View source for Medicine:Cervical cancer

{{short description|Cancer arising from the cervix}}
{{Infobox medical condition (new)
| name            = Cervical cancer
| image           = File:Blausen 0221 CervicalDysplasia.png
| alt             =
| caption         = Location of cervical cancer and an example of normal and abnormal cells
| field           = [[Medicine:Oncology|Oncology]]
| pronounce       = {{IPAc-en|uk|ˈ|s|əːr|v|ɪ|k|əl}} {{respell|SUR|vik|əl}}, {{IPAc-en|s|əːr|ˈ|v|aɪ|k|əl}} {{respell|sur|VY|kəl}}<br />{{IPAc-en|us|ˈ|s|əːr|v|ɪ|k|əl}} {{respell|SUR|vik|əl}}<ref>{{cite web |title=CERVICAL {{!}} meaning in the Cambridge English Dictionary |url=https://dictionary.cambridge.org/dictionary/english/cervical |website=dictionary.cambridge.org |access-date=5 October 2019 }}</ref>
| symptoms        = '''Early''': none<ref name=NCI2014Pt/><br />'''Later''': vaginal bleeding, [[Medicine:Pelvic pain|pelvic pain]], pain during sexual intercourse<ref name=NCI2014Pt/>
| complications   =
| onset           = Over 10 to 20 years<ref name=WCR2014/>
| duration        =
| types           = [[Medicine:Squamous cell carcinoma|Squamous cell carcinoma]], adenocarcinoma, others<ref name=NCI2014Pro/>
| causes          = [[Medicine:Human papillomavirus infection|Human papillomavirus infection]] (HPV)<ref name=Robbins/><ref name=Don2009/>
| risks           = [[Medicine:Smoking|Smoking]], weak immune system, birth control pills, starting sex at a young age, many sexual partners or a partner with many sexual partners<ref name=NCI2014Pt/><ref name=NCI2014Pro/><ref>{{cite journal | vauthors = Bosch FX, de Sanjosé S | title = The epidemiology of human papillomavirus infection and cervical cancer | journal = Disease Markers | volume = 23 | issue = 4 | pages = 213–227 | date = 2007 | pmid = 17627057 | pmc = 3850867 | doi = 10.1155/2007/914823 | doi-access = free }}</ref>
| diagnosis       = Cervical screening followed by a [[Medicine:Biopsy|biopsy]]<ref name=NCI2014Pt/>
| differential    =
| prevention      = Regular cervical screening, HPV vaccines, [[Biology:Sexual intercourse|sexual intercourse]] with [[Medicine:Condom|condom]]s,<ref name=NCI2014Pre/><ref name=NCI2011HPV/> [[Philosophy:Sexual abstinence|sexual abstinence]]
| treatment       = [[Medicine:Surgery|Surgery]], [[Medicine:Chemotherapy|chemotherapy]], [[Physics:Radiation therapy|radiation therapy]], [[Chemistry:Cancer immunotherapy|immunotherapy]]<ref name=NCI2014Pt/>
| medication      =
| prognosis       = [[Medicine:Five-year survival rate|Five-year survival rate]]:<br />68% {{wipe|United States}}<br />46% ({{wipe|India}})<ref name=Can2015>{{Cite web |url=https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/global-cancer-facts-and-figures/global-cancer-facts-and-figures-3rd-edition.pdf |title=Global Cancer Facts & Figures 3rd Edition |date=2015 |page=9 |archive-url=https://web.archive.org/web/20170822014408/https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/global-cancer-facts-and-figures/global-cancer-facts-and-figures-3rd-edition.pdf|archive-date=22 August 2017 |url-status=live |access-date=29 August 2017}}</ref>
| frequency       = 604,127 new cases (2020)<!-- incidence --><ref name=Sung2021>{{cite journal | vauthors = Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F | title = Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries | journal = CA: A Cancer Journal for Clinicians| volume = 71 | issue = 3 | pages = 209–249 | date = May 2021 | pmid = 33538338 | doi = 10.3322/caac.21660 | s2cid = 231804598 | doi-access = free }}</ref>
| deaths          = 341,831 (2020)<ref name=Sung2021/>
}}
<!-- Definition and symptoms  -->
'''Cervical cancer''' is a [[Medicine:Cancer|cancer]] arising from the [[Medicine:Cervix|cervix]].<ref name=NCI2014Pt/> It is due to the abnormal growth of [[Biology:Cell|cells]] that have the ability to invade or spread to other parts of the body.<ref name=NCI2014Def>{{cite web |title=Defining Cancer|url=http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer|website=National Cancer Institute |access-date=10 June 2014|url-status=live|archive-url=https://web.archive.org/web/20140625220940/http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer|archive-date=25 June 2014|date=17 September 2007}}</ref> Early on, typically no symptoms are seen.<ref name=NCI2014Pt/> Later symptoms may include abnormal vaginal bleeding, [[Medicine:Pelvic pain|pelvic pain]] or pain during sexual intercourse.<ref name=NCI2014Pt>{{cite web |title=Cervical Cancer Treatment (PDQ®) |url=http://www.cancer.gov/cancertopics/pdq/treatment/cervical/Patient/page1/AllPages |website=NCI |access-date=24 June 2014 |date=14 March 2014 |url-status=live|archive-url=https://web.archive.org/web/20140705230453/http://www.cancer.gov/cancertopics/pdq/treatment/cervical/Patient/page1/AllPages |archive-date=5 July 2014}}</ref> While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.<ref>{{cite journal | vauthors = Tarney CM, Han J | title = Postcoital bleeding: a review on etiology, diagnosis, and management | journal = Obstetrics and Gynecology International | volume = 2014 | page = 192087 | date = 2014 | pmid = 25045355 | pmc = 4086375 | doi = 10.1155/2014/192087 | doi-access = free }}</ref>

<!-- Cause and Diagnosis -->
[[Medicine:Human papillomavirus infection|Human papillomavirus infection]] (HPV) causes more than 90% of cases;<ref name=Robbins>{{cite book|vauthors=Kumar V, Abbas AK, Fausto N, Mitchell RN |year=2007 |title=Robbins Basic Pathology| edition=8th| publisher=Saunders Elsevier| pages=718–721 |isbn=978-1-4160-2973-1}}</ref><ref name=Don2009>{{cite book| vauthors=Kufe D |title=Holland-Frei cancer medicine |date=2009 |publisher=McGraw-Hill Medical |location=New York |isbn=978-1-60795-014-1 |page=1299 |edition=8th |url=https://books.google.com/books?id=R0FbhLsWHBEC&pg=PA1299 |url-status=live |archive-url=https://web.archive.org/web/20151201054742/https://books.google.com/books?id=R0FbhLsWHBEC&pg=PA1299 |archive-date=1 December 2015}}</ref> most  who have had HPV infections, however, do not develop cervical cancer.<ref name=WCR2014/><ref>{{cite journal |vauthors=Dunne EF, Park IU |title=HPV and HPV-associated diseases |journal=Infectious Disease Clinics of North America |volume=27 |issue=4 |pages=765–778 |date=December 2013 |pmid=24275269 |doi=10.1016/j.idc.2013.09.001 }}</ref> HPV 16 and 18 strains are responsible for nearly 50% of high grade cervical pre-cancers.<ref>{{Cite web |title=Cervical cancer |url=https://www.who.int/news-room/fact-sheets/detail/cervical-cancer |access-date=2022-05-13 |website=www.who.int |language=en}}</ref> Other risk factors include [[Medicine:Smoking|smoking]], a weak immune system, birth control pills, starting sex at a young age, and having many sexual partners, but these are less important.<ref name=NCI2014Pt/><ref name=NCI2014Pro/> [[Biology:Cervical Cancer Gene Database|Genetic factors]] also contribute to cervical cancer risk.<ref>{{cite journal |vauthors=Ramachandran D, Dörk T |title=Genomic Risk Factors for Cervical Cancer |journal=Cancers |volume=13 |issue=20 |page=5137 |date=October 2021 |pmid=34680286 |pmc=8533931 |doi=10.3390/cancers13205137 |doi-access=free}}</ref> Cervical cancer typically develops from [[Medicine:Precancerous condition|precancerous changes]] called cervical intraepithelial neoplasia over 10 to 20 years.<ref name=WCR2014/> About 90% of cervical cancer cases are [[Medicine:Squamous cell carcinoma|squamous cell carcinoma]]s, 10% are adenocarcinoma, and a small number are other types.<ref name=NCI2014Pro/> Diagnosis is typically by cervical screening followed by a [[Medicine:Biopsy|biopsy]].<ref name=NCI2014Pt/> [[Medicine:Medical imaging|Medical imaging]] is then done to determine whether or not the cancer has spread.<ref name=NCI2014Pt/>

<!-- Prevention and Treatment -->
HPV vaccines protect against two to seven high-risk strains of this family of [[Biology:Virus|virus]]es and may prevent up to 90% of cervical cancers.<ref name=NCI2011HPV/><ref>{{cite web|title=FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm|website=U.S. Food and Drug Administration|access-date=8 March 2015|date=10 December 2014|url-status=live|archive-url=https://web.archive.org/web/20150110233107/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm|archive-date=10 January 2015}}</ref><ref>{{cite book| vauthors=Tran NP, Hung CF, Roden R, Wu TC |title=Viruses and Human Cancer |chapter=Control of HPV Infection and Related Cancer Through Vaccination |series=Recent Results in Cancer Research |date=2014 |volume=193 |pages=149–171 |pmid=24008298 |doi=10.1007/978-3-642-38965-8_9 |isbn=978-3-642-38964-1}}</ref> As a risk of cancer still exists, guidelines recommend continuing regular [[Engineering:Pap test|Pap test]]s.<ref name=NCI2011HPV>{{cite web |title=Human Papillomavirus (HPV) Vaccines |url=http://www.cancer.gov/cancertopics/factsheet/prevention/HPV-vaccine|website=National Cancer Institute|access-date=25 June 2014 |date=29 December 2011 |url-status=live|archive-url=https://web.archive.org/web/20140704184759/http://www.cancer.gov/cancertopics/factsheet/prevention/HPV-vaccine|archive-date=4 July 2014}}</ref> Other methods of prevention include having few or no sexual partners and the use of [[Medicine:Condom|condom]]s.<ref name=NCI2014Pre>{{cite web|title=Cervical Cancer Prevention (PDQ®) |url=http://www.cancer.gov/cancertopics/pdq/prevention/cervical/HealthProfessional/page1/AllPages |website=National Cancer Institute |access-date=25 June 2014|date=27 February 2014|url-status=live|archive-url=https://web.archive.org/web/20140706002531/http://www.cancer.gov/cancertopics/pdq/prevention/cervical/HealthProfessional/page1/AllPages|archive-date=6 July 2014}}</ref> Cervical cancer screening using the Pap test or [[Chemistry:Acetic acid|acetic acid]] can identify precancerous changes, which when treated, can prevent the development of cancer.<ref name=WHO2014/> Treatment may consist of some combination of [[Medicine:Surgery|surgery]], [[Medicine:Chemotherapy|chemotherapy]], and [[Physics:Radiation therapy|radiation therapy]].<ref name=NCI2014Pt/> [[Medicine:Five-year survival rate|Five-year survival rate]]s in the United States are 68%.<ref name=SEER2014>{{cite web |title=SEER Stat Fact Sheets: Cervix Uteri Cancer |url=http://seer.cancer.gov/statfacts/html/cervix.html |website=NCI|date=10 November 2014|publisher=[[Organization:National Cancer Institute|National Cancer Institute]] |access-date=18 June 2014|url-status=live|archive-url=https://web.archive.org/web/20140706125134/http://seer.cancer.gov/statfacts/html/cervix.html|archive-date=6 July 2014}}</ref> Outcomes, however, depend very much on how early the cancer is detected.<ref name=NCI2014Pro>{{cite web|title=Cervical Cancer Treatment (PDQ®) |url=http://www.cancer.gov/cancertopics/pdq/treatment/cervical/HealthProfessional/page1/AllPages|website=National Cancer Institute|access-date=25 June 2014|date=14 March 2014|url-status=live|archive-url=https://web.archive.org/web/20140705230535/http://www.cancer.gov/cancertopics/pdq/treatment/cervical/HealthProfessional/page1/AllPages |archive-date=5 July 2014}}</ref>

