What are the Symptoms of Cervical Cancer?
Cervical cancer screenings, which typically include a pelvic exam and Pap smear, have significantly reduced cervical cancer incidence and death rates in the United States.
“The vast majority of cervical cancers are early stage and often asymptomatic, which is why screenings are important,” explains Alexi Wright, MD, MPH, a medical oncologist in the Gynecologic Oncology Program at Dana-Farber Brigham Cancer Center.
Symptoms of cervical cancer can include:
- Heavy vaginal bleeding
- Bleeding between periods
- Painful intercourse
- Bleeding after intercourse
- Unusual vaginal discharge; often watery or with an unpleasant odor
If you are experiencing any of these symptoms, or general pelvic discomfort, it is important to speak with your doctor.
What are the screening guidelines for cervical cancer?
In 2018, the U.S. Preventive Services Task Force (USPSTF), an independent, volunteer panel of experts that make evidence-based disease prevention recommendations, expanded their guidelines, suggesting an additional cervical cancer screening option for low-risk patients between ages 30 and 65.
In addition to selecting one of the two previously recommended screening options — a Pap test every three years, or a Pap test and human papillomavirus (HPV) test every five years — people can now choose to have just an HPV test every five years, if all prior tests are normal. A history of abnormal results may put a patient at higher risk, requiring more frequent testing.
These guidelines reflect recent research showing that testing for HPV — the virus responsible for most cases of cervical cancer — is more effective for early detection of precancerous changes in the cervix than the traditional Pap test. HPV testing checks for active expression of one of the “high risk” HPV viruses, whereas Pap testing looks for abnormal changes in a sample of cervical cells.
Screening recommendations for people with a cervix between ages 21 to 29 call for a Pap test every three years. USPSTF does not recommend screening for cervical cancer in people under age 21or in people over 65 who have had adequate prior screening and do not have a high risk of developing the disease.
HPV test self-collection
In May 2024, the U.S. Food Drug Administration (FDA) expanded approval for two tests that detect HPV as part of cervical cancer screening. People now have the option to collect a vaginal sample with a swab themselves for HPV testing if they cannot have or do not want a pelvic exam. The collection must be done in a health care setting (including primary care offices, urgent care, pharmacies, or mobile clinics).
Who can get vaccinated for HPV?
As effective as cervical cancer screening has been historically, the most effective way to prevent cervical cancer (and several other HPV-related cancers) is for children to receive preventive vaccination against the HPV virus, ideally by the age of 12 when it is most effective. Young adults who have missed this window should still speak with their doctor about the benefits of the vaccine.
“Moving forward, we may eventually be able to eliminate cervical cancer if everyone is vaccinated before exposure to HPV,” says Sarah Feldman, MD, MPH, OB/GYN at Brigham and Women’s Hospital.
The HPV vaccination Gardasil 9 is FDA-approved for ages 9 to 45 to prevent cancers caused by seven high-risk HPV types and genital warts caused by HPV types 6 and 11. The vaccine is most effective when administered before a person becomes sexually active. It is recommended for children at age 11 or 12 but can be given as early as age 9.
Cervical cancer causes and risk factors
Persistent infection with high-risk types of HPV causes most cervical cancers. Two high-risk types, HPV 16 and HPV 18, cause 70% of cervical cancers worldwide. When an infection lasts for years, it can lead to changes in the cervical cells, resulting in a precancerous lesion. If the precancerous lesion is not found and removed, it may eventually develop into cervical cancer.
People who become sexually active at a young age, especially before age 18, or have multiple sexual partners are more likely to become infected with a high-risk type of HPV if they do not practice safe sex. Condoms can decrease the risk of HPV transmission. However, they do not completely prevent it. Exposure to HPV is still possible in areas not covered by the condom.
Additional risk factors for persistent HPV infection and cervical cancer can also include:
- Having a weakened immune system
- Smoking or breathing in secondhand smoke
What are the screening guidelines for cervical cancer?
In 2018, the U.S. Preventive Services Task Force (USPSTF), an independent, volunteer panel of experts that make evidence-based disease prevention recommendations, expanded their guidelines, suggesting an additional cervical cancer screening option for low-risk patients between ages 30 and 65.
In addition to selecting one of the two previously recommended screening options — a Pap test every three years, or a Pap test and human papillomavirus (HPV) test every five years — people can now choose to have just an HPV test every five years, if all prior tests are normal. A history of abnormal results may put a patient at higher risk, requiring more frequent testing.
These guidelines reflect recent research showing that testing for HPV — the virus responsible for most cases of cervical cancer — is more effective for early detection of precancerous changes in the cervix than the traditional Pap test. HPV testing checks for active expression of one of the “high risk” HPV viruses, whereas Pap testing looks for abnormal changes in a sample of cervical cells.
Screening recommendations for people with a cervix between ages 21 to 29 call for a Pap test every three years. USPSTF does not recommend screening for cervical cancer in people under age 21or in people over 65 who have had adequate prior screening and do not have a high risk of developing the disease.
HPV test self-collection
In May 2024, the U.S. Food Drug Administration (FDA) expanded approval for two tests that detect HPV as part of cervical cancer screening. People now have the option to collect a vaginal sample with a swab themselves for HPV testing if they cannot have or do not want a pelvic exam. The collection must be done in a health care setting (including primary care offices, urgent care, pharmacies, or mobile clinics).
Who can get vaccinated for HPV?
As effective as cervical cancer screening has been historically, the most effective way to prevent cervical cancer (and several other HPV-related cancers) is for children to receive preventive vaccination against the HPV virus, ideally by the age of 12 when it is most effective. Young adults who have missed this window should still speak with their doctor about the benefits of the vaccine.
“Moving forward, we may eventually be able to eliminate cervical cancer if everyone is vaccinated before exposure to HPV,” says Sarah Feldman, MD, MPH, OB/GYN at Brigham and Women’s Hospital.
The HPV vaccination Gardasil 9 is FDA-approved for ages 9 to 45 to prevent cancers caused by seven high-risk HPV types and genital warts caused by HPV types 6 and 11. The vaccine is most effective when administered before a person becomes sexually active. It is recommended for children at age 11 or 12 but can be given as early as age 9.
Cervical cancer causes and risk factors
Persistent infection with high-risk types of HPV causes most cervical cancers. Two high-risk types, HPV 16 and HPV 18, cause 70% of cervical cancers worldwide. When an infection lasts for years, it can lead to changes in the cervical cells, resulting in a precancerous lesion. If the precancerous lesion is not found and removed, it may eventually develop into cervical cancer.
People who become sexually active at a young age, especially before age 18, or have multiple sexual partners are more likely to become infected with a high-risk type of HPV if they do not practice safe sex. Condoms can decrease the risk of HPV transmission. However, they do not completely prevent it. Exposure to HPV is still possible in areas not covered by the condom.
Additional risk factors for persistent HPV infection and cervical cancer can also include:
- Having a weakened immune system
- Smoking or breathing in secondhand smoke
About the Medical Reviewer
Dr. Wright is an Associate Professor of Medicine at Harvard Medical School and Dana-Farber Cancer Institute. She received her Medical Degree from University of Pennsylvania and completed a residency in Internal Medicine at Brigham and Women’s Hospital and a Medical Oncology fellowship at Dana-Farber Cancer Institute. She also obtained a Masters in Public Health at the Harvard School of Public Health. In 2009 she joined the faculty of Dana-Farber Cancer Institute, where she is a practicing medical oncologist who specializes in gynecologic oncology and health outcomes research.