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HPV Vaccines And Cervical Cancer Prevention: Where Are We Now?
The first human papillomavirus (HPV) vaccine, Gardasil, became FDA-approved back in 2006. Since then, HPV vaccines have become a part of the national immunization schedule of at least 145 countries, with the goal of reducing or even eliminating the occurrence of some cancers. One of those targets is cervical cancer; now, nearly 20 years later, are we any closer to wiping it out?
What is HPV? HPV refers to a group of viruses belonging to the Papillomaviridae viral family that can infect humans, often through intimate skin-to-skin contact such as vaginal, anal, or oral sex. In fact, HPV is the most common sexually transmitted infection in the US, with most sexually active people becoming infected at some point in their life. There are lots of different types of HPV, some of which are considered to be "high-risk" because they've been linked to certain types of cancer, including cervical, anal, vaginal, and some head and neck cancers. For example, nearly all cervical cancer is thought to be caused by long-term high-risk HPV infection. The good news is that thanks to the action of our immune systems, 90 percent of infections will go away by themselves within two years. However, sometimes an infection can last for longer, and if it's a high-risk type of HPV, the damage that it causes to cells and their DNA when it infects them can cause them to multiply uncontrollably. The immune system can get rid of these abnormal cells too – but that's not always the case. For cervical cells infected with high-risk HPV, they can become precancerous after around five to 10 years. After roughly 15-20 years, if those precancerous cells are left untreated, they can develop into cervical cancer, which killed around 350,000 people worldwide in 2022. How HPV vaccines work HPV vaccines aim to prevent the development of HPV-related cancers by stopping the viral infection from taking hold in the first place. Like other vaccines, they do this by making the immune system think it's been exposed to the actual virus, triggering it to produce antibodies against HPV. The immune system then "remembers" this and so, if actual HPV viruses enter the body, it then rapidly and effectively mounts a response to prevent a full-blown infection. In the case of HPV vaccines, this is achieved via purified non-infectious, virus-like particles of the L1 capsid protein – capsids form the shell that encloses a virus' genetic material. As it doesn't contain the full virus itself, the vaccine cannot infect patients with HPV. Cervarix, for example, contains L1 protein for HPV types 16 and 18, which are the cause of most HPV-related cancers. Depending on factors like age and the particular vaccine being given, effective immunization can generally be achieved with two or three doses, though some vaccines are now considered to be effective in just a single dose. What difference have HPV vaccines made? The impact of HPV vaccines nearly 20 years after they were first FDA-approved is one that, on the face of it, looks overwhelmingly positive. In 2024, Public Health Scotland announced that no cervical cancer cases had been detected in women who'd been fully vaccinated since its vaccination program started in 2008. A study published earlier this year found that England is on track to eliminate cervical cancer by 2040, with incidence of the disease in those born since 1991 having dropped drastically following the introduction of the vaccine – though "eliminate" in this case means reducing the rate of incidence to 4 in 100,000. It could soon become a similar story in the US too, with a recent study finding that just 13 women under the age of 25 died from cervical cancer between 2019 and 2021, compared to 55 between 1992 and 1994. Though other reasons for the reduction are also at play, the introduction of HPV vaccines is thought to be one of the major driving factors. Globally, however, there's some cause for concern. While several countries have pledged to help eliminate cervical cancer by introducing the HPV vaccine, the worldwide proportion of girls aged 9 to 14 having received their first dose stands at 27 percent, as of 2023. The World Health Organization's (WHO) target is to reach 90 percent coverage in the next five years – which doesn't look like a particularly realistic achievement in light of the most recent data. Add a little more context though, and it's not all doom and gloom. Global coverage back in 2022 was only 20 percent, meaning it increased by 7 percent in just two years. "If this rate of progress is maintained," the WHO said in a statement, "the world would be on track to meet the 2030 target to make HPV vaccines available to all girls everywhere." Nonetheless, the burden of cervical cancer is much greater in some countries than it is in others, so it's important that efforts to reach that goal also take this into account. The future of HPV vaccines While the use of vaccines to prevent disease is a well-trodden path, researchers have now suggested that the HPV vaccine could also be used to treat precancerous cells before they become malignant. This could help those with abnormal cells avoid the standard treatment of loop excision, which can have side effects such as infection and scarring. In a recent clinical trial, scientists aimed