Cervical cancer

Cancer of the cervix often has no symptoms in its early stages and may be detected after an abnormal screening smear test

• symptoms can be subtle and attributed to benign gynaecological conditions or remain asymptomatic until the cancer has reached an advanced stage
  
  
• when symptomatic, the most common symptoms are abnormal vaginal bleeding, intermenstrual (IMB), postcoital (PCB) or postmenopausal bleeding (PMB)
  
  • other symptoms of cervical cancer may include dyspareunia and abnormal vaginal discharge. Abnormal appearance of the cervix during examination should also raise suspicion and referral for further investigations (1)
    
    
  • it is possible for women of all ages to develop cervical cancer, but traditionally the condition mainly affected sexually active women aged between 30 and 45 years of age, however, data from Cancer Research UK shows the peak age of incidence has reduced to 25-29 years of age
    
  • cervical cancer is very rare in women under 25 years old and may be more difficult to prevent in younger age women (1)
    
    
  • extra cervical advanced stage disease with spread into surrounding tissue and organs, it can cause other symptoms, including haematuria, urinary incontinence, bone pain, lower limb oedema, flank or loin pain (due to hydroureter or hydronephrosis), changes to bladder and bowel habits, loss of appetite, weight loss and fatigue (2)

Prognosis correlates with stage, histological diagnosis, socio-economic status and age at presentation.

• More than 80% of women survive for one year or more.
• More than 65% of women survive for five years or more.
• Almost 65% of women survive for 10 years or more (3)
• Most recurrence happens within 2 to 3 years (4)

HPV genotype and cervical cancer

• a systematic analysis of over 110,000 HPV-positive invasive cervical cancer cases worldwide found that HPV 16 and HPV 18 are the predominant causal genotypes, together accounting for 61.7% and 15.3% of cases, respectively, with their combined proportion of cases ranging from 71.9% in Africa to 83.2% in central, western, and southern Asia (5)
  • other high-risk types, such as HPV 31, 33, 45 and 52, also contribute to the burden of disease (6)

HPV vaccination and reduced cervical cancer mortality

Mortality associated with cervical cancer has significantly reduced following the introduction of the HPV vaccination schedule in the UK in 2008. High HPV vaccination rates are associated with a substantial reduction in cervical cancer deaths, shown by the considerable decrease in cervical cancer deaths among women aged 20-29 years, particularly among those vaccinated aged 12-13 years (7):

• in women aged 20 to 24 years between 2020 and 2024, in whom vaccination coverage was around 88-90% at age 12-13 years, no deaths occurred vs 23.1 expected deaths based on historical rates, corresponding to a mortality reduction of 100% (95% CI 84-100)
• in earlier birth cohorts (offered vaccination up to age 18 years with coverage of around 63-87%), mortality reductions of 80% (51-94) in women aged 20 to 24 years in 2015-19, and 69% (55-79) in women aged 25 to 29 years in 2020-24 were observed
• relative risk reduction in vaccinated women was estimated from population-level data to be 100% (95% CI 81-00) in women aged 20 to 24 years, 100% (89-100) in those aged 25 to 29 years, and 63% (-13 to 100) in those aged 30 to 34 years
• up until the end of 2024, HPV vaccination in England was associated with a reduction of around 199.6 (95% CI 125.0-274.2) cervical cancer deaths

Studies in countries where HPV vaccination was introduced early have shown substantial decreases in cervical cancer incidence, reporting 84–88% reductions in vaccinated compared with unvaccinated women in studies in Sweden, Denmark, and England (8).

References:

1. British Gynaecological Cancer Society (BGCS) Cervical Cancer Guidelines: Recommendations for Practice.
2. Fowler J et al. Cervical Cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.2023 Nov 12.
3. National Cancer Institute: Surveillance, Epidemiology, and End Results (SEER) Program. Cancer stat facts: cervical cancer. 2023 [internet publication].
4. Elit L, Fyles AW, Oliver TK, et al. Follow-up for women after treatment for cervical cancer. Curr Oncol. 2010 Jun;17(3):65-9.
5. Wei F, Georges D, Man I, Baussano I, Clifford GM. Causal attribution of human papillomavirus genotypes to invasive cervical cancer worldwide: a systematic analysis of the global literature. Lancet. 2024;404(10451):435-44.
6. Institute NC. HPV and Cancer 2025 [updated 9 May 2025. Available from: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer]
7. Sasieni P, Falcaro M. Cervical cancer mortality trends following HPV vaccination in England, 2001–24: an analysis of population-based mortality data. The Lancet, 2026.
8. Portnoy A, Burger E. HPV vaccination and early declines in cervical cancer deaths. The Lancet, 2026.