<!-- Epidemiology -->
Worldwide, cervical cancer is both the fourth-most common type of cancer and the fourth-most common cause of death from cancer in women.<ref name=WCR2014>{{cite book|title=World Cancer Report 2014|date=2014|publisher=World Health Organization|isbn=978-92-832-0429-9|pages=Chapter 5.12}}</ref> In 2012, an estimated 528,000 cases of cervical cancer occurred, with 266,000 deaths.<ref name=WCR2014/> This is about 8% of the total cases and total deaths from cancer.<ref name=WCR2014Total>{{cite book|title=World Cancer Report 2014|date=2014|publisher=World Health Organization|isbn=978-92-832-0429-9|pages=Chapter 1.1}}</ref> About 70% of cervical cancers and 90% of deaths occur in [[Finance:Developing country|developing countries]].<ref name=WCR2014/><ref name=WHO2018Ko>{{cite web |title=Cervical cancer prevention and control saves lives in the Republic of Korea |url=https://www.who.int/news-room/feature-stories/detail/cervical-cancer-prevention-and-control-saves-lives-in-the-republic-of-korea |website=World Health Organization |access-date=1 November 2018}}</ref> In low-income countries, it is one of the most common causes of cancer death with an incidence rate of 47.3 per 100,000 women.<ref>{{cite journal | vauthors = Donnez J | title = An update on uterine cervix pathologies related to infertility | journal = Fertility and Sterility | volume = 113 | issue = 4 | pages = 683–684 | date = April 2020 | pmid = 32228872 | doi = 10.1016/j.fertnstert.2020.02.107 | doi-access = free }}</ref><ref name=WHO2014>{{cite web |author=World Health Organization |date=February 2014 |title=Fact sheet No. 297: Cancer |url=https://www.who.int/mediacentre/factsheets/fs297/en/index.html |access-date=24 June 2014 |url-status=live |archive-url=https://web.archive.org/web/20140213212322/http://www.who.int/mediacentre/factsheets/fs297/en/index.html |archive-date=13 February 2014 }}</ref> In developed countries, the widespread use of cervical screening programs has dramatically reduced rates of cervical cancer.<ref name=pmid10735343>{{cite journal | vauthors = Canavan TP, Doshi NR | title = Cervical cancer | journal = American Family Physician | volume = 61 | issue = 5 | pages = 1369–1376 | date = March 2000 | pmid = 10735343 | url = http://www.aafp.org/afp/20000301/1369.html | url-status = live | archive-url = https://web.archive.org/web/20050206141303/http://www.aafp.org/afp/20000301/1369.html | archive-date = 6 February 2005 }}</ref> Expected scenarios for the reduction of mortality due to cervical cancer worldwide (and specially in low-income countries) have been reviewed, given assumptions with respect to the achievement of recommended prevention targets using triple-intervention strategies defined by WHO.<ref>{{cite journal | vauthors = Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, Burger EA, Martin D, Nguyen DT, Bénard É, Sy S, Regan C, Drolet M, Gingras G, Laprise JF, Torode J, Smith MA, Fidarova E, Trapani D, Bray F, Ilbawi A, Broutet N, Hutubessy R | display-authors = 6 | title = Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries | journal = Lancet | volume = 395 | issue = 10224 | pages = 591–603 | date = February 2020 | pmid = 32007142 | pmc = 7043006 | doi = 10.1016/S0140-6736(20)30157-4 }}</ref> In medical research, the most famous immortalized cell line, known as [[Biology:HeLa|HeLa]], was developed from cervical cancer cells of a woman named Henrietta Lacks.<ref>{{cite book| vauthors = Carraher Jr CE |title=Carraher's polymer chemistry|date=2014|publisher=Taylor & Francis|location=Boca Raton |isbn=978-1-4665-5203-6 |page=385 |edition=9th |url=https://books.google.com/books?id=YXo0AAAAQBAJ&pg=PA385 |url-status=live |archive-url=https://web.archive.org/web/20151022002735/https://books.google.com/books?id=YXo0AAAAQBAJ&pg=PA385|archive-date=22 October 2015}}</ref>

==Signs and symptoms==
The early stages of cervical cancer may be completely [[Medicine:Asymptomatic|free of symptoms]].<ref name=Robbins/><ref name=pmid10735343/> Vaginal bleeding, contact bleeding (one most common form being bleeding after sexual intercourse), or (rarely) a vaginal mass may indicate the presence of malignancy. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer.<ref>{{cite web|url=https://www.medicinenet.com/cervical_cancer/article.htm#what_is_cervical_cancer|title=Cervical Cancer Symptoms, Signs, Causes, Stages & Treatment|website=medicinenet.com}}</ref> In advanced disease, [[Medicine:Metastasis|metastases]] may be present in the [[Biology:Abdomen|abdomen]], [[Medicine:Lung|lung]]s, or elsewhere.<ref>{{cite journal | vauthors = Li H, Wu X, Cheng X | title = Advances in diagnosis and treatment of metastatic cervical cancer | journal = Journal of Gynecologic Oncology | volume = 27 | issue = 4 | pages = e43 | date = July 2016 | pmid = 27171673 | pmc = 4864519 | doi = 10.3802/jgo.2016.27.e43 }}</ref>

Symptoms of advanced cervical cancer may include loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, swollen legs, heavy vaginal bleeding, bone fractures, and (rarely) leakage of urine or faeces from the vagina.<ref name="MedLine Plus Cerv Cancer">{{cite encyclopedia |url=https://www.nlm.nih.gov/medlineplus/ency/article/000893.htm |title=Cervical cancer |access-date=2 December 2007 |date=9 June 2006 |encyclopedia=MedlinePlus Medical Encyclopedia |publisher=[[Organization:National Institutes of Health|National Institutes of Health]] |url-status=live |archive-url=https://web.archive.org/web/20071011011822/http://www.nlm.nih.gov/medlineplus/ency/article/000893.htm |archive-date=11 October 2007 }}</ref> Bleeding after douching or after a pelvic exam is a common symptom of cervical cancer.<ref>{{Cite news| url=http://www.cancer.org/cancer/cervicalcancer/moreinformation/cervicalcancerpreventionandearlydetection/cervical-cancer-prevention-and-early-detection-cervical-cancer-signs-and-symptoms| title=Cervical Cancer Prevention and Early Detection| work=Cancer| archive-url=https://web.archive.org/web/20150710000534/http://www.cancer.org/cancer/cervicalcancer/moreinformation/cervicalcancerpreventionandearlydetection/cervical-cancer-prevention-and-early-detection-cervical-cancer-signs-and-symptoms| archive-date=10 July 2015| url-status=live}}</ref>

==Causes==
[[File:Figure 28 02 08.JPG|thumb|In most cases, cells infected with the HPV heal on their own. In some cases, however, the virus continues to spread and becomes an invasive cancer.]]
[[File:Figure 28 02 06.JPG|thumb|Cervix in relation to upper part of vagina and posterior portion of uterus, showing difference in covering epithelium of inner structures]]
Infection with some types of HPV is the greatest risk factor for cervical cancer, followed by smoking.<ref name="GadducciBarsotti2011">{{cite journal |vauthors= Gadducci A, Barsotti C, Cosio S, Domenici L, Riccardo Genazzani A |title=Smoking habit, immune suppression, oral contraceptive use, and hormone replacement therapy use and cervical carcinogenesis: a review of the literature |journal=Gynecological Endocrinology |volume=27 |issue=8 |pages=597–604 |date=August 2011 |pmid=21438669 |doi=10.3109/09513590.2011.558953 |s2cid=25447563 }}</ref> [[Biology:HIV|HIV]] infection is also a risk factor.<ref name="GadducciBarsotti2011"/> Not all of the causes of cervical cancer are known, however, and several other contributing factors have been implicated.<ref>{{cite book |title=Gynaecology by Ten Teachers | vauthors = Campbell S, Monga A |edition=18th |year=2006 |publisher=Hodder Education |isbn=978-0-340-81662-2 |url-access=registration |url=https://archive.org/details/gynaecology0000unse }}</ref><ref>{{cite web|url=https://www.medicinenet.com/cervical_cancer/article.htm#cervical_cancer_facts|title=Cervical Cancer Symptoms, Signs, Causes, Stages & Treatment|website=medicinenet.com}}</ref>

===Human papillomavirus===
[[Medicine:Human papillomavirus infection|HPV]] types 16 and 18 are the cause of 75% of cervical cancer cases globally, while 31 and 45 are the causes of another 10%.<ref>{{cite book| veditors = Dillman RK, Oldham RO |title=Principles of cancer biotherapy |year=2009 |publisher=Springer |location=Dordrecht|isbn=978-90-481-2289-9|page=149|url=https://books.google.com/books?id=emGC_fRJH_IC&pg=PA149|edition=5th |url-status=live|archive-url=https://web.archive.org/web/20151029195259/https://books.google.com/books?id=emGC_fRJH_IC&pg=PA149|archive-date=29 October 2015}}</ref>

Women who have multiple sexual partners, or have partners who have multiple sexual partners, regardless of sex are at higher risk of cervical cancer .<ref name="ACS What Causes">{{cite web|url=http://www.cancer.org/docroot/CRI/content/CRI_2_2_2X_What_causes_cancer_of_the_cervix_Can_it_be_prevented_8.asp?sitearea= |title=What Causes Cancer of the Cervix? |access-date=2 December 2007 |date=30 November 2006 |publisher=American Cancer Society |archive-url = https://web.archive.org/web/20071013160516/http://cancer.org/docroot/CRI/content/CRI_2_2_2X_What_causes_cancer_of_the_cervix_Can_it_be_prevented_8.asp?sitearea= <!-- Bot retrieved archive --> |archive-date = 13 October 2007}}</ref><ref name=pmid11392939>{{cite journal | vauthors = Marrazzo JM, Koutsky LA, Kiviat NB, Kuypers JM, Stine K | title = Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women | journal = American Journal of Public Health | volume = 91 | issue = 6 | pages = 947–952 | date = June 2001 | pmid = 11392939 | pmc = 1446473 | doi = 10.2105/AJPH.91.6.947 }}</ref>

Of the 150-200 types of HPV known,<ref name="MDL HPV Type-Detect">{{cite web|url=http://www.mdlab.com/html/testing/hpv_typedetect.html |title=HPV Type-Detect |access-date=2 December 2007 |date=30 October 2007|publisher=Medical Diagnostic Laboratories |archive-url =https://web.archive.org/web/20070927092931/http://www.mdlab.com/html/testing/hpv_typedetect.html <!-- Bot retrieved archive --> |archive-date = 27 September 2007}}</ref><ref name="NCI:Primer on HPV">{{cite web |url=http://www.cancer.gov/newscenter/benchmarks-vol2-issue4/page2 |title=A Primer on HPV |access-date=2 December 2007 |vauthors = Gottlieb N |date=24 April 2002 |work=Benchmarks |publisher=[[Organization:National Cancer Institute|National Cancer Institute]] |archive-url=https://web.archive.org/web/20071026061233/http://www.cancer.gov/newscenter/benchmarks-vol2-issue4/page2 |archive-date=26 October 2007 }}</ref>  15 are classified as high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82), three as probable high-risk (26, 53, and 66), and 12 as low-risk (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108).<ref name=pmid12571259>{{cite journal |vauthors = Muñoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsagué X, Shah KV, Snijders PJ, Meijer CJ |display-authors = 6 |title = Epidemiologic classification of human papillomavirus types associated with cervical cancer |journal = The New England Journal of Medicine |volume = 348 |issue = 6 |pages = 518–527 |date = February 2003 |pmid = 12571259 |doi = 10.1056/NEJMoa021641 |hdl-access = free |hdl = 2445/122831 |s2cid = 1451343 |url = https://revistasojs.ucaldas.edu.co/index.php/hacialapromociondelasalud/article/view/2173 }}</ref>

[[Medicine:Genital wart|Genital wart]]s, which are a form of [[Medicine:Benign tumor|benign tumor]] of [[Biology:Epithelium|epithelial]] cells, are also caused by various strains of HPV. However, these serotypes are usually not related to cervical cancer. Having multiple strains at the same time is common, including those that can cause cervical cancer along with those that cause warts. Infection with HPV is generally believed to be required for cervical cancer to occur.<ref name=pmid16362994>{{cite journal | vauthors = Snijders PJ, Steenbergen RD, Heideman DA, Meijer CJ | title = HPV-mediated cervical carcinogenesis: concepts and clinical implications | journal = The Journal of Pathology | volume = 208 | issue = 2 | pages = 152–164 | date = January 2006 | pmid = 16362994 | doi = 10.1002/path.1866 | s2cid = 25400770 | doi-access = free }}</ref>

=== Smoking ===
Cigarette smoking, both active and passive, increases the risk of cervical cancer. Among HPV-infected women, current and former smokers have roughly two to three times the incidence of invasive cancer. Passive smoking is also associated with increased risk, but to a lesser extent.<ref name="NIHNCIHPV2015">{{cite web | publisher = National Cancer Institute, National Institutes of Health | work = PDQ |  url = http://cancer.gov/cancertopics/pdq/prevention/cervical/HealthProfessional | title = Cervical Cancer Prevention | date = 26 December 2022 | location = Bethesda, MD }}</ref>

Smoking has also been linked to the development of cervical cancer.<ref name=LuhnWalker2013>{{cite journal |vauthors = Luhn P, Walker J, Schiffman M, Zuna RE, Dunn ST, Gold MA, Smith K, Mathews C, Allen RA, Zhang R, Wang S, Wentzensen N |display-authors = 6 |title = The role of co-factors in the progression from human papillomavirus infection to cervical cancer |journal = Gynecologic Oncology |volume = 128 |issue = 2 |pages = 265–270 |date = February 2013 |pmid = 23146688 |pmc = 4627848 |doi = 10.1016/j.ygyno.2012.11.003 }}</ref><ref name=RemschmidtKaufmann2013>{{cite journal | vauthors = Remschmidt C, Kaufmann AM, Hagemann I, Vartazarova E, Wichmann O, Deleré Y | title = Risk factors for cervical human papillomavirus infection and high-grade intraepithelial lesion in women aged 20 to 31 years in Germany | journal = International Journal of Gynecological Cancer | volume = 23 | issue = 3 | pages = 519–526 | date = March 2013 | pmid = 23360813 | doi = 10.1097/IGC.0b013e318285a4b2 | s2cid = 205679729 }}</ref><ref name=GadducciBarsotti2011/> Smoking can increase the risk in women a few different ways, which can be by direct and indirect methods of inducing cervical cancer.<ref name=LuhnWalker2013/><ref name=GadducciBarsotti2011/><ref name=AgorastosMiliaras2005>{{cite journal | vauthors = Agorastos T, Miliaras D, Lambropoulos AF, Chrisafi S, Kotsis A, Manthos A, Bontis J | title = Detection and typing of human papillomavirus DNA in uterine cervices with coexistent grade I and grade III intraepithelial neoplasia: biologic progression or independent lesions? | journal = European Journal of Obstetrics, Gynecology, and Reproductive Biology | volume = 121 | issue = 1 | pages = 99–103 | date = July 2005 | pmid = 15949888 | doi = 10.1016/j.ejogrb.2004.11.024 }}</ref> A direct way of contracting this cancer is a smoker has a higher chance of cervical intraepithelial neoplasia (CIN3) occurring, which has the potential of forming cervical cancer.<ref name=LuhnWalker2013/> When CIN3 lesions lead to cancer, most of them have the assistance of the HPV virus, but that is not always the case, which is why it can be considered a direct link to cervical cancer.<ref name=AgorastosMiliaras2005/> Heavy smoking and long-term smoking seem to have more of a risk of getting the CIN3 lesions than lighter smoking or not smoking at all.<ref name=JensenSchmiedel2012>{{cite journal | vauthors = Jensen KE, Schmiedel S, Frederiksen K, Norrild B, Iftner T, Kjær SK | title = Risk for cervical intraepithelial neoplasia grade 3 or worse in relation to smoking among women with persistent human papillomavirus infection | journal = Cancer Epidemiology, Biomarkers & Prevention | volume = 21 | issue = 11 | pages = 1949–1955 | date = November 2012 | pmid = 23019238 | pmc = 3970163 | doi = 10.1158/1055-9965.EPI-12-0663 }}</ref> Although smoking has been linked to cervical cancer, it aids in the development of HPV, which is the leading cause of this type of cancer.<ref name=GadducciBarsotti2011/> Also, not only does it aid in the development of HPV, but also if the woman is already HPV-positive, she is at an even greater likelihood of contracting cervical cancer.<ref name=JensenSchmiedel2012/>