to find out if their therapeutic HPV vaccine – called Vvax001 and designed to target HPV16 – could cause the regression of a type of precancerous condition called cervical intraepithelial neoplasia grade 3 (CIN3). While this is a group of abnormal precancerous cells, rather than cancer, around one-third of CIN3 cases progress to cervical cancer within 10 years if left untreated. Of the 18 CIN3 patients who received the vaccine as part of the trial, nine saw regression of their lesions – in three of those patients, the regression was complete. "To the best of our knowledge, this response rate makes Vvax001 one of the most effective therapeutic vaccines for HPV16-associated CIN3 lesions reported to date," said principal investigator Refika Yigit, MD, in a statement. "If confirmed in a larger trial, our results could mean that at least half of the patients with CIN3 might be able to omit surgery and avoid all its possible side effects and complications." All "explainer" articles are confirmed by fact checkers to be correct at time of publishing. Text, images, and links may be edited, removed, or added to at a later date to keep information current. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.Black Women Are Dying From Cervical Cancer At Alarming Rates—Here's Why
Cervical cancer is a slow-growing cancer that occurs in the cervix, the lower part of the uterus that connects to the vagina. This area, which has a donut-shaped structure, plays a crucial role in reproductive health. The primary cause of cervical cancer is the human papillomavirus (HPV), a common virus transmitted through sexual contact. While many people who contract HPV do not experience health consequences, certain high-risk strains of the virus can lead to cervical cancer over time if left undetected and untreated.
Cervical Cancer in the Black CommunityCervical cancer disproportionately affects Black women, who tend to have worse outcomes and higher mortality rates than other racial groups. In fact, Black women are 41 percent more likely to develop cervical cancer than white women and are 75 percent more likely to die from it. What's more, Black women are more likely to be diagnosed at a later stage, which contributes to low five-year survival for a type of cancer for which almost every case can be prevented.
According to the St. Jude HPV Cancer Prevention Program, Black women are more likely to die from the disease due to:
While it's true that women in general could improve follow-ups and health literacy, a significant factor often overlooked is medical racism. Implicit bias within the healthcare system can lead to primary care providers (PCPs) deprioritizing or overlooking preventive screenings for Black women, contributing to delayed diagnoses and poorer health outcomes. Studies have shown that Black patients are less likely to receive timely screenings, adequate pain management, and even referrals for specialist care compared to their white counterparts. Addressing these systemic issues is just as crucial as encouraging individual health advocacy.
RELATED: 5 Warning Signs Of Cervical Cancer Every Black Woman Should Know
The Connection Between HPV and Cervical CancerHPV is a sexually transmitted infection (STI) with over 100 different strains, some of which are classified as high-risk because they can cause abnormal cell changes in the cervix.
"If someone has one of those, a lot of times there are no symptoms. It can just continue to affect the cervix, leading to abnormal cells. Over time, if there's no detection or awareness, it can continue to develop and eventually turn into cancer," Joyce Idehen, MD tells BlackDoctor.Org
The Importance of Early Detection: Pap Smears & HPV TestingEarly detection is critical in preventing cervical cancer. A Pap smear is a test that collects cervical cells to check for abnormalities, while an HPV test detects the presence of HPV strains, including high-risk ones. Women over the age of 30 should receive both tests together every five years, while women aged 21–29 should receive Pap smears alone every three years. If abnormalities are detected, further testing or treatment can prevent cancer from developing.
"Patients can ask their doctor during their annual visit when they're due for their next pap smear. Even if it can't be done the same day, providers can schedule it," Dr. Idehen adds.
If you're unsure of when you had your last Pap smear, request access to your previous medical records and bring them to your next appointment.
RELATED: 10 People You Need on Your Cervical Cancer Care Dream Team
Dispelling Myths About HPV & Cervical CancerThere are many misconceptions surrounding HPV and cervical cancer, including:
Some factors that increase the risk of developing cervical cancer include:
The most effective ways to prevent cervical cancer include:
Discussing HPV and cervical cancer with partners, family, and friends helps normalize the conversation and promotes prevention. Men should also be involved in the discussion, as they can carry and spread HPV. Encouraging male partners to get vaccinated and tested can help reduce the risk for both partners.
"Open conversations with partners about vaccination and testing are key. Men also play a role—not just as partners but in encouraging their sisters, mothers, and others to take these steps. Awareness shouldn't just fall on women," Dr. Idehen advises.
