Cervical cancer will strike an estimated 13,360 American women in 2025 — most between the ages of 35 and 44 — and is expected to claim more than 4,320 lives. While these numbers have plateaued or decreased in urban areas, cervical cancer rates have increased disproportionately in rural counties. Additionally, a study published this month in JAMA Network Open found that women living rurally have a 25% higher incidence of cervical cancer and a 42% higher mortality than their urban counterparts due primarily to the difficulty in accessing preventive care.
More than 90% of cervical cancers are caused by the human papilloma virus (HPV), the most common sexually transmitted infection in the United States, with 14 million new cases reported annually. HPV is categorized into two types: low-risk, which can cause warts, and high-risk, which can cause cancer.
Cervical cancer is the most frequently diagnosed HPV-associated malignancy, but the virus is also a leading cause of anal, throat, and tongue cancers, which afflict both women and men.
Most people with HPV have no symptoms, and in 90% of cases the body’s immune system clears the virus within two years. However, one in 10 women with high-risk HPV develop a long-lasting infection, which can cause cervical cells to become abnormal and, potentially, malignant.
Cervical cancer is usually silent, but in advanced stages it can cause irregular vaginal bleeding, pelvic pain, and fatigue. By the time these symptoms become apparent, the disease is much less treatable. The five-year survival rate is 19% once the malignancy has metastasized, in contrast to a 91% survival rate if caught early.
Risk factors for a persistent high-risk HPV infection — and possible progression to cervical cancer — include a history of multiple (more than five) sexual partners, a suppressed immune system from chronic diseases like diabetes, and smoking (which interferes with the body’s ability to fight off infection). Women who haven’t had regular Papanicolaou (Pap) smears — a sampling of cervical cells that screens for precancerous changes — are also more likely to develop malignancy.
The best way to prevent cervical cancer is by vaccination against HPV, which is nearly 100% effective. Nationwide, more than 135 million doses of the vaccine have been administered to patients.
Side effects are rare and similar to the flu shot: low-grade fever, lightheadedness, or pain or redness at injection site. But vaccination rates in the U.S. are low: Only 64% of girls and 59% of boys are up to date with the two-dose immunization series, which research published in the Journal of Adolescent Health attributed to parental lack of knowledge about HPV and fear over the vaccine’s safety. The current recommendation by the American Academy of Pediatrics and other professional medical organizations is to start routine vaccination with Gardisil-9 between the ages of 9 and 12; catch-up vaccinations can be given to the age of 26.
Regular screening can also help prevent cervical cancer. HPV testing (done by swabbing the cervix) can detect the virus early and identify those at risk; routine Pap smears can find precancerous changes, leading to earlier treatment. The U.S. Preventive Services Task Force recommends that women ages 21 to 29 have a Pap smear every three years, and those 30 to 65 have an HPV test every five years, with or without a Pap smear.
Other ways to prevent cervical cancer include practicing safe sex by using condoms and dental dams.
The American Cancer Society Cancer Action Network is working with state legislators to improve access for rural New Yorkers to HPV vaccination and cervical cancer screening. Information about no or low-cost HPV immunizations in New York state can be found here; find free cervical and other cancer screening in the Hudson Valley here.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state.