Cervical cancer is the fourth most common cancer in women worldwide and fourth in cancer-related deaths. In 2020, there were an estimated 604,000 diagnosed new cases of cervical cancer and 342,000 deaths worldwide. Learn about the appropriate screening tests and the HPV vaccine to help prevent cervical cancer.

All women are at risk for cervical cancer. However, data show it occurs most often in women over the age of 30. The primary cause of cervical cancer is human papillomavirus (HPV), an extremely common family of viruses that are transmitted through sexual contact. HPV causes almost all cervical cancers. In the United States, Hispanic, non-Hispanic American Indian and Alaska Native, and non-Hispanic Black women have higher rates of new cervical cancer cases than women of other races and ethnicities. These higher rates may reflect differences in cervical cancer screening rates and outcomes that vary by socioeconomic status and access to quality care.

Cervical Cancer Prevention

Routine cancer screenings help prevent cervical cancer. The United States Preventive Services Task Force and the World Health Organization both recommend that women receive appropriate cervical cancer screenings. These screenings help to identify precancers that may lead to cervical cancer. In the United States, women aged 21– 65 years, who receive regular cervical cancer screenings are less likely to get cervical cancer and less likely to die from it. Women aged 21-29 years should only receive a Pap test to screen for cervical cancer. Women aged 30-65 years have three available options for cervical cancer screening: Pap testing alone, HPV testing alone, and HPV and Pap testing together. In general, women older than age 65 don’t need cervical cancer screening if their previous tests were negative and they have had three Pap tests, or two HPV tests (with or without the Pap test), in the preceding 10 years. However, there may be situations in which a health care provider may recommend continued Pap testing.

HPV vaccination is safe and effective. CDC recommends HPV vaccination at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already. Vaccination is also recommended for teens and young adults (15 – 26 years) who are not already vaccinated.

• CDC recommends two doses of HPV vaccine for persons who start the series before age 15 years. Three doses of the vaccine are recommended for those who start the series at age 15 years or older. Three doses are also recommended for people with weakened immune systems aged 9 through 26 years.

• Some adults between the ages of 27 and 45 years, who are not already vaccinated, may decide to get the HPV vaccine after consulting with their medical provider about their risk for new HPV infections.

Working Together to Reduce Cervical Cancer

We all play a role in preventing cervical cancer. Learn how you can lower your risk and promote the prevention and early detection of cervical cancer.

What can you do?

• Consult with your healthcare provider to understand the risk for new HPV infections and benefits of receiving the HPV vaccine.
• Ask your medical provider to screen for cervical cancer during gynecological visits.
• Receive cervical cancer screening tests to prevent cervical cancer or detect it early, when it easiest to treat.
• Continue to receive cervical cancer screenings, even after obtaining all recommended doses of the HPV vaccine.
• Practice safer sex and routinely get screened for any sexually transmitted infections.
• Avoid smoking to reduce cervical cancer risk.

What can parents do?

• Vaccinate both young girls and boys with the HPV vaccine to prevent future cases of HPV-associated cancers.
• Encourage children to receive the HPV vaccine at an early age.
• Remind children to be screened for cervical cancer when they are aged 21 years or older.

What can healthcare professionals do?

Recommendations for cervical cancer screening.

• Recommend that preteens and teens get vaccinated against HPV.
• Educate parents on the benefit of HPV vaccinations.
• Co-administer the HPV vaccination with other adolescent vaccines to reduce the number of clinical visits.
• Screen women for cervical cancer during regular gynecological visits. Remember family doctors and internists can also do cervical cancer screening. If a precancer or cancer is detected, get the right follow-up care
• Help women understand which screening tests are best for them and when to get them.

What can communities do?

• Collaborate with partners and advocates to educate community members on the prevention and control of cervical cancer.
• Build partnerships with local public health organizations and health departments to advise community members about cervical cancer prevention.
• Identify ways to increase accessibility to cervical cancer services with your local health officials and address challenges such as transportation and healthcare costs that may deter one from seeking medical care.
• Point community members to HPV vaccinations and cervical cancer screenings.
• Communicate accurate and culturally-relevant public health messages about cervical cancer prevention.

HPV infection causes cervical cancer

Long-lasting (persistent) infection with high-risk types of human papillomavirus (HPV) causes virtually all cervical cancer.