Resources for Those Without InsuranceFor those who lack health insurance, affordable and free resources are available:
RELATED: 10 Questions you Should Ask Your Doctor About Cervical Cancer
Final ThoughtsCervical cancer is preventable with regular Pap smears, HPV vaccination, and safe sexual practices. It's important for both men and women to be proactive about their sexual health, have open discussions, and advocate for early detection. Spreading awareness and ensuring equitable access to preventive care can help save lives.
"For women, take ownership of your preventive care—get your routine Pap smears and, if not vaccinated as a child, get vaccinated now. For men, get vaccinated and take responsibility for your sexual health. Prevention is key, and it's never too late to make these health changes," Dr. Idehen concludes.
If you haven't had your Pap smear or HPV vaccine, schedule an appointment today—it could make all the difference.
Medically Reviewed By:
Joyce Idehen, MDJoyce earned her Bachelor's in Nursing from Prairie View A&M before completing her medical degree at the American University of Antigua. She is the Social Media Manager for Black Girl White Coat, a nonprofit that mentors and motivates underrepresented minorities in medicine.
Could The FDA's Recently Approved Pap Smear Alternative Reduce Racial Disparities In Cervical Cancer Deaths?
January marks Cervical Health Awareness Month. Around 11,500 Americans are diagnosed with cervical cancer each year, according to data from the Centers for Disease Control and Prevention, and in 2022, over 4,000 people died from the disease despite it being considered highly preventable.
White women are more likely to be diagnosed with cervical cancer than any other group, CDC data shows. However, a 2022 study published in the Journal of Clinical Oncology found greater rates of diagnosis were mostly due to higher levels of screening. Black women have the lowest screening rates, the study found, "strongly driven by insurance and site of care, underscoring the value of addressing systemic inequity."
For decades, a Pap smear has been the standard way to detect cervical cancer. The uncomfortable and, for some, painful procedure entails using a small brush or spatula to lightly scrape the cervix to gather cells. Cells are then examined under a microscope for precancers or other abnormalities. This procedure also tests for the human papillomavirus, which can cause cell changes on the cervix that lead to cancer if not treated early.
But soon, a self-swab approved in May 2024 by the Food and Drug Administration might help people avoid the invasive procedure—and save lives. Patients will be able to use an at-home kit to swab their vaginal walls and send it to a lab to be tested for HPV. It's part of the National Cancer Institute's Cervical Cancer 'Last Mile' Initiative, which will study the accuracy and effectiveness of self-testing at 25 clinical sites nationwide. Participant enrollment began this past summer.
"Self-collection can expand access to screening and reduce barriers, which will give more people the opportunity to detect, treat, and ultimately survive cancer," Karen E. Knudsen, CEO of the American Cancer Society, said in a press statement after the announcement.
Northwell Health partnered with Stacker to explore disparities in cervical cancer deaths and what a new testing mechanism could mean for prevention. Data is from the Centers for Disease Control and Prevention.
Editor's note: Pap smears are a cervical cancer screening tool and are recommended for people with cervixes, not all of whom identify as women. In this article, we have used gender-neutral terms when possible. We use gendered language in the characterization of data to stay true to how sources collected and presented the information.
Photo illustration by Elizabeth Ciano // Shutterstock An opportunity to improve screening ratesEarly detection is the key to preventing cervical cancer deaths. Yet, data spanning June 2016 to May 2019 published in the American Journal of Preventive Medicine in October 2023 suggests that only two-thirds of at-risk people are up-to-date on screenings. For Black people, that number drops to about half.
One factor that impacts screening rates includes whether people have insurance coverage. A 2022 KFF Women's Health Survey found that 42% of uninsured women had received a cervical cancer screening in the past year, compared to 64% with private insurance and 56% of those with Medicaid. However, even when screening rates are equal, disparities in care and delays in treatment have contributed to lower survival rates among those who are diagnosed with cancer.
Within the health care system, racial bias and discrimination contribute to disparities in mortality rates. Differences in the quality of screening techniques and a lack of representation of people of color in the development of screening guidelines and clinical trials are just a few forms of systemic bias.
Research from the American Cancer Society released in January 2020 showed that even when adjusting for age, sex, and stage of diagnosis, Black people are 33% more likely to die from cancer than white patients. For American Indians and Alaska Natives, the risk of dying from cancer is 51% higher.
Where a patient lives can also affect screening rates. In 2022, less than half of rural residents received a Pap smear in the prior year, compared to about 2 in 3 urban residents, according to another study published in the Journal of the American Medical Association, which looked at data from 2019 to 2022.
