Cervical cancer is one of the most preventable cancers, although recent research suggests that the United States is backsliding in efforts to detect the disease early, when it is most curable.
A new study shows that the percentage of women screened for cervical cancer fell from 47% in 2019 to 41% in 2023.
Rural women are 25% more likely to be diagnosed and 42% more likely to die from cervical cancer than women who live in cities, a trend that likely reflects lower screening rates in less populated areas, according to the study, published in JAMA Network Open this month.
Every year, 13,000 women in the U.S. are diagnosed with cervical cancer, which is almost always caused by HPV, or human papillomavirus. About 4,320 die each year, according to the American Cancer Society.
Cervical cancer rates have been edging upward among women in their 30s and early 40s, perhaps because women ages 21 to 29 are the least likely to be up to date on their screenings, with 29% being overdue.
Cervical cancer takes several years to develop, progressing from abnormal cell changes and precancers before transforming into cancer. Studies show that women are also less likely to be screened if they are nonwhite, uninsured or identify as gay, lesbian or bisexual.
HPV vaccines are safe and can prevent 90% of cervical cancers. Yet resistance to the vaccine, which protects against cancer-causing strains of the sexually transmitted infection, has persisted since it was approved almost 20 years ago. Health Secretary Robert F. Kennedy Jr. has disparaged them as dangerous, linking HPV shots to autoimmune conditions and mental illness.
A federal judge in North Carolina on March 10 dismissed legal claims that the HPV shot, sold by Merck as Gardasil, could cause patients to develop certain health conditions.
Another lawsuit alleging that Gardasil causes serious side effects has been put on hold until September because of Kennedy’s involvement in the case. Although Kennedy disclosed in an ethics statement that he stood to receive referral fees from one of the law firms suing Merck, he later said he would give any earnings to his son.
Vaccine hesitancy has kept many parents from vaccinating their children. Only 61% of adolescents are up to date on all HPV vaccines, given as a series of two or three shots depending on age.
More than 42 million people in the U.S. carry at least one strain of HPV that can cause disease, including genital warts or cancer, and 47,000 a year are diagnosed with an HPV-linked malignancy. Yet research has found a decline in awareness that HPV is linked with a number of cancers, including cervical, throat and anal.
With so many people at risk, we asked experts to help clear up confusion over HPV vaccination and screening.
How often should women be screened for cervical cancer?
The American Cancer Society recommends that people have a primary HPV test every five years from ages 25 to 65. If primary HPV testing is not available, the society recommends either combining an HPV test with a Pap test every five years or a Pap test alone every three years
How have HPV vaccines affected rates of cervical cancer and precancer?
Among women ages 20 to 24 — who were eligible for HPV shots as adolescents — the incidence of cervical precancer fell nearly 80% from 2008 to 2002, according to the Centers for Disease Control and Prevention. Cervical cancer incidence fell 65% from 2012 to 2019 among women under 25. Death rates from cervical cancer among the same age group fell 62% from 2013-2015 to 2019-2021.
How common is HPV?
HPV is the most common sexually transmitted infection in the United States. Among sexually active people, more than 90% of men and 80% of women are infected with HPV during their lifetimes. About half of HPV infections involve high-risk strains. In addition to cervical cancer, HPV can cause cancers of the vagina, vulva, anus, penis and head and neck.
Given how common these viruses are, no one should feel embarrassed to learn they have HPV, said Dr. Rebecca Perkins, an obstetrician-gynecologist and investigator at the Woman, Mother and Baby Research Institute at Tufts Medical Center. “We need to decrease the stigma associated with having a positive test,” Perkins said.
What does it mean if a test shows you have high-risk HPV?
Although there are more than 200 types of HPV, only a few cause cancer. These types are known as high-risk strains and are included in routine cervical cancer screenings, because they have the highest chance of causing cancer, said Dr. Verda Hicks, immediate past president of the American College of Obstetricians and Gynecologists. “If an HPV test is positive for high-risk HPV, it indicates an active infection that increases the risk for development of a pre-cancer or cancer,” Hicks said.
Does being infected with high-risk HPV give you a high risk of cancer?
A. No. The immune system clears most HPV infections within a year or two, Hicks said. Most people with high-risk HPV experience short-term infections that cause mild changes in cervical cells, which return to normal once the infection clears.
Doctors become more concerned if someone tests positive for high-risk HPV for longer than two years as persistent infections can lead to the development of a precancer or cancer. About 1% of people with HPV develop a “long-term, chronic infection” and even fewer develop cervical cancer, Hicks said.
“Women should not freak out” just because they have high-risk HPV, Hicks said. A positive test “means the screening process is doing its job. It is identifying someone who possibly has a persistent infection.”
Undergoing routine screenings and any recommended follow-up tests allow doctors to catch these changes early, when they’re easier to treat, Perkins said.
That’s why it’s essential not to skip any checkups, she said.
“The longer that someone remains positive, the higher the risk” of developing cancer, Perkins said.
How common are high-risk HPV infections?
Among women screened for the first time in their 20s and 30s, up to 20% learn that they have high-risk HPV, said Dr. Mark Einstein, a professor of obstetrics and gynecology and women’s health at the Albert Einstein College of Medicine.
What should people with high-risk HPV infections do?
There’s no blanket prescription for people with high-risk HPV, said Hicks, who noted that doctors tailor their advice for each individual, depending on a variety of risk factors.
While people with high-risk HPV shouldn’t panic, they should take the finding seriously, follow their doctor’s advice and attend any recommended follow-up visits, she said. These visits allow doctors to look for abnormal cells, which can be removed before they turn into cancer.
Can people who were vaccinated against HPV still test positive?
Yes. That’s because the original HPV shots, which were approved for children and adolescents in 2006, protected against the two riskiest viral strains, which together cause 70% of cervical cancer, as well as two strains that cause genital warts. Although the first HPV vaccines were very effective, people who were vaccinated with them could be infected with one of the HPV strains that cause the other 30% of cervical cancers, Perkins said. Updated HPV shots now protect against nine strains of the virus and protect against 90% of cervical and anal cancers, as well as most strains that cause mouth and throat cancers.
Can you test positive for high-risk HPV years after being infected?
Yes. A positive HPV test doesn’t necessarily reflect a recent infection.
Although the immune system usually does a good job of controlling HPV, the virus doesn’t disappear from the body. HPV can sometimes reactivate, especially if a person’s immune system has been under stress due to an illness or certain medications, Perkins said.
“We see reactivations in women who have not been sexually active in 10 years,” Perkins said. “It’s just a function of the virus escaping the immune system. You should never get a divorce over a diagnosis of HPV.”
In some ways, HPV is similar to the chickenpox virus, which can hide in nerve cells for decades before reactivating and causing a painful condition called shingles.
“It doesn’t matter whether the infection is old or new; we still need to follow up,” Perkins said.