Nearly all people who are sexually active will become infected with HPV at some point in their lives. Around half of HPV infections are with a high-risk (cancer-causing) HPV type. High-risk HPV can cause several other types of cancer as well as cervical cancer. HPV16 and HPV18 are the high-risk types that cause most cases of cervical cancer.

Most HPV infections go away on their own as the immune system controls the infection. When a high-risk HPV infection lasts for many years, it can lead to changes in the cervical cells that, if untreated, can become cancer.

Other factors can increase your risk of cervical cancer

Some risk factors make it more likely for a person who has a high-risk HPV infection of the cervix to have a persistent infection that leads to severe cervical cell changes that can develop into cervical cancer. These risk factors include

• Having a weakened immune system: This can lower the body’s ability to fight HPV infection and other diseases. HPV infections are more likely to be persistent and progress to cancer in people who are immunocompromised than in people who are not immunocompromised. You may be immunocompromised if you:
  • Have HIV infection or another disease that weakens the immune system.
  • Take medicine to suppress your immune response, such as to prevent organ rejection after a transplant, to treat an autoimmune disease, or to treat cancer.
• Smoking or breathing in secondhand smoke: Those who either smoke or breathe in secondhand smoke have an increased risk of developing cervical cancer. The risk increases the more a person smokes per day and the longer a person has smoked.

  Learn about different tools to help you quit smoking and how to use them.

• Becoming sexually active at an early age: The risk of high-risk HPV infection that is persistent and ultimately leads to cervical cancer is higher in people who become sexually active before age 18 and in those who have had multiple sexual partners. This sexual history increases the chances of exposure to high-risk HPV.
• Other reproductive factors: Both the use of oral contraceptives (birth control pills) and giving birth to many children have been found to be associated with cervical cancer risk. The reasons for these associations are not well understood.

DES exposure is a rare cause of cervical cancer

Being exposed to a drug called diethylstilbestrol (DES) in the womb is an independent risk factor for a type of cervical cancer called clear cell adenocarcinoma. Between 1940 and 1971, DES was given to some pregnant women in the United States to prevent miscarriage (premature birth of a fetus that cannot survive) and premature labor. Women whose mothers took DES while pregnant have an increased risk of cervical cell abnormalities and of clear cell adenocarcinoma of the vagina and cervix.

Cervical cancer is preventable

Cervical cancer is highly preventable and highly curable if caught early. Nearly all cervical cancers could be prevented by HPV vaccination, routine cervical cancer screening, and appropriate follow-up treatment when needed.

HPV vaccination

HPV vaccination is a safe and effective way to help prevent cervical cancer. Gardasil 9 is the FDA-approved vaccine for females and males aged 9 to 45 years in the United States. Gardasil 9 is nearly 100% effective in preventing cancer caused by all seven cancer-causing HPV types (16, 18, 31, 33, 45, 52, and 58) that it targets. It also prevents most genital warts.

Timing of HPV vaccination

Because HPV is transmitted sexually, the HPV vaccine offers the most protection when given before a person becomes sexually active. Those who are already sexually active may get less benefit from the vaccine. This is because sexually active people may have been exposed to some of the HPV types targeted by the vaccine.

The Centers for Disease Control and Prevention recommends routine HPV vaccination for girls and boys at age 11 or 12 years, and the series can be started at age 9 years. For young people who weren’t vaccinated within the age recommendations, HPV vaccination is recommended up to age 26 years. Some adults between the ages of 27 and 45 years who are not already vaccinated may decide to get the HPV vaccine after talking with their doctor about their risk of new HPV infections.

Children who start the vaccine series before age 15 need two doses to be protected. Those who receive their first dose at age 15 or older need three doses to be protected. Learn more about HPV vaccines and how they protect against cervical cancer and other types of cancer.

Cervical cancer screening

Routine cervical cancer screening with HPV tests and Pap tests is also an important way to prevent cervical cancer. These tests can find abnormal cell changes and precancers that can be treated before they turn into cancer. So it is important for people with a cervix to have regular screening tests starting in their early 20s. Learn more about screening with the HPV test and Pap test.

Lack of access to cervical screening and follow-up of abnormal test results can cause certain groups, such as African American, Hispanic, American Indian and Alaskan Native people and those living in rural areas, to bear a disproportionate burden of cervical cancer. Learn about cancer health disparities.

Because HPV vaccination doesn’t protect against all HPV types that can cause cervical cancer, it’s still important to get screened at regular intervals.

Condoms

Condoms, which prevent some sexually transmitted diseases, decrease the risk of HPV transmission. However, they do not completely prevent it. Exposure to HPV is still possible in areas that are not protected by the condom.