The hope is that self-collection will improve screening rates among underserved populations in the U.S. Similar strategies have been adopted in Denmark, Sweden, and the Netherlands to much success. In Australia, more than 315,000 people have opted to self-collect since an initiative was launched in 2022. By March 2024, more than 1 in 4 screenings were done using collection kits in Australia.
Northwell Health Racial disparities require more than one solutionIn 2022, there were about 21 cervical cancer deaths for every million women living in the United States, according to the CDC. Broken down by race, Native Hawaiians and Pacific Islanders have the highest rates of cervical cancer deaths in the U.S.
Again, lack of access to quality care plays a role. Because Native Hawaiian and Pacific Islanders get tested less frequently, they are more likely to receive a late-stage cancer diagnosis, according to American Cancer Society research. This is particularly true among Native Hawaiians. While screening rates are generally similar across the state of Hawai'i, in 2022, just 79% of Native Hawaiian women between 25 and 65 years old were up-to-date on cervical cancer screenings, compared to 88% of white women.
The problem is most acute in the six U.S. Territories in the Pacific Islands, which includes Guam, American Samoa, and the Federated States of Micronesia, according to data analysis on more than 400 cervical cancer cases published in 2024 in JAMA Oncology. Researchers found nearly 7 in 10 cervical cancer cases were diagnosed at a late stage from 2007 to 2020.
Black and Indigenous women also have elevated death rates from cervical cancer due to a lack of follow-up care after an abnormal screening. While insurance coverage and socioeconomic factors are at play, medical distrust also plays a role. This is particularly true in the field of gynecology, which the medical community built on the backs of enslaved people in the Antebellum South.
J. Marion Sims is widely credited with developing many of the modern-day tools still used in gynecology today, including the speculum, a hinged tool inserted into the vagina and expanded to get a better view of the cervix. The first version was made of bent metal spoons, which Sims used while examining enslaved people in Montgomery, Alabama.
In recent years, many have reevaluated Sims' legacy in the field, largely due to the inhumane treatment of his Black patients, whom he rarely gave anesthesia during painful procedures. His studies reinforced the false belief that Black patients have higher pain thresholds, leading to pain being dismissed and downplayed even today.
This history is a testament to the importance of culturally competent care, the ability to communicate and collaborate with people from different backgrounds and understand how their identity and culture play a role in their views and understanding of health care A case study of 40 Black and Hispanic women in Texas found when provided with culturally competent education and a self-sampling kit for HPV, screening rose from about 6 in 10 to 9 in 10 among both groups.
Northwell Health Improving preventative care across the countryIn the Lower 48, cervical cancer deaths are higher in states with large uninsured populations and a high percentage of Black residents.
In Mississippi, which has the highest poverty rate in the nation, there are about 4 cervical cancer deaths per 100,000 women. The state health department's Breast and Cervical Cancer Program provides free Pap screenings at some clinics for uninsured people between the ages of 40 and 64. Kentucky, which has the third-highest cervical cancer rate in the country, runs a similar program for those 21 and older who do not have insurance and whose household income is less than 250% of the federal poverty level. Over 16% of the state's population lives below the poverty line.
However, while self-screening will undoubtedly increase early detection, it is just one factor in curbing cervical cancer deaths. Other preventative measures need improvement, including HPV vaccination rates, which have proven to be one of the most effective tools in reducing cervical cancer.
Globally, cervical cancer rates are higher in low- and middle-income countries. In 2020, the World Health Organization launched the Cervical Cancer Elimination Initiative, which includes the goal of vaccinating 90% of girls worldwide for HPV by the age of 15.
Self-exams don't replace pelvic exams, and encouraging follow-up appointments after an abnormal test is also important. A study of more than 160,000 women in New Mexico published in Preventative Medicine found that between January 2015 and August 2019, only half who tested positive for cancer-causing HPV cells followed guidelines and received a biopsy within six months. Three in 10 had not followed up within 18 months.
While it's clear continuous care and monitoring are necessary to prevent cervical cancer deaths, a holistic approach valuing the importance of self-care in cancer prevention is also vital.
Story editing by Alizah Salario. Additional editing by Kelly Glass. Copy editing by Kristen Wegrzyn.
This story originally appeared on Northwell Health and was produced and distributed in partnership with Stacker Studio.
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