, the lower part of the uterus that connects to the vagina, begin to grow in an uncontrolled way. While this diagnosis was once among the most common causes of cancer death in women, advances in screening and prevention have dramatically changed the outlook, making cervical cancer one of the most preventable and treatable cancers today.

Understanding Who Gets Cervical Cancer

Cervical cancer is the fourth most common cancer among women worldwide, with approximately 660,000 new cases diagnosed each year globally. In 2022 alone, around 350,000 women died from this disease, with about 94% of these deaths occurring in low- and middle-income countries. This striking difference reflects major inequalities in access to vaccination programs, screening services, and treatment facilities.^[6]

In the United States, about 14,000 people receive a cervical cancer diagnosis annually. The disease most commonly affects women between the ages of 35 and 44, though it can develop at any age in those who have a cervix.^[3] Women over 30 are at higher risk of developing cervical cancer, and the disease occurs most often in those who have not been screened regularly.^[4]

The highest rates of cervical cancer incidence and mortality are found in sub-Saharan Africa, Central America, and South-East Asia. These regional differences relate directly to inequalities in access to vaccination, screening, and treatment services, as well as risk factors such as HIV (human immunodeficiency virus) prevalence and social and economic challenges including poverty and gender-based barriers to healthcare.^[6]

What Causes Cervical Cancer

Almost all cervical cancers are caused by persistent infection with human papillomavirus, commonly known as HPV. This virus is extremely common and spreads through sexual contact, including vaginal, anal, and oral sex. At least half of all sexually active people will be infected with HPV at some point in their lives, though most will never know they had it because their immune systems clear the infection naturally.^[4]

There are over 100 types of HPV, and about a dozen of them are considered high-risk because they can lead to cancer. HPV types 16 and 18 are particularly dangerous, causing approximately 70% of all cervical cancer cases. When high-risk HPV persists in the body rather than being cleared by the immune system, it can cause abnormal changes in cervical cells over time.^[3]

The development from HPV infection to cervical cancer typically happens slowly. Before cancer appears in the cervix, cells go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue. These precancerous changes can be detected through screening tests. If left undetected or untreated, these abnormal cells may eventually become cancer cells and begin to grow and spread more deeply into the cervix and surrounding areas.^[2]

Women living with HIV are six times more likely to develop cervical cancer compared to women without HIV. An estimated 5% of all cervical cancer cases are attributable to HIV infection, which weakens the immune system’s ability to fight off HPV and prevent cellular changes.^[6]

Risk Factors That Increase Your Chances

While HPV infection is the primary cause of cervical cancer, several other factors can increase a person’s risk of developing the disease. Understanding these risk factors is important because some of them can be changed or controlled.

Smoking is one significant modifiable risk factor. Women who smoke are about twice as likely to develop cervical cancer as those who don’t smoke. Smoking weakens the immune system, making it harder for the body to fight off HPV infections and prevent cancer development.^[3]

Sexual history also plays a role in cervical cancer risk. Becoming sexually active at a young age, having many sexual partners, or having a partner who has had many sexual partners increases the risk. This is because these factors increase the likelihood of exposure to HPV. However, it’s important to remember that HPV can be transmitted with just one sexual partner, which is why safe sex practices are important for everyone.^[3]

People who have not had regular Pap tests (screening tests that check for abnormal cells on the cervix) are at higher risk because precancerous changes may go undetected. Screening is particularly important because it can identify problems before cancer develops.^[3]

Having a weakened immune system from any cause increases cervical cancer risk. This includes people taking immune-suppressing medications (such as after an organ transplant), those undergoing treatment for other cancers, and those living with HIV. A compromised immune system is less able to clear HPV infections and prevent abnormal cell changes.^[3]

Infection with chlamydia, a sexually transmitted disease, also increases cervical cancer risk. Additionally, cervical cancer can run in families. If an immediate family member has had cervical cancer, your risk is higher than if no one in your family has been affected.^[3]

Recognizing the Symptoms

One of the challenges with cervical cancer is that early stages often don’t cause any symptoms at all. This is why regular screening is so critical—it can detect problems before you feel anything is wrong. Many women diagnosed with early-stage cervical cancer have no symptoms and learn about their condition only through routine screening tests.^[3]

When cervical cancer does cause symptoms, they typically appear as the cancer grows larger or spreads to nearby tissues. The most common early symptom is unusual vaginal bleeding. This might include bleeding after sexual intercourse, bleeding between menstrual periods, bleeding after menopause, or menstrual periods that are heavier or longer than usual.^[3]

