What is cervical cancer?

Cervical cancer occurs when malignant (cancer) cells form in the tissues of the cervix. It used to be the leading cause of cancer death in women in the United States, but regular screening (Pap tests) has significantly decreased the number of cervical cancer deaths (1).

What is cancer?
Cancer occurs when cells in the body grow out of control and start spreading to places that they normally wouldn’t grow. Normal cells in the body only grow when they receive signals to tell them to, and they stop dividing when they receive signals for apoptosis (programmed cell death). In contrast, cancer cells grow even when there are no growth signals and continue growing even when they are signaled to stop growing (2).

Cancer cells can also tell blood vessels to grow towards them to provide extra nutrients and oxygen, as well as tricking the immune system into protecting the tumor rather than attacking it. Cancer cells can spread into other areas of the body and they also accumulate lots of changes in their chromosomes, including large duplications and deletions (2).

Where does cervical cancer occur?
Cancer can start almost anywhere in the body, and the place that it starts is what the cancer is called, even if it then spreads elsewhere in the body. When cancer starts in the cervix, it is called cervical cancer. The cervix is the lower, narrow end of the uterus (womb where a fetus grows). It connects the vagina (birth canal) to the upper part of the uterus (3).

What are the symptoms of cervical cancer?
Cervical cancer usually develops slowly over many years. Before cancer cells form, a process called dysplasia occurs, where abnormal (but non-cancerous) cells appear in the cervical tissue (4). There are no symptoms associated with these abnormal cells, and often there are also no symptoms associated with the early stages of cervical cancer. Cervical cancer is one of the most successfully treatable forms of cancer, but ONLY if detected and treated early (5). This is why routine screening is highly recommended (see ‘How can I reduce my risk of cervical cancer?’ section below).

Advanced cervical cancer can cause abnormal bleeding or discharge from the vagina, such as bleeding after sex. These symptoms can also be caused by other things, but if you experience these symptoms, it is very important that you see your healthcare professional for an examination and consultation (3).

How common is cervical cancer?
Due to increased access to screening tests (Pap smears and HPV tests), the incidence of cervical cancer and associated deaths in the United States is now a lot lower than it used to be. In 2018, 12,733 new cervical cancer cases were reported in the United States, with 4,138 deaths from cervical cancer (6).

What are the risk factors for cervical cancer?
Human papillomavirus (HPV) infection is the cause of nearly all cervical cancers. But that’s not to say that everyone who has an HPV infection will get cervical cancer! HPV is a very common sexually transmitted virus. There are more than 100 genotypes of HPV, of which 14 are considered high-risk for cervical disease. Women who have persistent infection with one of the high-risk genotypes have an increased risk of cervical cancer (7). Read our HPV Quick Facts article for more information.

Other factors that are associated with an increased risk of cervical cancer include (3):

• HIV infection reduces the body’s ability to defend itself from pathogens, including HPV
• Other health issues that inhibit the body’s normal immune response
• Smoking
• Extended use of birth control pills (5+ years)
• Giving birth to 3 or more children
• Having several sexual partners

How can I reduce my risk of cervical cancer?

• Get the HPV vaccine. This vaccine is recommended at 11–12 years of age and for anyone through to 26 years if they have not been vaccinated already. It is of less benefit for adults over 26 years, as most people of this age have already been exposed to HPV. The vaccine prevents new HPV infections but does not treat existing infections (3).
• Get regular Pap tests (Pap smears). These are generally recommended once every three years (assuming results are normal) from 21 years of age. Pap tests detect abnormal cell changes in the cervix that may lead to cervical cancer (3).
• Take an HPV test, such as this one here. These tests detect the 14 high-risk HPV genotypes, which are associated with an increased risk of cervical cancer. HPV tests are often recommended from ages 30–65 years (3).
• Abstain from smoking
• Use condoms during sex
• Limit your number of sexual partners

References:
1. Cervical Cancer Statistics. CDC. Reviewed June 2021.
2. What is cancer? NIH, National Cancer Institute. Updated May 2021.
3. Basic information about cervical cancer. CDC. Reviewed Jan 2021.
4. Cervical Cancer Treatment (PDQ®)–Patient Version. NIH, National Cancer Institute. Updated August 2021.
5. Cervical Cancer. WHO.
6. S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2020 submission data (1999-2018): U.S. Department of Health and Human Services, CDC, Released in June 2021.
7. Kjaer SK, et al. (2002). Type-specific persistence of high-risk human papillomavirus (HPV) as an indicator of high grade cervical squamous intraepithelial lesions in young women: population-based prospective follow-up study. BMJ, 325 (7364), 572-579.