===Oral contraceptives===
Long-term use of oral contraceptives is associated with increased risk of cervical cancer in women who have had [[Medicine:Human papillomavirus infection|HPV]]. Women who have used oral contraceptives for 5 to 9 years have about three times the incidence of invasive cancer, and those who used them for 10 years or longer have about four times the risk.<ref name=NIHNCIHPV2015/><ref>{{cite journal | vauthors = Asthana S, Busa V, Labani S | title = Oral contraceptives use and risk of cervical cancer-A systematic review & meta-analysis | journal = European Journal of Obstetrics, Gynecology, and Reproductive Biology | volume = 247 | pages = 163–175 | date = April 2020 | pmid = 32114321 | doi = 10.1016/j.ejogrb.2020.02.014 | s2cid = 211728228 }}</ref>

===Multiple pregnancies===
Having many pregnancies is associated with an increased risk of cervical cancer. Among HPV-infected women, those who have had seven or more full-term pregnancies have around four times the risk of cancer compared with women with no pregnancies, and two to three times the risk of women who have had one or two full-term pregnancies.<ref name=NIHNCIHPV2015/>

==Diagnosis==
[[File:Ca cervicis uteri T2 SAG.jpg|thumb|Cervical cancer seen on a T2-weighted sagittal MR image of the pelvis]]

===Biopsy===
The [[Engineering:Pap test|Pap test]] can be used as a [[Medicine:Screening|screening test]], but produces a [[False positives and false negatives#False negative error|false negative]] in up to 50% of cases of cervical cancer.<ref>Cecil Medicine: Expert Consult Premium Edition . {{ISBN|1-4377-3608-4}}, 9781437736083. Page 1317.</ref><ref>Berek and Hacker's Gynecologic Oncology. {{ISBN|0-7817-9512-5}}, 9780781795128. Page 342</ref> Other concerns is the cost of doing Pap tests, which make them unaffordable in many areas of the world.<ref>{{cite journal | vauthors = Cronjé HS | title = Screening for cervical cancer in developing countries | journal = International Journal of Gynaecology and Obstetrics | volume = 84 | issue = 2 | pages = 101–108 | date = February 2004 | pmid = 14871510 | doi = 10.1016/j.ijgo.2003.09.009 | s2cid = 21356776 }}</ref>

Confirmation of the diagnosis of cervical cancer or precancer requires a biopsy of the cervix. This is often done through colposcopy, a magnified visual inspection of the cervix aided by using a dilute [[Chemistry:Acetic acid|acetic acid]] (e.g. [[Chemistry:Vinegar|vinegar]]) solution to highlight abnormal cells on the surface of the cervix,<ref name=Robbins/> with visual contrast provided by staining the normal tissues a mahogany brown with Lugol's iodine.<ref>{{cite book | vauthors = Sellors JW |title=Colposcopy and treatment of cervical intraepithelial neoplasia: a beginners' manual |date=2003 |isbn=978-92-832-0412-1 |chapter-url=http://screening.iarc.fr/colpochap.php?lang=1&chap=4 |chapter=Chapter 4: An introduction to colposcopy: indications for colposcopy, instrumentation, principles and documentation of results|publisher=International Agency for Research on Cancer }}</ref> Medical devices used for biopsy of the cervix include [[Medicine:Instruments used in obstetrics and gynecology|punch forceps]]. Colposcopic impression, the estimate of disease severity based on the visual inspection, forms part of the diagnosis. Further diagnostic and treatment procedures are [[Medicine:Loop electrical excision procedure|loop electrical excision procedure]] and [[Medicine:Cervical conization|cervical conization]], in which the inner lining of the cervix is removed to be examined pathologically. These are carried out if the biopsy confirms severe cervical intraepithelial neoplasia.<ref name=":1">{{cite journal | vauthors = Athanasiou A, Veroniki AA, Efthimiou O, Kalliala I, Naci H, Bowden S, Paraskevaidi M, Arbyn M, Lyons D, Martin-Hirsch P, Bennett P, Paraskevaidis E, Salanti G, Kyrgiou M | display-authors = 6 | title = Comparative effectiveness and risk of preterm birth of local treatments for cervical intraepithelial neoplasia and stage IA1 cervical cancer: a systematic review and network meta-analysis | journal = The Lancet. Oncology | volume = 23 | issue = 8 | pages = 1097–1108 | date = August 2022 | pmid = 35835138 | pmc = 9630146 | doi = 10.1016/S1470-2045(22)00334-5 }}</ref><ref name=":2">{{Cite journal |date=2023-11-10 |title=Prevention of cervical cancer: what are the risks and benefits of different treatments? |url=https://evidence.nihr.ac.uk/alert/prevention-of-cervical-cancer-what-are-the-risks-and-benefits-of-different-treatments/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_60599|s2cid=265201829 }}</ref>

[[File:Squamous carcinoma of the cervix.jpg|right|thumb|This large squamous carcinoma (bottom of picture) has obliterated the cervix and invaded the lower uterine segment. The uterus also has a round [[Medicine:Leiomyoma|leiomyoma]] up higher.]]

Often before the biopsy, the doctor asks for medical imaging to rule out other causes of woman's symptoms. Imaging modalities such as [[Physics:Ultrasound|ultrasound]], CT scan, and MRI have been used to look for alternating disease, spread of the tumor, and effect on adjacent structures. Typically, they appear as heterogeneous mass on the cervix.<ref>{{cite journal | vauthors = Pannu HK, Corl FM, Fishman EK | title = CT evaluation of cervical cancer: spectrum of disease | journal = Radiographics | volume = 21 | issue = 5 | pages = 1155–1168 | date = September–October 2001 | pmid = 11553823 | doi = 10.1148/radiographics.21.5.g01se311155 }}</ref>

Interventions such as playing music during the procedure and viewing the procedure on a monitor can reduce the anxiety associated with the examination.<ref>{{cite journal | vauthors = Galaal K, Bryant A, Deane KH, Al-Khaduri M, Lopes AD | title = Interventions for reducing anxiety in women undergoing colposcopy | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 12 | pages = CD006013 | date = December 2011 | pmid = 22161395 | pmc = 4161490 | doi = 10.1002/14651858.cd006013.pub3 }}</ref>

===Precancerous lesions===
thumb|Histopathologic image ([[H&E stain) of carcinoma ''in situ'' (also called CIN3), stage 0: The normal architecture of stratified squamous epithelium is replaced by irregular cells that extend throughout its full thickness. Normal columnar epithelium is also seen.]]
Cervical intraepithelial neoplasia (CIN) means the development of abnormal cells on the surface of the cervix. It is caused by an HPV infection but in most cases it is resolved by the immune system. However a small percentage of people might develop a more serious CIN which, if left untreated, can develop into cervical cancer.<ref>{{cite book | vauthors = Mello V, Sundstrom RK | chapter = Cervical Intraepithelial Neoplasia |date=2023 | chapter-url = http://www.ncbi.nlm.nih.gov/books/NBK544371/ | title = StatPearls |access-date=2023-11-16 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31335091 }}</ref><ref name=":3">{{Cite web |title=Cervical Dysplasia: Causes, Symptoms, Diagnosis & Treatment |url=https://my.clevelandclinic.org/health/diseases/15678-cervical-intraepithelial-neoplasia-cin |access-date=2023-11-16 |website=Cleveland Clinic |language=en}}</ref> CIN is often diagnosed during routine Pap smear examination or colposcopy.<ref name=":3" />

The naming and [[Biology:Histology|histologic]] classification of cervical carcinoma precursor lesions has changed many times over the 20th century. The [[Organization:World Health Organization|World Health Organization]] classification system was descriptive of the lesions, naming them mild, moderate, or severe [[Biology:Dysplasia|dysplasia]] or [[Medicine:Carcinoma in situ|carcinoma ''in situ'']] (CIS).<ref name="CAresearchUK" /><ref name="DeMay">{{cite book |title=Practical principles of cytopathology. Revised edition. |vauthors=DeMay M |publisher=American Society for Clinical Pathology Press |year=2007 |isbn=978-0-89189-549-7 |location=Chicago, IL}}</ref> The term cervical intraepithelial neoplasia (CIN) was developed to place emphasis on the spectrum of abnormality in these lesions, and to help standardize treatment.<ref name=DeMay/> For premalignant dysplastic changes, cervical intraepithelial neoplasia grading  (CIN 1–3) is used. It classifies mild dysplasia as CIN1, moderate dysplasia as CIN2, and severe dysplasia and CIS as CIN3.<ref>{{cite book | vauthors = Salcedo MP, Phoolcharoen N, Schmeler KM | chapter = Intraepithelial neoplasia of the lower genital tract (cervix, vagina, vulva) |date=2022 | title = Comprehensive Gynecology |pages=637–647.e2 |publisher=Elsevier |language=en |doi=10.1016/b978-0-323-65399-2.00038-3 |isbn=978-0-323-65399-2 }}</ref> More recently, CIN2 and CIN3 have been combined into CIN2/3.  These results are what a pathologist might report from a biopsy.{{citation needed|date=September 2020}}

These should not be confused with the [[Biology:Bethesda system|Bethesda system]] terms for Pap test ([[Biology:Cytopathology|cytopathology]]) results.  Among the Bethesda results: [[Biology:Bethesda system|Low-grade squamous intraepithelial lesion]] (LSIL) and [[Biology:Bethesda system#HSIL|high-grade squamous intraepithelial lesion]] (HSIL). An LSIL Pap may correspond to CIN1, and HSIL may correspond to CIN2 and CIN3,<ref name=DeMay/> but they are results of different tests, and the Pap test results need not match the histologic findings.{{medical citation needed|date=May 2021}}

===Cancer subtypes===
[[Medicine:Histopathology|Histologic]] subtypes of invasive cervical carcinoma include:<ref>{{cite web |url=http://www.emedicine.com/med/topic324.htm#section~workup |title=Cervical Cancer |access-date=2 December 2007 |vauthors=Garcia A, Hamid O, El-Khoueiry A |date=6 July 2006 |work=eMedicine |publisher=[[Company:WebMD|WebMD]] |url-status=live |archive-url=https://web.archive.org/web/20071209093214/http://www.emedicine.com/med/TOPIC324.HTM#section~workup |archive-date=9 December 2007 }}</ref><ref>{{cite news | vauthors = Dolinsky C |title=Cervical Cancer: The Basics |date=17 July 2006 |publisher=[[Organization:University of Pennsylvania|Abramson Cancer Center of the University of Pennsylvania]] | url=http://www.oncolink.upenn.edu/types/article.cfm?c=6&s=17&ss=129&id=8226 | work=OncoLink | access-date=2 December 2007 | archive-url=https://web.archive.org/web/20080118175524/http://www.oncolink.upenn.edu/types/article.cfm?c=6&s=17&ss=129&id=8226 | archive-date=18 January 2008 }}</ref>
* [[Medicine:Squamous cell carcinoma|Squamous cell carcinoma]] (about 80–85%<ref>{{cite web|title=What Is Cervical Cancer?|url=https://www.cancer.org/cancer/cervical-cancer/about/what-is-cervical-cancer.html|publisher=American Cancer Society}}</ref><ref>{{cite web|title=Cervical cancer – Types and grades|url=http://www.cancerresearchuk.org/about-cancer/cervical-cancer/stages-types-grades/types-and-grades|publisher=Cancer Research UK}}</ref>)
* adenocarcinoma (about 15% of cervical cancers in the UK<ref name=CAresearchUK>{{cite web |title = Cancer Research UK website |url = http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/ |access-date = 3 January 2009 |archive-url = https://web.archive.org/web/20090116222837/http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/ |archive-date = 16 January 2009 }}</ref>)
* Adenosquamous carcinoma
* Small cell carcinoma
* Neuroendocrine tumour
* [[Medicine:Glassy cell carcinoma of the cervix|Glassy cell carcinoma]]
* [[Medicine:Villoglandular adenocarcinoma of the cervix|Villoglandular adenocarcinoma]]
<gallery mode="packed" heights="160">
Image:Histopathology of squamous cell carcinoma of the cervix.png|Invasive squamous cell carcinoma of the cervix is characterized by infiltration as irregular anastomosing nests or single cells.<ref>{{cite web | vauthors = Turashvili G | title = Squamous cell carcinoma and variants | website= Pathology Outlines |url= https://www.pathologyoutlines.com/topic/cervixscc.html }}</ref> This case is poorly differentiated. H&E stain.
File:Immunohistochemistry for p16 in cervical squamous cell carcinoma.jpg|Cervical squamous cell carcinoma generally shows diffuse staining of both nuclei and cytoplasm on [[Biology:P16|p16]] [[Biology:Immunohistochemistry|immuno-<br />histochemistry]] (except verrucous variant).<ref>Image by Mikael Häggström, MD. Source for caption: {{cite web|url=https://www.pathologyoutlines.com/topic/cervixscc.html|title=Cervix - Squamous cell carcinoma and variants|website=Pathology Outlines|vauthors=Turashvili G}} Last author update: 24 September 2020</ref>
File:Invasive cervical squamous cell carcinoma on H&E histopathology and Ki-67 immunohistochemistry.jpg|Invasive cervical squamous cell carcinoma on H&E histopathology and Ki-67 immunohistochemistry. The latter correlates well with the degree and level of dysplasia.<ref>Image by Mikael Häggström, MD. Source for caption: {{cite journal|vauthors=Ghosh A, Nirupama M, Padmanabha N, Kini H| title=Assessment of p16 and Ki67 Immunohistochemistry Expression in Squamous Intraepithelial Lesion with Cytohistomorphological Correlation. | journal=Iran J Pathol | year= 2020 | volume= 15 | issue= 4 | pages= 268–273 | pmid=32944038 | doi=10.30699/ijp.2020.112421.2208 | pmc=7477676 }}</ref>
Image:Cervix quadrants and directions.svg|The location of cervical cancer can be described in terms of quadrants, or corresponding to a clock face when the subject is in [[Biology:Supine position|supine position]].
</gallery>