Another common symptom is unusual discharge from the vagina. This discharge may be watery or bloody and may have a foul odor. Some women experience pain during sexual intercourse, which doctors call dyspareunia. Pain in the pelvic region that isn’t related to your menstrual cycle can also be a warning sign.^[3]

If cervical cancer has spread to nearby tissues or organs, additional symptoms may develop. These can include difficult or painful urination, sometimes with blood in the urine. Some women experience diarrhea, pain, or bleeding from the rectum during bowel movements. General symptoms like fatigue, loss of weight and appetite, and an overall feeling of being unwell may also occur. A dull backache or swelling in the legs can indicate more advanced disease.^[3]

It’s important to know that these symptoms can be caused by many other health conditions that are not cancer. However, if you experience any abnormal bleeding, unusual vaginal discharge, or other unexplained symptoms, you should contact a healthcare provider promptly. Early investigation of symptoms can lead to earlier diagnosis and better outcomes.^[3]

Prevention Strategies That Work

Cervical cancer is largely preventable through a combination of vaccination, regular screening, and healthy lifestyle choices. Taking advantage of these prevention strategies can significantly reduce your risk of developing the disease.

The HPV vaccine is one of the most effective prevention tools available. It protects against the types of HPV that cause approximately 90% of cervical cancers. The vaccine is most effective when given before a person becomes sexually active, which is why it’s recommended for boys and girls between ages 11 and 12. However, catch-up vaccination is available for everyone through age 26, and adults aged 27 to 45 may also benefit from the vaccine after discussing it with their doctor.^[3]

Regular screening through Pap tests and HPV testing is crucial for cervical cancer prevention. Screening doesn’t prevent HPV infection itself, but it can detect precancerous changes in cervical cells before they develop into cancer. Most screening guidelines recommend that people with a cervix begin Pap tests at age 21 and continue every three years until age 65, depending on their results and whether HPV testing is also performed.^[7]

Practicing safer sex is another important prevention strategy. Using condoms consistently and limiting the number of sexual partners can reduce the risk of HPV transmission and other sexually transmitted infections that may increase cervical cancer risk. While condoms don’t provide complete protection against HPV (because the virus can infect areas not covered by a condom), they are associated with lower cervical cancer rates.^[3]

If you smoke, quitting is one of the most important steps you can take to reduce your cervical cancer risk. Smoking not only increases cancer risk but also makes it harder for your body to fight off HPV infections. Even if you’ve smoked for years, quitting now can improve your health and reduce your cancer risk.^[22]

Maintaining a healthy diet rich in fruits, vegetables, and whole grains supports a strong immune system, which helps your body clear HPV infections and prevent cellular changes. Regular physical activity also supports immune function and has been associated with reduced cervical cancer risk.^[22]

How the Disease Develops in Your Body

The cervix has two main parts, and understanding them helps explain how cervical cancer develops. The ectocervix is the outer part of the cervix that doctors can see during a gynecologic exam. It’s covered with thin, flat cells called squamous cells. The endocervix is the inner part that forms a canal connecting the vagina to the uterus. This area is covered with column-shaped glandular cells that produce mucus.^[2]

The area where these two types of cells meet is called the squamocolumnar junction or transformation zone. This is where most cervical cancers begin. The transformation zone is particularly vulnerable to HPV infection and the cellular changes that can lead to cancer.^[2]

There are two main types of cervical cancer, named after the type of cell where they start. Squamous cell carcinoma accounts for 80% to 90% of cervical cancers and develops from cells in the ectocervix. Adenocarcinoma accounts for 10% to 20% of cases and develops in the glandular cells of the endocervix. Sometimes cervical cancer has features of both types, which is called mixed carcinoma or adenosquamous carcinoma.^[2]

When high-risk HPV infects cervical cells, it can cause changes in the cell’s DNA that tell the cells to multiply out of control. These cells accumulate in growths. Initially, these changes produce precancerous lesions called cervical intraepithelial neoplasia or dysplasia. Not all precancerous lesions will progress to cancer—in fact, many resolve on their own or can be treated before cancer develops. However, if left untreated, some of these lesions will eventually become invasive cancer that grows deeper into the cervix and can spread to surrounding areas.^[1]

The immune system plays a crucial role in this process. Most people’s immune systems successfully clear HPV infections within one to two years. Only persistent infections with high-risk HPV types, where the virus remains in the body for many years, lead to the cellular changes that can progress to cancer. This is why factors that weaken the immune system, such as HIV infection or immunosuppressive medications, significantly increase cervical cancer risk.^[6]

Cervical cancer disproportionately affects younger women, and as a result, 20% of children who lose their mother to cancer do so due to cervical cancer. This devastating impact on families highlights the importance of prevention and early detection efforts.^[6]