HPV (human papillomavirus) is a sexually transmitted virus. It is passed on through genital contact (such as vaginal and anal sex). It is also passed on by skin-to-skin contact. HPV is not a new virus. But many people don't know about it. Most people don't have any signs. HPV may go away on its own without causing any health problems.

Frequently asked questions

Who can get HPV?

Anyone who has ever had genital contact with another person may have HPV. Both men and women may get it—and pass it on—without knowing it. Since there might not be any signs, a person may have HPV even if years have passed since he or she had sex.

You are more likely to get HPV if you have:

• sex at an early age,
• many sex partners, or
• a sex partner who has had many partners.

If there are no signs, why do I need to worry about HPV?

There are over 100 different kinds of HPV and not all of them cause health problems. Some kinds of HPV may cause problems like genital warts. Some kinds of HPV can also cause cancer of the cervix, vagina, vulva, or anus. Most of these problems are caused by types 6, 11, 16 or 18.

Is there a test for HPV?

Yes. It tests for the kinds of HPV that may lead to cervical cancer. The FDA approved the HPV test to be used for women over 30 years old. It may find HPV even before there are changes to the cervix. Women who have the HPV test still need to get the Pap test.

Can I prevent HPV?

FDA has approved vaccines that prevent certain diseases, including cervical cancer, caused by some types of HPV. Ask your health care provider if you should get the HPV Vaccine.

What else can I do to lower my chances of getting HPV?

• You can choose not to have sex (abstinence).
• If you have sex, you can limit the number of partners you have.
• Choose a partner who has had no or few sex partners. The fewer partners your partner has had—the less likely he or she is to have HPV.
• It is not known how much condoms protect against HPV. Areas not covered by a condom can be exposed to the virus.

Is there a cure for HPV?

There is no cure for the virus (HPV) itself. There are treatments for the health problems that HPV can cause, such as genital warts, cervical changes, and cervical cancer.

What should I know about genital warts?

There are many treatment choices for genital warts. But even after the warts are treated, the virus might still be there and may be passed on to others. If genital warts are not treated, they may go away, stay the same, or increase in size or number, but they will not turn into cancer.

HPV and cancer

What should I know about cervical cancer?

All women should get regular Pap tests. The Pap test looks for cell changes caused by HPV. The test finds cell changes early—so the cervix can be treated before the cells turn into cancer. This test can also find cancer in its early stages so it can be treated before it becomes too serious. It is rare to die from cervical cancer if the disease is caught early.

What should I know about vaginal or vulvar cancer?

Vaginal cancer is cancer of the vagina (birth canal). Vulvar cancer is cancer of the clitoris, vaginal lips, and opening to the vagina. Both of these kinds of cancer are very rare. Not all vaginal or vulvar cancer is caused by HPV.

What should I know about anal cancer?

Anal cancer is cancer that forms in tissues of the anus. The anus is the opening of the rectum (last part of the large intestine) to the outside of the body.

Human papillomavirus (HPV) is one of the most common sexually transmitted infections. There are many types of HPV. Most are fairly harmless. Some can cause genital warts, and others certain cancers.

Anyone who is sexually active can get one of these harmful types of HPV. Most people don’t know they have the virus.

“Over a lifetime, up to 80% of people will be exposed to this virus,” says Dr. Aimée Kreimer, an NIH expert on cancer and HPV. For most, the infection goes away on its own. The body’s immune system controls the virus.

But some people can’t successfully fight off HPV. It stays in their body and can cause health problems. Those can include genital warts or cancer in the parts of the body it infects.

Cancers related to HPV can take many years to develop after exposure. Worldwide, there are over 570,000 cases of cervical cancer each year and 311,000 deaths. HPV also causes cancer of the vulva, vagina, penis, anus, and back of the throat.

Fortunately, there are vaccines that can prevent HPV infection. Getting the HPV vaccine could protect against over 90% of the cancers caused by the virus.

“We now have more than a decade of evidence that this vaccine works incredibly well to protect against HPV infections,” says Kreimer.

Gardasil 9 is the HPV vaccine now used in the U.S. It protects against nine types of disease-causing HPV. When first introduced, the vaccine only protected against four HPV types.

For the HPV vaccine to be most effective, it needs to be given before exposure to the virus. The CDC recommends that both boys and girls get the HPV vaccine at age 11 or 12. At this age, the vaccine is given in two doses.