Though squamous cell carcinoma is the cervical cancer with the most incidence, the incidence of adenocarcinoma of the cervix has been increasing in recent decades.<ref name=Robbins/> Endocervical adenocarcinoma represents 20–25% of the histological types of cervical carcinoma. Gastric-type mucinous adenocarcinoma of the cervix is a rare type of cancer with aggressive behavior. This type of malignancy is not related to high-risk human papillomavirus (HPV).<ref>{{cite journal |vauthors = Mulita F, Iliopoulos F, Kehagias I |title = A rare case of gastric-type mucinous endocervical adenocarcinoma in a 59-year-old woman |journal = Przeglad Menopauzalny = Menopause Review |volume = 19 |issue = 3 |pages = 147–150 |date = September 2020 |pmid = 33100952 |pmc = 7573334 |doi = 10.5114/pm.2020.99563 }}</ref>
Noncarcinoma malignancies which can rarely occur in the cervix include [[Medicine:Melanoma|melanoma]] and [[Medicine:Lymphoma|lymphoma]].  The International Federation of Gynecology and Obstetrics (FIGO) stage does not incorporate [[Biology:Lymph node|lymph node]] involvement in contrast to the TNM staging for most other cancers. For cases treated surgically, information obtained from the pathologist can be used in assigning a separate pathologic stage, but is not to replace the original clinical stage.{{citation needed|date=September 2020}}

===Staging===
{{Main|Medicine:Cervical cancer staging}}
Cervical cancer is staged by the FIGO system, which is based on clinical examination rather than surgical findings. Prior to the 2018 revisions to FIGO staging, the system allowed only these diagnostic tests to be used in determining the stage: palpation, inspection, colposcopy, endocervical [[Medicine:Curettage|curettage]], hysteroscopy, cystoscopy, [[Medicine:Proctoscopy|proctoscopy]], intravenous urography, and [[Physics:X-ray|X-ray]] examination of the lungs and skeleton, and cervical conization. However, the current system allows use of any imaging or pathological methods for staging.<ref>{{cite journal |vauthors = Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, Kehoe ST, Konishi I, Olawaiye AB, Prat J, Sankaranarayanan R, Brierley J, Mutch D, Querleu D, Cibula D, Quinn M, Botha H, Sigurd L, Rice L, Ryu HS, Ngan H, Mäenpää J, Andrijono A, Purwoto G, Maheshwari A, Bafna UD, Plante M, Natarajan J |display-authors = 6 |title = Revised FIGO staging for carcinoma of the cervix uteri |journal = International Journal of Gynaecology and Obstetrics |volume = 145 |issue = 1 |pages = 129–135 |date = April 2019 |pmid = 30656645 |doi = 10.1002/ijgo.12749 |s2cid = 58656013 }}</ref>

<gallery>
File:Diagram showing stage 1A cervical cancer CRUK 200.svg|Stage 1A cervical cancer
File:Diagram showing stage 1B cervical cancer CRUK 203.svg|Stage 1B cervical cancer
File:Diagram showing stage 2A cervical cancer CRUK 212.svg|Stage 2A cervical cancer
File:Diagram showing stage 2B cervical cancer CRUK 216.svg|Stage 2B cervical cancer
File:Diagram showing stage 3B cervical cancer CRUK 226.svg|Stage 3B cervical cancer
File:Diagram showing stage 4A cervical cancer CRUK 236.svg|Stage 4A cervical cancer
File:Diagram showing stage 4B cervical cancer CRUK 239.svg|Stage 4B cervical cancer
</gallery>

==Prevention {{Anchor | prevention}}==<!-- Other articles link here. -->

=== Screening ===
[[File:Cervical screening Test Vehicle in Minsheng Community 20120421.jpg|thumb|Cervical screening test vehicle in Taiwan]]
[[File:VIANeg.gif|thumb|Negative visual inspection with acetic acid of the cervix]]
[[File:VIAPosCIN1.gif|thumb|Positive visual inspection with acetic acid of the cervix for CIN-1]]
Checking cervical cells with the [[Engineering:Pap test|Papanicolaou test]] (Pap test) for cervical pre-cancer has dramatically reduced the number of cases of, and mortality from, cervical cancer.<ref name=pmid10735343/> Liquid-based cytology may reduce the number of inadequate samples.<ref>{{cite journal |vauthors=Payne N, Chilcott J, McGoogan E |title=Liquid-based cytology in cervical screening: a rapid and systematic review |journal=Health Technology Assessment |volume=4 |issue=18 |pages=1–73 |year=2000 |pmid=10932023 |doi=10.3310/hta4180 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Karnon J, Peters J, Platt J, Chilcott J, McGoogan E, Brewer N |title=Liquid-based cytology in cervical screening: an updated rapid and systematic review and economic analysis |journal=Health Technology Assessment |volume=8 |issue=20 |pages=iii, 1-iii, 78 |date=May 2004 |pmid=15147611 |doi=10.3310/hta8200 |doi-access=free}}</ref><ref>{{cite web |url=http://www.cancerscreening.nhs.uk/cervical/lbc.html |title=Liquid Based Cytology (LBC): NHS Cervical Screening Programme|archive-url=https://web.archive.org/web/20110108144400/http://www.cancerscreening.nhs.uk/cervical/lbc.html |archive-date=8 January 2011 |url-status=live |access-date=1 October 2010}}</ref> Pap test screening every three to five years with appropriate follow-up can reduce cervical cancer incidence up to 80%.<ref name=Arbyn10>{{cite journal | vauthors = Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, Wiener H, Herbert A, von Karsa L | display-authors = 6 | title = European Guidelines for Quality Assurance in Cervical Cancer Screening. Second edition--summary document | journal = Annals of Oncology | volume = 21 | issue = 3 | pages = 448–458 | date = March 2010 | pmid = 20176693 | pmc = 2826099 | doi = 10.1093/annonc/mdp471 }}</ref>

Pap test screening can reveal abnormal cells on the surface of the cervix called cervical intraepithelial neoplasia (CIN) that in a small percentage can develop into cervical cancer. These precancerous changes can be confirmed with further examination known as colposcopy.

Personal invitations encouraging women to get screened are effective at increasing the likelihood they will do so. Educational materials also help increase the likelihood women will go for screening, but they are not as effective as invitations.<ref>{{cite journal | vauthors = Staley H, Shiraz A, Shreeve N, Bryant A, Martin-Hirsch PP, Gajjar K | title = Interventions targeted at women to encourage the uptake of cervical screening | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 9 | pages = CD002834 | date = September 2021 | pmid = 34694000 | pmc = 8543674 | doi = 10.1002/14651858.CD002834.pub3 }}</ref>

According to the 2010 European guidelines, the age at which to start screening ranges between 20 and 30 years of age, but preferentially not before age 25 or 30 years, and depends on burden of the disease in the population and the available resources.<ref name="Arbyn10"/>

In the United States, screening is recommended to begin at age 21, regardless of age at which a woman began having sex or other risk factors.<ref name=USAScreen2014/> Pap tests should be done every three years between the ages of 21 and 65.<ref name=USAScreen2014/> In women over the age of 65, screening may be discontinued if no abnormal screening results were seen within the previous 10 years and no history of CIN2 or higher exists.<ref name=USAScreen2014>{{cite web|title=Cervical Cancer Screening Guidelines for Average-Risk Women|website=cdc.gov |url=https://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf |access-date=8 November 2014|url-status=live|archive-url=https://web.archive.org/web/20150201182536/http://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf|archive-date=1 February 2015}}</ref><ref name=Committee38/><ref name=Kar2013>{{cite journal |vauthors=Karjane N, Chelmow D |title=New cervical cancer screening guidelines, again |journal=Obstetrics and Gynecology Clinics of North America |volume=40 |issue=2 |pages=211–223 |date=June 2013 |pmid=23732026 |doi=10.1016/j.ogc.2013.03.001}}</ref> HPV vaccination status does not change screening rates.<ref name=Committee38>{{cite journal |title=ACOG Practice Bulletin Number 131: Screening for cervical cancer |journal=Obstetrics and Gynecology |volume=120 |issue=5 |pages=1222–1238 |date=November 2012 |pmid=23090560 |doi=10.1097/AOG.0b013e318277c92a |author1=Committee on Practice Bulletins—Gynecology}}</ref>

A number of recommended options exist for screening those 30 to 65.<ref name=USPSTF2018/> This includes cervical cytology every 3 years, HPV testing every 5 years, or HPV testing together with cytology every 5 years.<ref name=USPSTF2018>{{cite journal | vauthors = Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW, Wong JB | display-authors = 6 | title = Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 320 | issue = 7 | pages = 674–686 | date = August 2018 | pmid = 30140884 | doi = 10.1001/jama.2018.10897 | doi-access = free }}</ref><ref name=Committee38/> Screening is not beneficial before age 25, as the rate of disease is low. Screening is not beneficial in women older than 60 years if they have a history of negative results.<ref name=NIHNCIHPV2015/> The American Society of Clinical Oncology guideline has recommend for different levels of resource availability.<ref name="Primary Prevention of Cervical Canc">{{cite journal | vauthors = Arrossi S, Temin S, Garland S, Eckert LO, Bhatla N, Castellsagué X, Alkaff SE, Felder T, Hammouda D, Konno R, Lopes G, Mugisha E, Murillo R, Scarinci IC, Stanley M, Tsu V, Wheeler CM, Adewole IF, de Sanjosé S | display-authors = 6 | title = Primary Prevention of Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Guideline | journal = Journal of Global Oncology | volume = 3 | issue = 5 | pages = 611–634 | date = October 2017 | pmid = 29094100 | pmc = 5646902 | doi = 10.1200/JGO.2016.008151 }}</ref>

Pap tests have not been as effective in developing countries.<ref name=":0">{{Cite book|title = Comprehensive cervical cancer control. A guide to essential practice | edition = Second | publisher = World Health Organization|year = 2014|isbn = 978-92-4-154895-3|url =https://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-guide/en/|url-status = live|archive-url = https://web.archive.org/web/20150504101022/http://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-guide/en/|archive-date = 4 May 2015}}</ref> This is in part because many of these countries have an impoverished health care infrastructure, too few trained and skilled professionals to obtain and interpret Pap tests, uninformed women who get lost to follow-up, and a lengthy turn-around time to get results.<ref name=":0" /> Visual inspection with acetic acid and HPV DNA testing have been tried, though with mixed success.<ref name=":0" />

=== Barrier protection ===
Barrier protection or spermicidal gel use during sexual intercourse decreases, but does not eliminate risk of transmitting the infection,<ref name=NIHNCIHPV2015/> though condoms may protect against genital warts.<ref name="Manhart2002">{{cite journal | vauthors = Manhart LE, Koutsky LA | title = Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis | journal = Sexually Transmitted Diseases | volume = 29 | issue = 11 | pages = 725–735 | date = November 2002 | pmid = 12438912 | doi = 10.1097/00007435-200211000-00018 | s2cid = 9869956 | doi-access = free }}</ref>  They also provide protection against other sexually transmitted infections, such as HIV and ''[[Medicine:Chlamydia infection|Chlamydia]]'', which are associated with greater risks of developing cervical cancer.{{medical citation needed|date=May 2021}}

=== Vaccination ===
Three HPV vaccines ([[Biology:Gardasil|Gardasil]], Gardasil 9, and [[Chemistry:Cervarix|Cervarix]]) reduce the risk of cancerous or precancerous changes of the cervix and perineum by about 93% and 62%, respectively.<ref name="Vaccine09">{{cite journal | vauthors = Medeiros LR, Rosa DD, da Rosa MI, Bozzetti MC, Zanini RR | title = Efficacy of human papillomavirus vaccines: a systematic quantitative review | journal = International Journal of Gynecological Cancer | volume = 19 | issue = 7 | pages = 1166–1176 | date = October 2009 | pmid = 19823051 | doi = 10.1111/IGC.0b013e3181a3d100 | s2cid = 24695684 }}</ref> The vaccines are between 92% and 100% effective against HPV 16 and 18 up to at least 8 years.<ref name=NIHNCIHPV2015/>

HPV vaccines are typically given to age 9 to 26, as the vaccine is most effective if given before infection occurs. The duration of effectiveness and whether a booster will be needed is unknown. The high cost of this vaccine has been a cause for concern. Several countries have considered (or are considering) programs to fund HPV vaccination. The American Society of Clinical Oncology guideline has recommendations for different levels of resource availability.<ref name="Primary Prevention of Cervical Canc"/>

Since 2010, young women in Japan have been eligible to receive the cervical cancer vaccination for free.<ref name="Japan2013">{{cite news|url=http://ajw.asahi.com/article/behind_news/social_affairs/AJ201306150057|title=Health ministry withdraws recommendation for cervical cancer vaccine |date=15 June 2013|newspaper=The Asahi Shimbun|archive-url=https://web.archive.org/web/20130619025016/http://ajw.asahi.com/article/behind_news/social_affairs/AJ201306150057|archive-date=19 June 2013}}</ref> In June 2013, the Japanese Ministry of Health, Labor and Welfare mandated that, before administering the vaccine, medical institutions must inform women that the ministry does not recommend it.<ref name="Japan2013" /> However, the vaccine is still available at no cost to Japanese women who choose to accept the vaccination.<ref name="Japan2013" />

=== Nutrition ===
[[Chemistry:Vitamin A|Vitamin A]] is associated with a lower risk<ref>{{cite journal | vauthors = Zhang X, Dai B, Zhang B, Wang Z | title = Vitamin A and risk of cervical cancer: a meta-analysis | journal = Gynecologic Oncology | volume = 124 | issue = 2 | pages = 366–373 | date = February 2012 | pmid = 22005522 | doi = 10.1016/j.ygyno.2011.10.012 }}</ref> as are [[Biology:Vitamin B12|vitamin B12]], [[Biology:Vitamin C|vitamin C]], [[Chemistry:Vitamin E|vitamin E]], and [[Chemistry:Beta-Carotene|beta-Carotene]].<ref>{{cite journal | vauthors = Myung SK, Ju W, Kim SC, Kim H | title = Vitamin or antioxidant intake (or serum level) and risk of cervical neoplasm: a meta-analysis | journal = BJOG | volume = 118 | issue = 11 | pages = 1285–1291 | date = October 2011 | pmid = 21749626 | doi = 10.1111/j.1471-0528.2011.03032.x | hdl-access = free | s2cid = 38761694 | hdl = 2027.42/86903 }}</ref>

