16 May 2025
Cervical cancer is a disease that affects hundreds of thousands of women worldwide. It is the fourth most common cancer among women globally, with approximately 660,000 new cases and about 350,000 deaths in 2022.
While cervical cancer can be a serious condition, it is also largely preventable. To help you learn more about cervical cancer and managing your risk, we spoke with Leslie Saltzman, DO, chief product officer and medical discipline director at Ovia Health and founder of the Rittenhouse Women’s Wellness Center. She answered your top questions about cervical cancer screening, symptoms, risk factors and more.
What is cervical cancer?
Cervical cancer is a type of cancer that begins in the cells of the cervix, the lower part of the uterus that connects to the vagina. Cervical cancer typically develops slowly over time and is often linked to a persistent genital infection with certain strains of the human papillomavirus (HPV).
What causes cervical cancer?
The main cause of cervical cancer is persistent infection with high-risk strains of HPV, a common virus that is transmitted through sexual contact.
The strains of HPV that cause cervical cancer are mostly asymptomatic, so people often don’t know they have it. Although most HPV infections go away on their own, in some cases, the virus can persist and cause changes in cervical cells, leading to cancer.
Other risk factors for cervical cancer include:
- Smoking and/or exposure to secondhand smoke
- A weakened immune system due to health conditions such as HIV or treatment with an immune-suppressive drug
- Obesity, which can make cervical cancer screening more difficult
Certain aspects of reproductive health may also increase the risk of cervical cancer. For example, long-term use of oral contraceptives (birth control pills), as well as giving birth to multiple children (three or more), are linked with an increased risk, though the reasons for these associations are not well understood.
What are the signs and symptoms of cervical cancer?
In its early stages, cervical cancer may not cause noticeable symptoms. However, as the disease progresses, some potential symptoms may include:
- Abnormal vaginal bleeding, such as bleeding between periods, or after menopause
- Unusual vaginal discharge, which may be watery or bloody
- Pelvic pain or general pain during or after sexual intercourse
- Painful urination or blood in the urine (if cancer spreads to nearby organs)
These symptoms can also be associated with other conditions, so it’s essential to work with your healthcare provider for proper evaluation.
Can you reduce your risk of developing cervical cancer?
You can minimize your risk of developing cervical cancer by reducing your risk of developing an HPV infection and by getting screened. Steps you can take include:
- Getting the HPV vaccine: The HPV vaccine is typically given to boys and girls at age 11 or 12 (before they are sexually active). If you’re vaccinated before being exposed to the virus, the HPV vaccine is 97% effective in preventing cervical cancer and cell changes that could lead to cancer. If you didn’t receive the vaccine, or didn’t complete the series, the vaccination is recommended up to age 26. Some adults ages 27 through 45 years might decide to get the HPV vaccine based on discussion with their clinician if they were not adequately vaccinated when they were younger and are at risk of exposure to new strains of HPV
- Regular screening and follow-up: Early detection through regular Papanicolaou (Pap) smears and HPV testing can help identify precancerous changes before they develop into cervical cancer. If additional testing is recommended, it’s important to follow up with your healthcare provider
- Practicing safe sex: Limiting the number of sexual partners, using condoms and avoiding sexual contact with individuals who have HPV can help reduce the risk of HPV infection
- Avoiding smoking: Smoking has been shown to increase the risk of cervical cancer in women with HPV infections
“Cervical cancer is highly treatable when caught early,” says Dr. Saltzman. “Regular screening, as well as any follow-up testing recommended by your provider, can reduce cervical cancer risk by up to 80%.”
What are the guidelines for cervical cancer screenings?
The U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS) and the American College of Obstetrics and Gynecology (ACOG) all issue guidelines for cervical cancer screening. There are some differences, but in general:
- Women ages 21 to 29:
- Start screening at age 21, Pap test every 3 years (ACOG/USPSTF)
- Start screening at age 25, primary HPV (HPV test alone) every 5 years. If primary HPV testing is not available, screening may be done with either a co-test that combines an HPV test with a Papanicolaou (Pap) test every 5 years or a Pap test alone every 3 years (ACS)
- Women aged 30 to 65:
- Primary HPV testing every 5 years. If primary HPV testing is not available, screening may be done with either a co-test that combines an HPV test with a Pap test every 5 years or a Pap test alone every 3 years (ACS/USPSTF)
- HPV testing every 5 years, cervical cytology alone every 3 years or co-testing with a combination of cytology and HPV testing every 5 years (ACOG)
- Women aged 65 and older: Screening may be discontinued if you have had regular screenings with all normal results in the past 10 years and are not at high risk for cervical cancer
- Women who have had a hysterectomy: If the surgery was done for non-cancerous reasons, you may no longer need screening. However, if you have a history of cervical cancer or other risk factors, you may need continued screening
“As always, be sure to consult with a physician to help determine the right screening recommendations for you,” says Dr. Saltzman.
What are the testing options for cervical cancer?
Cervical cancer screening involves two primary tests:
- Pap test (Pap smear): This test involves collecting cells from the cervix to check for abnormal changes that could lead to cancer
- HPV test: This test detects the presence of high-risk HPV strains. It can be done alone (primary HPV) or in combination with a Pap test (known as co-testing)
How can I get tested for HPV?
HPV testing can be performed in two different ways. The first is a collection that can be done by your healthcare provider as part of your regular checkup. This involves a metal or plastic speculum to separate the walls of the vagina and a small spatula or brush to gently take a sample of cells from the cervix for lab testing.
A second option is a self-collection HPV test that can be performed in your provider’s office or at a lab patient service center. “Self-testing and screening options offer you the privacy needed to feel comfortable for regular STI screenings and testing,” says Dr. Saltzman. “This can help reduce delayed or skipped screenings and help close the gap and time spent between diagnosis and treatment and when and where it is needed.”
How is cervical cancer diagnosed?
Cervical cancer is typically diagnosed after abnormal screening results. If you have abnormal results on a Pap test or HPV test, the next steps may include:
- Colposcopy: A procedure in which a healthcare provider uses a special magnifying instrument (colposcope) to examine the cervix and look for abnormal areas. A biopsy (tissue sample) may be taken during this procedure for further examination
- Biopsy: A small sample of tissue from the cervix is examined under a microscope to check for cancer cells
- Imaging tests: In some cases, imaging tests like CT scans, MRIs or ultrasounds may be used to check if the cancer has spread
Can any healthcare provider screen for cervical cancer?
“Yes, most gynecologists, primary care providers and nurse practitioners are trained to screen for cervical cancer,” says Dr. Saltzman. “They can perform Pap tests and HPV tests, depending on your needs and your age.”
If you have any specific concerns or questions about your own health or screening, it's best to talk to a healthcare professional who can provide personalized advice based on your medical history.
Your best defense against cervical cancer: Prevention, proactive health and partnering with your provider
Understanding cervical cancer is crucial for a woman’s health. Remember: Cervical cancer is largely preventable through HPV vaccination, regular screening and early detection. By staying informed and proactive about your health and partnering with your healthcare provider on regular screening and check-ups, you can significantly reduce your risk of cervical cancer and protect your health.