“If you start the vaccine early, you provide protection starting from that age onward,” says Dr. Carolyn Deal, an NIH expert on sexually transmitted diseases.

People who start the HPV vaccine at age 15 or older will need three doses. The vaccine is recommended for everyone up to 26 years of age.

The HPV vaccine has also been recently approved for those 27 to 45 years old. However, HPV vaccination of people in this age range provides less benefit, as more have been already exposed to HPV.

Since the vaccine was introduced, HPV infection rates have fallen dramatically. Among teen girls, infections with the types of HPV that cause genital warts and cancer have dropped by 86%.

“It’s a highly effective vaccine,” Deal says. “Cervical cancer is a devastating disease and, through vaccination, we have the potential to reduce it or even eliminate it down the road.”

In addition to getting vaccinated, if you’re sexually active, use condoms every time you have sex. This reduces your chances of getting HPV and other sexually transmitted infections.

Women ages 21 to 65 should also get screened for cervical cancer routinely.

Who should get the HPV vaccine?

• All boys and girls ages 11 to 12.
• Everyone through age 26 years, if you’re not already vaccinated.
• Some adults aged 27 through 45 years, but benefits in this age range tend to be minimal. Those concerned about their risk of infection should consult with their health care provider.

The U.S. Preventive Services Task Force (USPSTF) recommends screening for cervical cancer every 3 years with a Pap test in women ages 21 to 29 years. For women ages 30 to 65 years, USPSTF recommends screening every 3 years with a Pap test, every 5 years with high-risk human papillomavirus (hrHPV) testing, or every 5 years with both types of tests. In addition, USPSTF recommends against screening for cervical cancer in women who:

• Are younger than 21 years
• Have had a hysterectomy and haven’t had a high-grade precancerous lesion or cervical cancer
• Are older than 65 years, have had adequate screening, and aren’t at high risk for cervical cancer

NIH and Dr. Sarah Kobrin work to make HPV vaccination and detection more widely available

Important research by investigators at the National Institutes of Health (NIH) and beyond has shown that the human papillomavirus (HPV) vaccine can prevent cervical cancer, which is caused by HPV.

And the latest NIH research has taken another important step in cervical cancer treatment: developing at-home HPV testing for people who may be at risk.

Sarah Kobrin, Ph.D., talked about this research and provided prevention information. Dr. Kobrin is the chief of the Health Systems and Interventions Research Branch at the National Cancer Institute.

What can you tell us about HPV vaccine research today?

There is more evidence now that the long-term effects of the HPV vaccine will benefit everyone.

- Sarah Kobrin, Ph.D.

The Centers for Disease Control and Prevention has been researching the HPV vaccine for about 15 years. They are constantly reviewing when you should be vaccinated, how effective the vaccines are, and who should receive them.

There is more evidence now that the long-term effects of the HPV vaccine will benefit everyone. The schedule of when people should be vaccinated may change from time to time. But this is because we are constantly learning more about the safety of the vaccine.

We hope to soon have Food and Drug Administration-approved home tests for HPV. People may feel more comfortable taking an HPV test in the privacy of their own home and mailing in a sample. This would make the process easier and more convenient for everyone.

What can be done to make cervical cancer prevention easier?

Awareness is a necessary first step. But awareness is not enough. In general, people are more aware of the HPV vaccine. The most important challenge is giving everyone access to it.

People have to actually get vaccinated and get regular cervical cancer screening tests, like the Pap smear and HPV tests, to prevent cervical cancer. Talk with your health care provider and get the vaccine (for you or your children), according to the recommended timetable.

How is HPV detected?

Health care providers test for antibodies to see if a person has been exposed to HPV. There are many types of HPV, but only a small number of them are associated with causing cancer.

What should people know about cervical cancer?

It's important for all women to get regular cervical cancer screening tests. These include the Pap smear and HPV tests—what's best for each woman depends on her age and past experience with these tests. The tests help detect [cervical] cells that have been changed by HPV. A Pap smear can detect early stages of cancer that can be treated. When found early, the cells can be treated before they become cervical cancer. The HPV vaccine is a preventive step.

Do we have less cervical cancer today?

We are measuring this as closely as we can. Because it takes a long time for an HPV infection to cause cancer, the first change we can see is a large reduction in the number of HPV infections. That is already happening. This means that the number of people with cervical cancer will be going down in the future. Therefore, the people who are not getting the infection now will not get cervical cancer later.