==Treatment==
[[File:Cervical Cryotherapy.png|thumb|Cervical cryotherapy]]
The treatment of cervical cancer varies worldwide, largely due to access to surgeons skilled in radical pelvic surgery and the emergence of fertility-sparing therapy in developed nations. Less advanced stages of cervical cancer typically have treatment options that allow fertility to be maintained if the patient desires.<ref>{{Cite web|title=Cervical Cancer Treatment Options {{!}} Treatment Choices by Stage|url=https://www.cancer.org/cancer/cervical-cancer/treating/by-stage.html|access-date=12 September 2020|website=www.cancer.org}}</ref>

Because cervical cancers are radiosensitive, radiation may be used in all stages where surgical options do not exist. Surgical intervention may have better outcomes than radiological approaches.<ref name="BaalbergenVeenstra2013">{{cite journal | vauthors = Baalbergen A, Veenstra Y, Stalpers L | title = Primary surgery versus primary radiotherapy with or without chemotherapy for early adenocarcinoma of the uterine cervix | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 1 | pages = CD006248 | date = January 2013 | pmid = 23440805 | pmc = 7387233 | doi = 10.1002/14651858.CD006248.pub3 }}</ref> In addition, chemotherapy can be used to treat cervical cancer and is more effective than radiation alone.<ref>{{cite journal | vauthors = Einhorn N, Tropé C, Ridderheim M, Boman K, Sorbe B, Cavallin-Ståhl E | title = A systematic overview of radiation therapy effects in cervical cancer (cervix uteri) | journal = Acta Oncologica | volume = 42 | issue = 5–6 | pages = 546–556 | date = 2003 | pmid = 14596512 | doi = 10.1080/02841860310014660 | doi-access = free }}</ref> Chemoradiotherapy may increase overall survival and reduce the risk of disease recurrence compared to radiotherapy alone.<ref>{{cite journal | title = Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD008285 | date = January 2010 | pmid = 20091664 | pmc = 7105912 | doi = 10.1002/14651858.cd008285 | author1 = Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration (CCCMAC) | volume = 2010 }}</ref>

Precancerous cells (cervical intraepithelial neoplasia) that would lead to cancer and early-stage cervical cancer (IA1) can be treated effectively by various surgical techniques. Surgical treatment methods include excision, where a [[Medicine:Cervical conization|cone-shaped portion]] of the cervix is removed, and ablation which removes only the parts with abnormal tissues. While these effectively reduce the risk of cancer developing or spreading, they cause an increased risk of [[Medicine:Preterm birth|premature birth]] in future pregnancies. Surgical techniques that remove more cervical tissue come with less risk of the cancer recurring but a higher chance of giving birth prematurely. Due to this risk, taking into account the age, childbearing plans of the woman, the size and location of the cancer cells are crucial for choosing the right procedure.<ref name=":1" /><ref name=":2" /> There is low-certainty evidence that peri-operative care approaches, such as 'fast-track surgery' or 'enhanced recovery programmes' may lower surgical stress and improve recovery after gynaecological cancer surgery.<ref>{{cite journal |vauthors=Chau JP, Liu X, Lo SH, Chien WT, Hui SK, Choi KC, Zhao J |date=March 2022 |title=Perioperative enhanced recovery programmes for women with gynaecological cancers |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=3 |pages=CD008239 |doi=10.1002/14651858.CD008239.pub5 |pmc=8922407 |pmid=35289396}}</ref>

Microinvasive cancer (stage IA) may also be treated by [[Biology:Hysterectomy|hysterectomy]] (removal of the whole uterus, including part of the [[Biology:Vagina|vagina]]).<ref>{{cite journal | vauthors = van Nagell JR, Greenwell N, Powell DF, Donaldson ES, Hanson MB, Gay EC | title = Microinvasive carcinoma of the cervix | journal = American Journal of Obstetrics and Gynecology | volume = 145 | issue = 8 | pages = 981–991 | date = April 1983 | pmid = 6837683 | doi = 10.1016/0002-9378(83)90852-9 }}</ref> For stage IA2, the [[Biology:Lymph node|lymph node]]s are removed as well. Alternatives include local surgical procedures such as a [[Medicine:Loop electrical excision procedure|loop electrical excision procedure]] <!-- (LEEP) --> or [[Medicine:Cervical conization|cone biopsy]].<ref>{{cite web | vauthors = Erstad S | title=Cone biopsy (conization) for abnormal cervical cell changes | date=12 January 2007 | website=[[Company:WebMD|WebMD]] | url=http://www.webmd.com/cancer/cervical-cancer/cone-biopsy-conization-for-abnormal-cervical-cell-changes | access-date=2 December 2007 | url-status=live | archive-url=https://web.archive.org/web/20071119114319/http://www.webmd.com/cancer/cervical-cancer/cone-biopsy-conization-for-abnormal-cervical-cell-changes | archive-date=19 November 2007 }}</ref><ref name="LinZhou2017">{{cite journal | vauthors = Lin Y, Zhou J, Dai L, Cheng Y, Wang J | title = Vaginectomy and vaginoplasty for isolated vaginal recurrence 8 years after cervical cancer radical hysterectomy: A case report and literature review | journal = The Journal of Obstetrics and Gynaecology Research | volume = 43 | issue = 9 | pages = 1493–1497 | date = September 2017 | pmid = 28691384 | doi = 10.1111/jog.13375 | s2cid = 42161609 }}</ref> A systematic review concluded that more evidence is needed to inform decisions about different surgical techniques for women with cervical cancer at stage IA2.<ref>{{cite journal | vauthors = Kokka F, Bryant A, Brockbank E, Jeyarajah A | title = Surgical treatment of stage IA2 cervical cancer | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD010870 | date = May 2014 | volume = 2018 | pmid = 24874726 | pmc = 6513277 | doi = 10.1002/14651858.cd010870.pub2 }}</ref>

If a cone biopsy does not produce clear margins<ref name=pmid8244170>{{cite journal | vauthors = Jones WB, Mercer GO, Lewis JL, Rubin SC, Hoskins WJ | title = Early invasive carcinoma of the cervix | journal = Gynecologic Oncology | volume = 51 | issue = 1 | pages = 26–32 | date = October 1993 | pmid = 8244170 | doi = 10.1006/gyno.1993.1241 }}</ref> (findings on biopsy showing that the tumor is surrounded by cancer free tissue, suggesting all of the tumor is removed), one more possible treatment option for women who want to preserve their fertility is a trachelectomy.<ref>{{cite web |url=http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm |title=Trachelectomy |access-date=2 December 2007 | vauthors = Dolson L |year=2001 |archive-url=https://web.archive.org/web/20070927143641/http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm |archive-date=27 September 2007 }}</ref> This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care,<ref name=pmid16493253>{{cite journal | vauthors = Burnett AF | title = Radical trachelectomy with laparoscopic lymphadenectomy: review of oncologic and obstetrical outcomes | journal = Current Opinion in Obstetrics & Gynecology | volume = 18 | issue = 1 | pages = 8–13 | date = February 2006 | pmid = 16493253 | doi = 10.1097/01.gco.0000192968.75190.dc | s2cid = 22958941 }}</ref> as few doctors are skilled in this procedure. Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown. If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the woman is under general anaesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the woman consented. Due to the possible risk of cancer spreading to the lymph nodes in stage 1B cancers and some stage 1A cancers, the surgeon may also need to remove some lymph nodes from around the uterus for pathologic evaluation.{{citation needed|date=September 2017}}

A radical trachelectomy can be performed abdominally<ref name=pmid15918265>{{cite journal | vauthors = Cibula D, Ungár L, Svárovský J, Zivný J, Freitag P | title = [Abdominal radical trachelectomy--technique and experience] | language = cs | journal = Ceska Gynekologie | volume = 70 | issue = 2 | pages = 117–122 | date = March 2005 | pmid = 15918265 }}</ref> or vaginally<ref name=pmid15936061>{{cite journal | vauthors = Plante M, Renaud MC, Hoskins IA, Roy M | title = Vaginal radical trachelectomy: a valuable fertility-preserving option in the management of early-stage cervical cancer. A series of 50 pregnancies and review of the literature | journal = Gynecologic Oncology | volume = 98 | issue = 1 | pages = 3–10 | date = July 2005 | pmid = 15936061 | doi = 10.1016/j.ygyno.2005.04.014 }}</ref> and opinions are conflicting as to which is better.<ref name=pmid8812529>{{cite journal | vauthors = Roy M, Plante M, Renaud MC, Têtu B | title = Vaginal radical hysterectomy versus abdominal radical hysterectomy in the treatment of early-stage cervical cancer | journal = Gynecologic Oncology | volume = 62 | issue = 3 | pages = 336–339 | date = September 1996 | pmid = 8812529 | doi = 10.1006/gyno.1996.0245 }}</ref> A radical abdominal trachelectomy with lymphadenectomy usually only requires a two- to three-day hospital stay, and most women recover very quickly (about six weeks). Complications are uncommon, although women who can conceive after surgery are susceptible to preterm labour and possible late miscarriage.<ref name=pmid10760765>{{cite journal | vauthors = Dargent D, Martin X, Sacchetoni A, Mathevet P | title = Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients | journal = Cancer | volume = 88 | issue = 8 | pages = 1877–1882 | date = April 2000 | pmid = 10760765 | doi = 10.1002/(SICI)1097-0142(20000415)88:8<1877::AID-CNCR17>3.0.CO;2-W | doi-access = free }}</ref> A wait of at least one year is generally recommended before attempting to become pregnant after surgery.<ref name=pmid12548192>{{cite journal | vauthors = Schlaerth JB, Spirtos NM, Schlaerth AC | title = Radical trachelectomy and pelvic lymphadenectomy with uterine preservation in the treatment of cervical cancer | journal = American Journal of Obstetrics and Gynecology | volume = 188 | issue = 1 | pages = 29–34 | date = January 2003 | pmid = 12548192 | doi = 10.1067/mob.2003.124 }}</ref> Recurrence in the residual cervix is rare if the trachelectomy has cleared the cancer.<ref name=pmid16493253/> Yet, women are recommended to practice vigilant prevention and follow-up care, including Pap screenings/colposcopy, with biopsies of the remaining lower uterine segment as needed (every 3–4 months for at least 5 years) to monitor for any recurrence in addition to minimizing any new exposures to HPV through safe sex practices until one is actively trying to conceive.{{citation needed|date=September 2017}}

Early stages (IB1 and IIA less than 4&nbsp;cm) can be treated with radical hysterectomy with removal of the lymph nodes or [[Physics:Radiation therapy|radiation therapy]]. Radiation therapy is given as external beam radiotherapy to the pelvis and [[Medicine:Brachytherapy|brachytherapy]] (internal radiation). Women treated with surgery who have high-risk features found on pathologic examination are given radiation therapy with or without chemotherapy to reduce the risk of relapse.{{citation needed|date=September 2017}}  A Cochrane review has found moderate-certainty evidence that radiation decreases the risk of disease progression in people with stage IB cervical cancer, when compared to no further treatment.<ref name = "Rogers_2012">{{cite journal | vauthors = Rogers L, Siu SS, Luesley D, Bryant A, Dickinson HO | title = Radiotherapy and chemoradiation after surgery for early cervical cancer | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD007583 | date = May 2012 | volume = 5 | pmid = 22592722 | pmc = 4171000 | doi = 10.1002/14651858.cd007583.pub3 }}</ref> However, little evidence was found on its effects on overall survival.<ref name = "Rogers_2012" />
[[File:Diagram showing the position of the applicators for internal radiotherapy for cervical cancer CRUK 344.svg|thumb|right|Brachytherapy for cervical cancer]]

Larger early-stage tumors (IB2 and IIA more than 4&nbsp;cm) may be treated with radiation therapy and [[Biology:Cisplatin|cisplatin]]-based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or cisplatin chemotherapy followed by hysterectomy. When cisplatin is present, it is thought to be the most active single agent in periodic diseases.<ref>{{cite journal | vauthors = Waggoner SE | title = Cervical cancer | journal = Lancet | volume = 361 | issue = 9376 | pages = 2217–2225 | date = June 2003 | pmid = 12842378 | doi = 10.1016/S0140-6736(03)13778-6 | s2cid = 24115541 }}</ref> Such addition of platinum-based chemotherapy to chemoradiation seems not only to improve survival but also reduces risk of recurrence in women with early stage cervical cancer (IA2–IIA).<ref>{{cite journal | vauthors = Falcetta FS, Medeiros LR, Edelweiss MI, Pohlmann PR, Stein AT, Rosa DD | title = Adjuvant platinum-based chemotherapy for early stage cervical cancer | journal = The Cochrane Database of Systematic Reviews | volume = 11 | pages = CD005342 | date = November 2016 | issue = 11 | pmid = 27873308 | pmc = 4164460 | doi = 10.1002/14651858.CD005342.pub4 }}</ref> A Cochrane review found a lack of evidence on the benefits and harms of primary hysterectomy compared to primary chemoradiotherapy for cervical cancer in stage IB2.<ref>{{cite journal | vauthors = Nama V, Angelopoulos G, Twigg J, Murdoch JB, Bailey J, Lawrie TA | title = Type II or type III radical hysterectomy compared to chemoradiotherapy as a primary intervention for stage IB2 cervical cancer | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 10 | pages = CD011478 | date = October 2018 | pmid = 30311942 | pmc = 6516889 | doi = 10.1002/14651858.cd011478.pub2 }}</ref>

