Cervical Cancer: Understanding the Basics

Cervical cancer is the fourth most common cancer in women worldwide, after breast, colorectal, and lung cancer. It remains a public health concern, and is especially common in low- and middle-income countries. Although a cancer diagnosis can sound frightening, cervical cancer is also one of the most preventable cancers. With effective vaccination programmes and routine screening, it can often be detected at an early stage when treatment is highly successful. This makes awareness, prevention, and early detection critically important. This article explains what cervical cancer is, its causes, risk factors, prevention, and treatment.

What is cervical cancer and what causes it?

Cervical cancer is a type of cancer that begins in the cervix, which is the lower part of the uterus that connects to the vagina. In about 99% of cases, it is caused by infection with the human papillomavirus (HPV), most often high-risk types (such as HPV 16 and 18), which are spread through sexual contact. In most people, the immune system clears the virus naturally. However, in some cases, the virus persists and can interfere with the DNA of healthy cervical cells. Instead of following the normal cell cycle where damaged cells die and are replaced, these altered cells continue to grow and divide uncontrollably, eventually forming a tumour that may develop into cancer.

What are the risk factors for cervical cancer?

Certain factors can increase the chance of developing cervical cancer. The most important risk factor is infection with HPV. In many women, the infection clears naturally, but in some it persists and may lead to abnormal changes in the cervix. Having a family history of cervical or other cancers may also slightly increase risk. Other factors relate to lifestyle or health conditions. These include having multiple sexual partners, becoming sexually active at a young age, or having other sexually transmitted infections such as gonorrhoea, chlamydia, or HIV. Early or multiple pregnancies, smoking, and a weakened immune system also increase the risk. Using birth control pills for more than five years may add to the risk, as can certain medications. Some of these factors, such as smoking or sexual health practices, can be changed to help lower your risk, while others cannot be controlled.

How does cervical cancer develop?

HPV is the main cause of cervical cancer, responsible for more than 95% of cases. While other risk factors can also contribute to cell changes in the cervix, HPV is the predominant driver. There are over 200 types of HPV, but only about a dozen are classified as high-risk. Among these, HPV types 16 and 18 account for roughly 70% of cervical cancer cases. Other high-risk types include 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 66.

In most women, HPV infection is temporary — the immune system clears the virus naturally, and no disease develops. However, in some cases, the virus persists and begins to alter the DNA of cervical cells, causing them to grow abnormally.This stage is called cervical intraepithelial neoplasia (CIN), or cervical dysplasia. CIN is not cancer, but rather a precancerous change — which is why regular screening is so important.

Over time, these abnormal cells may either return to normal or progress toward cancer. The transition from HPV infection to invasive cervical cancer is usually very slow, often taking 10–15 years. Once cancer develops, the abnormal cells can grow into surrounding cervical tissue and may eventually spread to nearby organs such as the bladder or rectum. At this stage, symptoms typically become noticeable.

Read more on HPV in our article here.

What are the symptoms of cervical cancer?

In the early stages, cervical cancer often has no symptoms, and by the time signs appear, the disease may already be quite advanced. This underscores the importance of regular screenings and tests. The most common early sign is unusual vaginal bleeding, which may occur between periods, after sexual intercourse, after menopause, or as heavier or longer menstrual bleeding than usual. Other possible symptoms include pelvic pain, pain during intercourse, and watery or bloody discharge that may have an unpleasant odour. If you experience any of these symptoms, it is important to see a doctor as soon as possible.

What can be done to reduce my risk of cervical cancer?

There are several evidence-based strategies to reduce the risk of developing cervical cancer. These include vaccination, regular screening, safe sexual practices, and healthy lifestyle choices. Each is outlined below.

Vaccination

HPV vaccination is one of the most effective ways of preventing cervical cancer. It is recommended for both boys and girls, ideally between the ages of 11 and 12, although it may safely be given from the age of 9. Vaccination at this age offers the greatest benefit as it is given before sexual activity. Getting your children the HPV vaccine is one of the best ways to protect them. In South African, the Department of Health offers free vaccination to girls aged 9–14 years (grades 5, 6, and 7) through the school immunisation programme. Boys should also be vaccinated, as this contributes to herd immunity and protects against HPV-associated diseases in both sexes. Parents can obtain the vaccine for boys from private healthcare providers. The vaccine protects against the high-risk HPV types most commonly associated with cervical cancer, as well as genital warts. HPV is also implicated in other cancers, including those of the anus, penis, vulva, vagina, and oropharynx. Catch-up vaccination is recommended up to the age of 26 if not received earlier.

Regular screenings

Screening allows for the early detection of precancerous changes and enables timely treatment before progression to invasive cancer. Two main tests are used, namely Pap smears (cytology) and HPV testing. Pap smear (cytology) can be performed by a general practitioner or gynaecologist. A sample of cells is gently collected from the cervix and examined in the laboratory for abnormal cellular changes. Screening usually begins at age 21 (or from the start of sexual activity) and is repeated every three years if results are normal. HPV testing detects infection with high-risk HPV types known to cause cervical cancer. It may be performed on its own or alongside cytology. Co-testing (i.e. a combination of Pap smear and HPV testing) is recommended from the age of 30 as it provides a more comprehensive risk assessment.

Lifestyle choices

Several behavioural and lifestyle factors can influence the risk of cervical cancer. Practicing safe sex by using condoms, limiting the number of sexual partners, and avoiding early initiation of sexual activity can significantly reduce the likelihood of HPV infection. Smoking is another major risk factor, as it damages DNA and weakens the immune system’s ability to clear HPV; however, the risk decreases over time after quitting and eventually approaches that of a non-smoker after approximately 15 years. Maintaining a healthy weight is also important, as overweight and obesity are linked to an increased risk of several cancers, including cervical cancer. In addition, a balanced diet rich in fruits, vegetables, folate, and antioxidants supports immune function and may help the body defend against HPV infection.

If I am diagnosed, what treatment options are available?

If cervical cancer develops, there are several effective treatments available, and the choice of treatment depends largely on the stage of the disease. In the early stages, surgery is often the main option. This may involve procedures such as conisation (removal of a small cone-shaped piece of cervical tissue) or hysterectomy (removal of the uterus). When cervical cancer is detected at this early, localised stage, outcomes are excellent, with a 5-year survival rate of over 90%.

For more advanced disease that has spread within the pelvis (locally advanced), treatment usually involves a combination of radiation therapy and chemotherapy, with good chances of long-term control. If the cancer has spread to nearby tissues or lymph nodes, the 5-year survival rate is around 60%.

In more advanced or recurrent cases, treatment may include chemotherapy, targeted therapy, or immunotherapy. These treatments can help control the cancer and improve quality of life, but outcomes are not as good once the cancer has spread to distant sites. At this stage, survival rates are much lower and only about 20% of women live for five years or longer after diagnosis. This makes it clear why HPV vaccination and regular screening are important as they greatly reduce the risk of developing cervical cancer and increase the likelihood of detecting it early, when treatment is most effective and outcomes are far better.

Final Thoughts

Cervical cancer is largely preventable and, when found early, highly treatable. Vaccination, screening, and healthy lifestyle choices are powerful tools to protect your health. Even if cancer does develop, effective treatments are available — especially when it is detected early.