Advanced-stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy. On 15 June 2006, the US [[Organization:Food and Drug Administration|Food and Drug Administration]] approved the use of a combination of two chemotherapy drugs, hycamtin and cisplatin, for women with late-stage (IVB) cervical cancer treatment.<ref>{{cite news | title=FDA Approves First Drug Treatment for Late-Stage Cervical Cancer | date=15 June 2006 | publisher=[[Organization:Food and Drug Administration|U.S. Food and Drug Administration]] | url=https://www.fda.gov/bbs/topics/NEWS/2006/NEW01391.html | access-date=2 December 2007 | url-status=live | archive-url=https://web.archive.org/web/20071010035641/https://www.fda.gov/bbs/topics/NEWS/2006/NEW01391.html | archive-date=10 October 2007 }}</ref> Combination treatment has significant risk of [[Medicine:Neutropenia|neutropenia]], [[Medicine:Anemia|anemia]], and [[Medicine:Thrombocytopenia|thrombocytopenia]] side effects.<ref>{{cite journal | vauthors = Moon JY, Song IC, Ko YB, Lee HJ | title = The combination of cisplatin and topotecan as a second-line treatment for patients with advanced/recurrent uterine cervix cancer | journal = Medicine | volume = 97 | issue = 14 | pages = e0340 | date = April 2018 | pmid = 29620661 | pmc = 5902288 | doi = 10.1097/MD.0000000000010340 }}</ref>

There is insufficient evidence whether anticancer drugs after standard care help women with locally advanced cervical cancer to live longer.<ref>{{cite journal | vauthors = Tangjitgamol S, Katanyoo K, Laopaiboon M, Lumbiganon P, Manusirivithaya S, Supawattanabodee B | title = Adjuvant chemotherapy after concurrent chemoradiation for locally advanced cervical cancer | journal = The Cochrane Database of Systematic Reviews | issue = 12 | pages = CD010401 | date = December 2014 | volume = 2019 | pmid = 25470408 | pmc = 6402532 | doi = 10.1002/14651858.cd010401.pub2 }}</ref>

For surgery to be curative, the entire cancer must be removed with no cancer found at the margins of the removed tissue on examination under a microscope.<ref name="Sar2015" /> This procedure is known as exenteration.<ref name="Sar2015">{{cite journal | vauthors = Sardain H, Lavoue V, Redpath M, Bertheuil N, Foucher F, Levêque J | title = Curative pelvic exenteration for recurrent cervical carcinoma in the era of concurrent chemotherapy and radiation therapy. A systematic review | journal = European Journal of Surgical Oncology | volume = 41 | issue = 8 | pages = 975–985 | date = August 2015 | pmid = 25922209 | doi = 10.1016/j.ejso.2015.03.235 | s2cid = 21911045 | url = https://hal-univ-rennes1.archives-ouvertes.fr/hal-01147372/file/Curative%20Pelvic%20Exenteration%20For%20Recurrent%20Cervical.pdf }}</ref>

No evidence is available to suggest that any form of follow‐up approach is better or worse in terms of prolonging survival, improving quality of life or guiding the management of problems that can arise because of the treatment and that in the case of radiotherapy treatment worsen with time.<ref>{{cite journal | vauthors = Lanceley A, Fiander A, McCormack M, Bryant A | title = Follow-up protocols for women with cervical cancer after primary treatment | journal = The Cochrane Database of Systematic Reviews | issue = 11 | pages = CD008767 | date = November 2013 | volume = 2014 | pmid = 24277645 | doi = 10.1002/14651858.CD008767.pub2 | pmc = 8969617 | collaboration = Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group }}</ref> A 2019 review found no controlled trials regarding the efficacy and safety of interventions for vaginal bleeding in women with advanced cervical cancer.<ref>{{cite journal | vauthors = Eleje GU, Eke AC, Igberase GO, Igwegbe AO, Eleje LI | title = Palliative interventions for controlling vaginal bleeding in advanced cervical cancer | journal = The Cochrane Database of Systematic Reviews | volume = 3 | issue = 3 | pages = CD011000 | date = March 2019 | pmid = 30888060 | pmc = 6423555 | doi = 10.1002/14651858.cd011000.pub3 }}</ref>

[[Chemistry:Tisotumab vedotin|Tisotumab vedotin]] (Tivdak) was approved for medical use in the United States in September 2021.<ref name="Tivdak FDA label">{{Cite web|url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/761208s000lbl.pdf|title=Enforcement Reports|access-date=21 September 2021|archive-date=21 September 2021|archive-url=https://web.archive.org/web/20210921051657/https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/761208s000lbl.pdf}}</ref><ref name="Seagen PR">{{cite web | title=Seagen and Genmab Announce FDA Accelerated Approval for Tivdak (tisotumab vedotin-tftv) in Previously Treated Recurrent or Metastatic Cervical Cancer | publisher=Seagen | via=Business Wire | date=20 September 2021 | url=https://www.businesswire.com/news/home/20210920005921/en/ | access-date=20 September 2021}}</ref>

<gallery>
File:Diagram showing the area removed with a posterior exenteration for cancer of the cervix CRUK 288.svg|Diagram showing the area removed with a posterior surgery
File:Diagram showing the area removed with a total exenteration operation for cancer of the cervix CRUK 289.svg|Diagram showing the area removed with a total operation
File:Diagram showing the area removed with an anterior exenteration operation for cancer of the cervix CRUK 290.svg|Diagram showing the area removed with an anterior operation
</gallery>

==Prognosis==

===Stage===
Prognosis depends on the stage of the cancer. For intraepithelial cervical neoplasmas the prognosis is good.<ref>{{cite book | vauthors = Mello V, Sundstrom RK | chapter = Cervical Intraepithelial Neoplasia. | title = StatPearls [Internet] | location = Treasure Island (FL) | publisher = StatPearls Publishing | date = January 2022 | pmid = 31335091 | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK544371/ }}</ref>  With treatment, the five-year relative survival rate for the earliest stage of invasive cervical cancer is 92%, and the overall (all stages combined) five-year survival rate is about 66%. These statistics may be improved when applied to women newly diagnosed, bearing in mind that these outcomes may be partly based on the state of treatment five years ago when the women studied were first diagnosed.<ref name="ACS Key Stats">{{cite web|url=https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/survival.html|title=Survival Rates for Cervical Cancer |access-date=27 February 2022 |date=January 3, 2020|publisher=American Cancer Society |archive-url = https://web.archive.org/web/20220227182815/https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/survival.html|archive-date = 27 February 2022}}</ref>

With treatment, 80–90% of women with stage I cancer and 60–75% of those with stage II cancer are alive 5 years after diagnosis. Survival rates decrease to 58% for women with stage III cancer and 17% or fewer of those with stage IV cancer five years after diagnosis.<ref name="ACS Key Stats" /> Recurrent cervical cancer detected at its earliest stages might be successfully treated with surgery, radiation, chemotherapy, or a combination of the three. About 35% of women with invasive cervical cancer have persistent or recurrent disease after treatment.<ref name=AMN>{{cite web | title=Cervical Cancer | work=Cervical Cancer: Pathology, Symptoms and Signs, Diagnosis, Prognosis and Treatment | url=http://www.health.am/cr/cervical-cancer/ | publisher=Armenian Health Network, Health.am | url-status=live | archive-url=https://web.archive.org/web/20070207232901/http://www.health.am/cr/cervical-cancer/ | archive-date=7 February 2007 }}</ref>

===By country===
Five-year survival in the United States for [[Biography:White people|White women]] is 69% and for [[Biography:Black people|Black women]] is 57%.{{update after|2021|3|16}}<ref>{{Cite news|url=http://www.cancer.net/cancer-types/cervical-cancer/statistics|title=Cervical Cancer: Statistics {{!}} Cancer.Net|date=25 June 2012|work=Cancer.Net|access-date=27 August 2017|url-status=live|archive-url=https://web.archive.org/web/20170827172807/http://www.cancer.net/cancer-types/cervical-cancer/statistics|archive-date=27 August 2017}}</ref>

Regular screening has meant that precancerous changes and early-stage cervical cancers have been detected and treated early. Figures suggest that cervical screening is saving 5,000 lives each year in the UK by preventing cervical cancer.<ref name=chelp>{{cite web | title=Cervical cancer statistics and prognosis | url=http://www.cancerhelp.org.uk/help/default.asp?page=9260 | publisher=Cancer Research UK | access-date=24 March 2007 | archive-url=https://web.archive.org/web/20070520092010/http://www.cancerhelp.org.uk/help/default.asp?page=9260 | archive-date=20 May 2007 }}</ref>
About 1,000 women per year die of cervical cancer in the UK.  All of the [[Place:Nordic countries|Nordic countries]] have cervical cancer-screening programs in place.<ref name=Nygard2011>{{cite journal | vauthors = Nygård M | title = Screening for cervical cancer: when theory meets reality | journal = BMC Cancer | volume = 11 | page = 240 | date = June 2011 | pmid = 21668947 | pmc = 3146446 | doi = 10.1186/1471-2407-11-240 | doi-access = free }}</ref> The Pap test was integrated into clinical practice in the Nordic countries in the 1960s.<ref name=Nygard2011/>

In Africa outcomes are often worse as diagnosis is frequently at a latter stage of disease.<ref>{{cite journal | vauthors = Muliira RS, Salas AS, O'Brien B | title = Quality of Life among Female Cancer Survivors in Africa: An Integrative Literature Review | journal = Asia-Pacific Journal of Oncology Nursing | volume = 4 | issue = 1 | pages = 6–17 | date = 2016 | pmid = 28217724 | pmc = 5297234 | doi = 10.4103/2347-5625.199078 | doi-access = free }}</ref> In a scoping review of publicly-available cervical cancer prevention and control plans from African countries, plans tended to emphasize survivorship rather than early HPV diagnosis and prevention.<ref>{{Cite journal| vauthors = Dutta T, Meyerson B, Agley J |date=2018|title=African cervical cancer prevention and control plans: A scoping review|journal=Journal of Cancer Policy|volume=16|pages=73–81|doi=10.1016/j.jcpo.2018.05.002|s2cid=81552501}}</ref>

==Epidemiology==
[[File:Cervix uteri cancer world map - Death - WHO2004.svg|thumb|upright=1.3|[[Age adjustment|Age-standardized]] death from cervical cancer per 100,000&nbsp;inhabitants in 2004<ref>{{cite web |url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2009 |publisher=World Health Organization |access-date=11 November 2009 |url-status=live |archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |archive-date=11 November 2009 }}</ref>
{{Col-begin}}
{{Col-break}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|<2.4}}
{{legend|#fff200|2.4–4.8}}
{{legend|#ffdc00|4.8–7.2}}
{{legend|#ffc600|7.2–9.6}}
{{legend|#ffb000|9.6–12}}
{{legend|#ff9a00|12–14.4}}
{{Col-break}}
{{legend|#ff8400|14.4–16.8}}
{{legend|#ff6e00|16.8–19.2}}
{{legend|#ff5800|19.2–21.6}}
{{legend|#ff4200|21.6–24}}
{{legend|#ff2c00|24–26.4}}
{{legend|#cb0000|>26.4}}
{{col-end}}
]]

Worldwide, cervical cancer is both the fourth-most common cause of cancer and deaths from cancer in women.<ref name=WCR2014/> In 2018, 570,000 cases of cervical cancer were estimated to have occurred, with over 300,000 deaths.<ref>{{Cite web|url=https://www.who.int/en/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer|title=WHO Fact Sheet on HPV and Cervical Cancer|date=24 January 2018|website=World Health Organization|access-date=4 June 2019}}</ref> It is the second-most common cause of female-specific cancer after [[Medicine:Breast cancer|breast cancer]], accounting for around 8% of both total cancer cases and total cancer deaths in women.<ref name=WCR2014Total/> About 80% of cervical cancers occur in developing countries.<ref name=Kent2010>{{cite journal | vauthors = Kent A | title = HPV Vaccination and Testing | journal = Reviews in Obstetrics & Gynecology | volume = 3 | issue = 1 | pages = 33–34 | date = Winter 2010 | pmid = 20508781 | pmc = 2876324 }}</ref> It is the most frequently detected cancer during pregnancy, with an occurrence of 1.5 to 12 for every 100,000 pregnancies.<ref name=CordeiroGemignani2017>{{cite journal | vauthors = Cordeiro CN, Gemignani ML | title = Gynecologic Malignancies in Pregnancy: Balancing Fetal Risks With Oncologic Safety | journal = Obstetrical & Gynecological Survey | volume = 72 | issue = 3 | pages = 184–193 | date = March 2017 | pmid = 28304416 | pmc = 5358514 | doi = 10.1097/OGX.0000000000000407 }}</ref>

===Australia===
In 2022, it is estimated that 942 new cases of cervical cancer will be diagnosed in Australia. In 2022, it is estimated that a female has a 1 in 180 (or 0.56%) risk of being diagnosed with cervical cancer by the age of 85.<ref>{{Cite web |date=18 August 2022 |title=Cervical cancer in Australia statistics |url=https://www.canceraustralia.gov.au/cancer-types/cervical-cancer/statistics |access-date=21 January 2023 |website=Australian Government- Cancer Australia}}</ref>

In 2020, there were 165 women aged 25–74 who died from cervical cancer, which is a mortality rate of 2 deaths per 100,000 women in the population. Over the 5 years 2016–2020, there were 62 Aboriginal and Torres Strait Islander women aged 25–74 who died from cervical cancer, which is a mortality rate of 7 deaths per 100,000 Indigenous women in the population. Over the 5 years 2016–2020, the age-standardised mortality rate among Aboriginal and Torres Strait Islander women was 3.8 times the rate of non-Indigenous Australians.<ref>{{Cite web |title=National Cervical Screening Program monitoring report 2022, Summary |url=https://www.aihw.gov.au/reports/cancer-screening/ncsp-monitoring-2022/summary |access-date=2023-01-21 |website=Australian Institute of Health and Welfare |date=December 2022 |language=en-AU}}</ref>

The number of women diagnosed with cervical cancer has dropped on average by 4.5% each year since organised screening began in 1991 (1991–2005).<ref>{{cite web|url=  http://www.papscreen.org.au/browse.asp?ContainerID=c15|title=  Incidence and mortality rates|date= January 1900|url-status=  live|archive-url=  https://web.archive.org/web/20090912091409/http://www.papscreen.org.au/browse.asp?ContainerID=c15|archive-date=12 September 2009}}</ref> Regular twice-yearly Pap tests can reduce the incidence of cervical cancer up to 90% in Australia, and save 1,200 Australian women from dying from the disease each year.<ref>{{cite web |url=http://www.papscreen.org.au/ |title = Papscreen Victoria |access-date=7 March 2011 |url-status=live |archive-url=https://web.archive.org/web/20110314211744/http://www.papscreen.org.au/ |archive-date=14 March 2011 }}</ref>  It is predicted that because of the success of the primary HPV testing programme there will be fewer than four new cases per 100 000 women annually by 2028.<ref name="pmid30291040">{{cite journal | vauthors = Hall MT, Simms KT, Lew JB, Smith MA, Brotherton JM, Saville M, Frazer IH, Canfell K | title = The projected timeframe until cervical cancer elimination in Australia: a modelling study | journal = The Lancet. Public Health | volume = 4 | issue = 1 | pages = e19–e27 | date = January 2019 | pmid = 30291040 | doi = 10.1016/S2468-2667(18)30183-X | s2cid = 52924713 | doi-access = free }}</ref>

=== Canada ===
An estimated 1,450 Canadians will be diagnosed with cervical cancer in 2022. An estimated 380 will die from it.<ref>{{Cite web |date=May 2022 |title=Cervical Cancer statistics |url=https://cancer.ca/en/cancer-information/cancer-types/cervical/statistics |access-date=21 January 2023 |website=Canadian Cancer Society}}</ref>

=== India ===
In India, the number of people with cervical cancer is rising, but overall the age-adjusted rates are decreasing.<ref>National Cancer Registry Programme under Indian Council of Medical Research Reports</ref><ref>https://www.plunes.com/</ref> Usage of condoms in the female population has improved the survival of women with cancers of the cervix.<ref>{{cite journal | vauthors = Krishnatreya M, Kataki AC, Sharma JD, Nandy P, Gogoi G | title = Association of educational levels with survival in Indian patients with cancer of the uterine cervix | journal = Asian Pacific Journal of Cancer Prevention | volume = 16 | issue = 8 | pages = 3121–3123 | date = 2015 | pmid = 25921107 | doi = 10.7314/apjcp.2015.16.8.3121 | doi-access = free }}</ref>

=== European Union ===
As of 2022, the World Health Organization announced that "each year in the WHO European Region more than 66 000 women are newly diagnosed with cervical cancer and more than 30 000 die from this preventable disease."<ref>{{Cite web |title=The cancer we can eliminate – WHO/Europe urges Member States to consign cervical cancer to history |url=https://www.who.int/europe/news/item/12-09-2022-the-cancer-we-can-eliminate---who-europe-urges-member-states-to-consign-cervical-cancer-to-history |access-date=2023-01-21 |website=www.who.int |language=en}}</ref>

=== United Kingdom ===
Cervical cancer is the 12th-most common cancer in women in the UK (around 3,100 women were diagnosed with the disease in 2011), and accounts for 1% of cancer deaths (around 920 died in 2012).<ref>{{cite web|title=Cervical cancer statistics |url=http://www.cancerresearchuk.org/cancer-info/cancerstats/types/cervix/|website=Cancer Research UK|access-date=27 October 2014|url-status=live|archive-url=https://web.archive.org/web/20141007131242/http://www.cancerresearchuk.org/cancer-info/cancerstats/types/cervix/ |archive-date=7 October 2014}}</ref> With a 42% reduction from 1988 to 1997, the NHS-implemented screening programme has been highly successful, screening the highest-risk age group (25–49 years) every 3 years, and those ages 50–64 every 5 years.{{citation needed|date=May 2021}}

===United States===
An estimated 13,170 new cervical cancers and 4,250 cervical cancer deaths will occur in the United States in 2019.<ref>{{Cite web|url=https://seer.cancer.gov/statfacts/html/cervix.html|title=Cancer Stat Facts: Cervical Cancer|website=National Cancer Institute SEER Program|access-date=4 June 2019}}</ref> The median age at diagnosis is 50. The rates of new cases in the United States was 7.3 per 100,000 women, based on rates from 2012 to 2016. Cervical cancer deaths decreased by approximately 74% in the last 50 years, largely due to widespread Pap test screening.<ref name=Armstrong10>{{cite journal | vauthors = Armstrong EP | title = Prophylaxis of cervical cancer and related cervical disease: a review of the cost-effectiveness of vaccination against oncogenic HPV types | journal = Journal of Managed Care Pharmacy | volume = 16 | issue = 3 | pages = 217–230 | date = April 2010 | pmid = 20331326 | doi = 10.18553/jmcp.2010.16.3.217 | pmc = 10437588 | s2cid = 14373353 }}</ref> The annual direct medical cost of cervical cancer prevention and treatment prior to introduction of the HPV vaccine was estimated at $6&nbsp;billion.<ref name=Armstrong10/>

=== Nigeria ===
The Nigerian Institute of Medical Research (NIMR) reports that 28 Nigerian women lose their lives daily due to this disease. This alarming statistic underscores the pressing need for better awareness, prevention, and treatment efforts across the country. Numerous Nigerian women lack access to these preventive measures. In many regions of the country, screening tests such as Pap tests and HPV tests are not easily accessible or affordable<ref>{{Cite web |date=2023-04-04 |title=Eliminating Cervical Cancer in Nigeria: How Awareness, Infrastructure, and Government Support Can Make a Difference - My Daily News Usa |url=https://mydailynewsusa.com/eliminating-cervical-cancer-in-nigeria-how-awareness-infrastructure-and-government-support-can-make-a-difference/ |access-date=2023-04-15 |language=en-US}}</ref><ref>{{Cite web| vauthors = Sahana DU |date=2023-04-04 |title=Eliminating Cervical Cancer in Nigeria: How Awareness, Infrastructure, and Government Support Can Make a Difference |url=https://mydailynewsusa.com/eliminating-cervical-cancer-in-nigeria-how-awareness-infrastructure-and-government-support-can-make-a-difference/ |access-date=2023-04-15 |website=My Daily News Usa}}</ref>

==History==
* 400 BCE: [[Biography:Hippocrates|Hippocrates]] noted that cervical cancer was incurable.<!--{{Cn}}-->
* 1925: Hinselmann invented the colposcope.<!--{{Cn}}-->
* 1928: Papanicolaou developed the Papanicolaou technique.<!--{{Cn}}-->
* 1941: Papanicolaou and Traut: [[Engineering:Pap test|Pap test]] screening began.<!--{{Cn}}-->
* 1946: Aylesbury spatula was developed to scrape the cervix, collecting the sample for the Pap test.<!--{{Cn}}-->
* 1951: First successful in-vitro cell line, [[Biology:HeLa|HeLa]], derived from biopsy of cervical cancer of Henrietta Lacks.<!--{{Cn}}-->
* 1976: [[Biography:Harald zur Hausen|Harald zur Hausen]] and Gisam found HPV DNA in cervical cancer and genital warts; Hausen later won the Nobel Prize for his work.<ref name=zur2002>{{cite journal |vauthors=zur Hausen H |title=Papillomaviruses and cancer: from basic studies to clinical application |journal=Nature Reviews. Cancer |volume=2 |issue=5 |pages=342–350 |date=May 2002 |pmid=12044010 |doi=10.1038/nrc798 |s2cid=4991177|doi-access=free }}</ref>
* 1988: Bethesda System for reporting Pap results was developed.<!--{{Cn}}-->
* 2006: First [[Medicine:HPV vaccine|HPV vaccine]] was approved by the FDA.<!--{{Cn}}-->
* 2015: HPV Vaccine shown to protect against infection at multiple body sites.<ref>{{cite journal |vauthors=Beachler DC, Kreimer AR, Schiffman M, Herrero R, Wacholder S, Rodriguez AC, Lowy DR, Porras C, Schiller JT, Quint W, Jimenez S, Safaeian M, Struijk L, Schussler J, Hildesheim A, Gonzalez P |display-authors=6 |title=Multisite HPV16/18 Vaccine Efficacy Against Cervical, Anal, and Oral HPV Infection |journal=Journal of the National Cancer Institute |volume=108 |issue=1 |pages=djv302 |date=January 2016 |pmid=26467666 |pmc=4862406 |doi=10.1093/jnci/djv302}}</ref>
* 2018: Evidence for single-dose protection with HPV vaccine.<ref>{{cite journal |vauthors = Kreimer AR, Herrero R, Sampson JN, Porras C, Lowy DR, Schiller JT, Schiffman M, Rodriguez AC, Chanock S, Jimenez S, Schussler J, Gail MH, Safaeian M, Kemp TJ, Cortes B, Pinto LA, Hildesheim A, Gonzalez P |display-authors=6 |title=Evidence for single-dose protection by the bivalent HPV vaccine-Review of the Costa Rica HPV vaccine trial and future research studies |journal=Vaccine |volume=36 |issue=32 Pt A |pages=4774–4782 |date=August 2018 |pmid=29366703 |pmc=6054558 |doi=10.1016/j.vaccine.2017.12.078 }}</ref>

[[Social:Epidemiology|Epidemiologists]] working in the early 20th century noted that cervical cancer behaved like a sexually transmitted disease. In summary:
<!--three of the following statements are unsourced, but it is not necessary to tag everything-->
# Cervical cancer was noted to be common in female sex workers.
# It was rare in [[Philosophy:Nun|nun]]s, except for those who had been sexually active before entering the convent (Rigoni in 1841).
# It was more common in the second wives of men whose first wives had died from cervical cancer.
# It was rare in Jewish women.<ref name=pmid12674663>{{cite journal |vauthors=Menczer J |title=The low incidence of cervical cancer in Jewish women: has the puzzle finally been solved? |journal=The Israel Medical Association Journal |volume=5 |issue=2 |pages=120–123 |date=February 2003 |pmid=12674663 |url=http://www.ima.org.il/IMAJ/ViewArticle.aspx?year=2003&month=02&page=120 |access-date=28 November 2015 |url-status=live |archive-url=https://web.archive.org/web/20151208145603/http://www.ima.org.il/IMAJ/ViewArticle.aspx?year=2003&month=02&page=120 |archive-date=8 December 2015 }}</ref>
# In 1935, Syverton and Berry discovered a relationship between RPV (Rabbit Papillomavirus) and skin cancer in [[Biology:Rabbit|rabbit]]s.<ref>{{cite journal |last1=Syverton |first1=J. T. |last2=Berry |first2= G. P. |title=Carcinoma in the Cottontail Rabbit Following Spontaneous Virus Papilloma (Shope) |journal=Experimental Biology and Medicine |date=1935 |volume=33 |issue=3 |pages=399-400 |doi=10.3181/00379727-33-8386P}}</ref> (HPV is species-specific and therefore cannot be transmitted to rabbits).<ref>{{cite book |title=Human Papillomaviruses |date=2007 |location=Lyon, France|url=https://www.ncbi.nlm.nih.gov/books/NBK321758/ |chapter=Studies of Animal Papillomaviruses |volume=90 |last=IARC Working Group on the Evaluation of Carcinogenic Risks to Humans |series=IARC Monographs on the Evaluation of Carcinogenic Risks to Humans}}</ref>

These historical observations suggested that cervical cancer could be caused by a sexually transmitted agent. Initial research in the 1940s and 1950s attributed cervical cancer to [[Biology:Smegma|smegma]].<ref name=Heins1958>{{cite journal | vauthors = Heins HC, Dennis EJ, Pratthomas HR | title = The possible role of smegma in carcinoma of the cervix | journal = American Journal of Obstetrics and Gynecology | volume = 76 | issue = 4 | pages = 726–33; discussion 733–5 | date = October 1958 | pmid = 13583012 | doi = 10.1016/0002-9378(58)90004-8 }}</ref> During the 1960s and 1970s it was suspected that infection with herpes simplex virus was the cause of the disease. In summary, HSV was seen as a likely cause because it is known to survive in the female reproductive tract, to be transmitted sexually in a way compatible with known risk factors, such as promiscuity and low socioeconomic status.<ref name=pmid4352386>{{cite journal | vauthors = Alexander ER | title = Possible etiologies of cancer of the cervix other than herpesvirus | journal = Cancer Research | volume = 33 | issue = 6 | pages = 1485–1490 | date = June 1973 | pmid = 4352386 }}</ref> Herpes viruses were also implicated in other malignant diseases, including Burkitt's lymphoma, Nasopharyngeal carcinoma, [[Biology:Marek's disease|Marek's disease]] and the Lucké renal adenocarcinoma. HSV was recovered from cervical tumour cells.{{citation needed|date=January 2023}}

A description of human papillomavirus (HPV) by [[Physics:Electron microscopy|electron microscopy]] was given in 1949, and HPV-DNA was identified in 1963.<ref>{{Cite book|url=https://books.google.com/books?id=IS84In6aguYC&pg=PA6|title=Human Papillomavirus: A Practical Guide for Urologists| vauthors = Rosenblatt A, de Campos Guidi HG |date=6 August 2009|publisher=Springer Science & Business Media|isbn=978-3-540-70974-9}}</ref> It was not until the 1980s that HPV was identified in cervical cancer tissue.<ref name=pmid6304740>{{cite journal | vauthors = Dürst M, Gissmann L, Ikenberg H, zur Hausen H | title = A papillomavirus DNA from a cervical carcinoma and its prevalence in cancer biopsy samples from different geographic regions | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 80 | issue = 12 | pages = 3812–3815 | date = June 1983 | pmid = 6304740 | pmc = 394142 | doi = 10.1073/pnas.80.12.3812 | doi-access = free | bibcode = 1983PNAS...80.3812D }}.</ref>  It has since been demonstrated that HPV is implicated in virtually all cervical cancers.<ref name=pmid16670757>{{cite journal | vauthors = Lowy DR, Schiller JT | title = Prophylactic human papillomavirus vaccines | journal = The Journal of Clinical Investigation | volume = 116 | issue = 5 | pages = 1167–1173 | date = May 2006 | pmid = 16670757 | pmc = 1451224 | doi = 10.1172/JCI28607 }}</ref> Specific viral subtypes implicated are HPV 16, 18, 31, 45 and others.<!--{{cn}}-->

In work that was initiated in the mid-1980s, the HPV vaccine was developed, in parallel, by researchers at Georgetown University Medical Center, the [[Organization:University of Rochester|University of Rochester]], the University of Queensland in Australia, and the U.S. [[Organization:National Cancer Institute|National Cancer Institute]].<ref>{{cite journal |vauthors=McNeil C |title=Who invented the VLP cervical cancer vaccines? |journal=Journal of the National Cancer Institute |volume=98 |issue=7 |page=433 |date=April 2006 |pmid=16595773 |doi=10.1093/jnci/djj144 |doi-access=free}}</ref> In 2006, the U.S. Food and Drug Administration (FDA) approved the first preventive HPV vaccine, marketed by Merck & Co. under the trade name Gardasil.{{citation needed|date=January 2023}}

In November 2020, the [[Organization:World Health Organization|World Health Organization]], under backing from the [[Organization:World Health Assembly|World Health Assembly]], set out a strategy to eliminate cervical cancer by 2050. The strategy involves vaccinating 90% of girls by the age of 15, screening 70% of women by the age of 35 and again by the age of 45, and treating 90% of women identified with cervical disease.<ref>{{Cite web |date=16 November 2020 |title=WHO rolls out plan to rid world of cervical cancer, saving millions of lives |url=https://news.un.org/en/story/2020/11/1077752 |access-date=27 November 2020 |website=UN News}}</ref>

==Society and culture==
===Australia===
In Australia, Aboriginal women are more than five times more likely to die from cervical cancer than non-Aboriginal women, suggesting that Aboriginal women are less likely to have regular Pap tests.<ref name=CSP>{{cite web | author = Cancer Institute NSW | publisher = NSW Government | archive-url = https://web.archive.org/web/20130411015842/http://www.csp.nsw.gov.au/aboriginal | archive-date = 11 April 2013 | url = http://www.csp.nsw.gov.au/aboriginal | title = Information about cervical screening for Aboriginal women | year = 2013 }}</ref> There are several factors that may limit indigenous women from engaging in regular cervical screening practices, including sensitivity in discussing the topic in Aboriginal communities, embarrassment, anxiety and fear about the procedure.<ref name=SciNetwork2011>{{cite web | vauthors = Romano MA | publisher = Science Network Western Australia | archive-url = https://web.archive.org/web/20130514223512/http://www.sciencewa.net.au/topics/health-a-medicine/item/995-aboriginal-cervical-cancer-rates-parallel-health-inequity.html | archive-date = 14 May 2013 | url = http://www.sciencewa.net.au/topics/health-a-medicine/item/995-aboriginal-cervical-cancer-rates-parallel-health-inequity.html | title = Aboriginal cervical cancer rates parallel health inequity | date = 17 October 2011 }}</ref> Difficulty in accessing screening services (for example, transport difficulties) and a lack of female GPs, trained Pap test providers and trained female Aboriginal Health Workers are also issues.<ref name=SciNetwork2011/>

The Australian Cervical Cancer Foundation (ACCF), founded in 2008, promotes 'women's health by eliminating cervical cancer and enabling treatment for women with cervical cancer and related health issues, in Australia and in developing countries.'<ref name=ACCFVision>{{cite web | author = Australian Cervical Cancer Foundation | publisher = Australian Cervical Cancer Foundation | archive-url = https://web.archive.org/web/20130512195946/http://accf.org.au/about/vision.html | archive-date = 12 May 2013 | url = http://accf.org.au/about/vision.html | title = Vision and Mission }}</ref> Ian Frazer, one of the developers of the Gardasil cervical cancer vaccine, is the scientific advisor to ACCF.<ref name=ACCFPeople>{{cite web | author = Australian Cervical Cancer Foundation | publisher = Australian Cervical Cancer Foundation | archive-url = https://web.archive.org/web/20130512195956/http://accf.org.au/about/ourboard.html | archive-date = 12 May 2013 | url = http://accf.org.au/about/ourboard.html | title = Our People }}</ref> Janette Howard, the wife of the then-Prime Minister of Australia, John Howard, was diagnosed with cervical cancer in 1996, and first spoke publicly about the disease in 2006.<ref name=JanetteHoward>{{cite web | vauthors = Bradford G | publisher = Australian Broadcasting Corporation | archive-url = https://web.archive.org/web/20121103140141/http://www.abc.net.au/pm/content/2006/s1766104.htm | archive-date = 3 November 2012 | url = http://www.abc.net.au/pm/content/2006/s1766104.htm | date=16 October 2006 | title = Janette Howard speaks on her battle with cervical cancer }}</ref>

===United States===
[[File:CDC health disparities for cervical cancer PSA.jpg|thumb|A Centers for Disease Control and Prevention public service announcement about cervical cancer health disparities in the United States.]]

A 2007 survey of American women found 40% had heard of HPV infection and less than half of those knew it causes cervical cancer.<ref name=pmid17267388>{{cite journal | vauthors = Tiro JA, Meissner HI, Kobrin S, Chollette V | title = What do women in the U.S. know about human papillomavirus and cervical cancer? | journal = Cancer Epidemiology, Biomarkers & Prevention | volume = 16 | issue = 2 | pages = 288–294 | date = February 2007 | pmid = 17267388 | doi = 10.1158/1055-9965.EPI-06-0756 | doi-access = free }}</ref> Over a longitudinal study from 1975 to 2000, it was found that people of lower socioeconomic census brackets had higher rates of late-stage cancer diagnosis and higher morbidity rates. After controlling for stage, there still existed differences in survival rates.<ref>{{cite journal | vauthors = Singh GK, Miller BA, Hankey BF, Edwards BK | title = Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975–2000 | journal = Cancer | volume = 101 | issue = 5 | pages = 1051–1057 | date = September 2004 | pmid = 15329915 | doi = 10.1002/cncr.20467 | s2cid = 26033629 | doi-access = free }}</ref> Women in the US experience [[Social:Social stigma|stigma]] around HPV infection, vaccination and cervical cancer. This is predominantly driven by fear of social judgment and rejection, self-blame, and shame, with notable negative influences from gender and social norms, as both human papillomavirus infection and cervical cancer were stigmatized due to the perception that they arise from reckless behavior such as having multiple sexual partners or neglecting screening.<ref name="pmid34662598">{{cite journal |vauthors=Peterson CE, Silva A, Goben AH, Ongtengco NP, Hu EZ, Khanna D, Nussbaum ER, Jasenof IG, Kim SJ, Dykens JA |date=December 2021 |title=Stigma and cervical cancer prevention: A scoping review of the U.S. literature |url=https://figshare.com/articles/journal_contribution/16926994 |journal=Prev Med |volume=153 |issue= |page=106849 |doi=10.1016/j.ypmed.2021.106849 |pmid=34662598 |s2cid=239027566}}</ref>

=== LGBTQ populations ===
Transgender men and gender-diverse people who have a cervix (even if partially intact) or have a prior history of cervical cancer or precancerous conditions, and are age 21 or older who has ever had sex with anyone need to get screened for cervical cancer.<ref>{{Cite web |title=As a trans man, do I need to get screened for cervical cancer? |url=https://cancer.ca/en/cancer-information/find-cancer-early/screening-in-lgbtq-communities/as-a-trans-man-do-i-need-to-get-screened-for-cervical-cancer |access-date=21 January 2023 |website=Canadian Cancer Society}}</ref><ref>{{Cite web |date=2018-06-27 |title=Should trans men have cervical screening tests? |url=https://www.nhs.uk/common-health-questions/sexual-health/should-trans-men-have-cervical-screening-tests/ |access-date=2023-01-21 |website=nhs.uk |language=en}}</ref> Transmasculine people are just as likely as cisgender women to have cervical cancer, but are less likely to undergo cervical screening, because of dysphoria, gender disaffirmation or disempowerment of the individual by healthcare providers,<ref>{{cite journal | vauthors = Peitzmeier SM, Bernstein IM, McDowell MJ, Pardee DJ, Agénor M, Alizaga NM, Reisner SL, Potter J | display-authors = 6 | title = Enacting power and constructing gender in cervical cancer screening encounters between transmasculine patients and health care providers | journal = Culture, Health & Sexuality | volume = 22 | issue = 12 | pages = 1315–1332 | date = December 2020 | pmid = 31661659 | pmc = 7188565 | doi = 10.1080/13691058.2019.1677942 }}</ref> or being misinformed of HPV and cervical cancer risks<ref>{{cite journal | vauthors = Potter J, Peitzmeier SM, Bernstein I, Reisner SL, Alizaga NM, Agénor M, Pardee DJ | title = Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians | journal = Journal of General Internal Medicine | volume = 30 | issue = 12 | pages = 1857–1864 | date = December 2015 | pmid = 26160483 | pmc = 4636588 | doi = 10.1007/s11606-015-3462-8 }}</ref>  as well as many healthcare providers perceiving transmasculine individuals to be at low risk of cervical cancer.<ref>{{cite journal | vauthors = Agénor M, Peitzmeier SM, Bernstein IM, McDowell M, Alizaga NM, Reisner SL, Pardee DJ, Potter J | display-authors = 6 | title = Perceptions of cervical cancer risk and screening among transmasculine individuals: patient and provider perspectives | journal = Culture, Health & Sexuality | volume = 18 | issue = 10 | pages = 1192–1206 | date = October 2016 | pmid = 27142466 | doi = 10.1080/13691058.2016.1177203 | s2cid = 22036018 }}</ref>

Transgender women who have not had bottom surgery have no risk of cervical cancer, as they do not have a cervix. Trans women who have had bottom surgery to create a vagina (vaginoplasty) and possibly a cervix, are at a very small risk to develop cancer in the tissues of their neo-vagina or neo-cervix as these tissues are made up of different cells than a cervix in a cisgender woman<ref>{{Cite web |date=2019-10-10 |title=I'm trans or non-binary, does this affect my cancer screening? |url=https://www.cancerresearchuk.org/about-cancer/cancer-symptoms/spot-cancer-early/screening/trans-and-non-binary-cancer-screening |access-date=2023-01-21 |website=Cancer Research UK |language=en}}</ref><ref>{{Cite web |title=As a trans woman, do I need to get screened for cervical cancer? |url=https://cancer.ca/en/cancer-information/find-cancer-early/screening-in-lgbtq-communities/as-a-trans-woman-do-i-need-to-get-screened-for-cervical-cancer |access-date=21 January 2023 |website=Canadian Cancer Society}}</ref> Cervical cancer screening is not necessary in trans women who have undergone vaginoplasty because they do not have a cervix.<ref>{{cite journal | vauthors = Labanca T, Mañero I, Pannunzio M | title = Transgender patients: considerations for routine gynecologic care and cancer screening | journal = International Journal of Gynecological Cancer | volume = 30 | issue = 12 | pages = 1990–1996 | date = December 2020 | pmid = 33109526 | doi = 10.1136/ijgc-2020-001860 | s2cid = 225096075 | doi-access = free }}</ref>

Intersex people with a cervix are also able to have cervical cancer.<ref>{{Cite web |date=2017-10-20 |title=Causes of cervical cancer |url=https://www.nhs.uk/conditions/cervical-cancer/causes/ |access-date=2023-01-21 |website=nhs.uk |language=en}}</ref>
{{clear}}

== References ==
{{Reflist|30em}}

== Further reading ==
{{Refbegin}}
* {{Cite journal | vauthors = Arbyn M, Castellsagué X, de Sanjosé S, Bruni L, Saraiya M, Bray F, Ferlay J | title = Worldwide burden of cervical cancer in 2008 | journal = Annals of Oncology | volume = 22 | issue = 12 | pages = 2675–2686 | date = December 2011 | pmid = 21471563 | doi = 10.1093/annonc/mdr015 | doi-access = free }}
* {{Cite journal | vauthors = Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R | title = Cancer of the cervix uteri | journal = International Journal of Gynaecology and Obstetrics | volume = 143 | issue = Suppl 2 | pages = 22–36 | date = October 2018 | pmid = 30306584 | doi = 10.1002/ijgo.12611 | doi-access = free }}
* {{Cite journal | vauthors = Chuang LT, Temin S, Camacho R, Dueñas-Gonzalez A, Feldman S, Gultekin M, Gupta V, Horton S, Jacob G, Kidd EA, Lishimpi K, Nakisige C, Nam JH, Ngan HY, Small W, Thomas G, Berek JS | display-authors = 6 | title = Management and Care of Women With Invasive Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline | journal = Journal of Global Oncology | volume = 2 | issue = 5 | pages = 311–340 | date = October 2016 | pmid = 28717717 | pmc = 5493265 | doi = 10.1200/JGO.2016.003954 }}
* {{Cite journal | vauthors = Peto J, Gilham C, Fletcher O, Matthews FE | title = The cervical cancer epidemic that screening has prevented in the UK | journal = Lancet | volume = 364 | issue = 9430 | pages = 249–256 | year = 2004 | pmid = 15262102 | doi = 10.1016/S0140-6736(04)16674-9 | s2cid = 11059712 }}
* {{Cite journal | vauthors = Pimenta JM, Galindo C, Jenkins D, Taylor SM | title = Estimate of the global burden of cervical adenocarcinoma and potential impact of prophylactic human papillomavirus vaccination | journal = BMC Cancer | volume = 13 | issue = 1 | page = 553 | date = November 2013 | pmid = 24261839 | pmc = 3871005 | doi = 10.1186/1471-2407-13-553 | doi-access = free }}
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{{Refend}}

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* [https://www.who.int/news-room/fact-sheets/detail/cervical-cancer Fact sheet on cervical cancer] by the [[Organization:World Health Organization|WHO]]
* [https://www.cancer.gov/types/cervical Cervical cancer] at the [[Organization:National Cancer Institute|NIH National Cancer Institute]]
* [https://www.jostrust.org.uk/ Jo's Cervical Cancer Trust], UK cervical cancer charity

{{Medical resources
|  DiseasesDB      = 2278
|  ICD10           = {{ICD10|C|53||c|51}}
|  ICD9            = {{ICD9|180}}
|  ICDO            =
|  OMIM            = 603956
|  MedlinePlus     = 000893
|  eMedicineSubj   = med
|  eMedicineTopic  = 324
|  eMedicine_mult  = {{eMedicine2|radio|140}}
|  MeshID          = D002583
}}
{{Human papillomavirus}}

{{DEFAULTSORT:Cervical Cancer}}
[[Category:Wikipedia medicine articles ready to translate]]

{{Sourceattribution|Cervical cancer}}