How Does HPV Cause Cervical Cancer and How Can You Prevent It?

Name: How Does HPV Cause Cervical Cancer and How Can You Prevent It?
Creator: Marcus Johnson, RN, BSN
Published: 2026-02-12T19:50:55.258Z

Understanding the HPV-cervical cancer link, HPV vaccination, Pap smears, HPV testing, and how cervical cancer can be virtually eliminated through prevention.

MJRB

Written by Marcus Johnson, RN, BSN

RN, BSN, Health Writer

DLT

Reviewed by Dr. Lisa Thompson, DO, FACOG

Board-Certified OB/GYN · Mount Sinai Hospital

Written Feb 12, 2026Reviewed Feb 12, 2026Fact-checked Feb 12, 20264 sources citedMedically Fact-Checked

What Should You Do to Prevent Cervical Cancer?

Get vaccinated against HPV (ideally ages 9-12, available through age 45), follow cervical screening guidelines with Pap smears and/or HPV testing, don't smoke (smoking doubles cervical cancer risk in HPV-positive women), and practice safer sex. These combined strategies can prevent virtually all cervical cancers.

Strong EvidenceRandomized trials and real-world effectiveness data from national vaccination programs provide strong evidence for HPV vaccination in cervical cancer prevention.

HPV vaccination is the most important prevention tool. Gardasil 9 protects against nine HPV types: 6, 11, 16, 18, 31, 33, 45, 52, and 58. Types 16 and 18 cause approximately 70% of cervical cancers, while the additional five types covered by Gardasil 9 cause another 20%. Real-world data from countries with high vaccination rates demonstrate dramatic reductions — Scotland reported an 89% reduction in cervical precancer among vaccinated women, and Australia is on track to eliminate cervical cancer as a public health problem by 2028.

Regular cervical screening remains essential even for vaccinated women, as the vaccine does not cover all cancer-causing HPV types. The 2020 American Cancer Society guideline endorses primary HPV testing every 5 years starting at age 25 as the preferred screening strategy, though Pap smear-based approaches remain acceptable. Screening should continue through age 65 for women with adequate prior negative screening history.

Scotland reported an 89% reduction in cervical precancer among vaccinated women

How Does HPV Cause Cervical Cancer?

High-risk HPV types (mainly 16 and 18) cause cervical cancer by integrating their DNA into cervical cells, producing proteins (E6 and E7) that disable the cell's tumor suppressor genes (p53 and Rb). This allows uncontrolled cell growth over 10-20 years, progressing from normal cells to precancerous lesions (CIN) and eventually to invasive cervical cancer.

HPV infects the basal cells of the cervical transformation zone — the area where the columnar epithelium of the endocervix meets the squamous epithelium of the ectocervix. This transformation zone is particularly susceptible to HPV infection, especially during adolescence when it is more exposed. In most women, the immune system clears the infection within 1-2 years. Persistent infection with high-risk HPV types leads to progressive cervical intraepithelial neoplasia (CIN): CIN 1 (mild dysplasia, often regresses), CIN 2 (moderate dysplasia), and CIN 3 (severe dysplasia/carcinoma in situ).

The progression from CIN 3 to invasive cancer takes an additional 10-20 years in most cases, providing an excellent opportunity for detection through screening. This slow progression explains why cervical screening programs have been so effective — detecting and treating CIN 2/3 before it becomes cancer is essentially curing a precancerous condition. Without screening, the lifetime risk of cervical cancer in unvaccinated women is approximately 1-2% in high-resource settings and significantly higher in low-resource settings.

What Are the Current Cervical Cancer Screening Guidelines?

Under age 21: no screening. Ages 21-29: Pap smear alone every 3 years. Ages 30-65: Pap with HPV co-testing every 5 years (preferred), Pap alone every 3 years, or primary HPV testing every 5 years. Over 65 with adequate prior screening: discontinue screening. These are for average-risk women — immunocompromised women and those with prior cervical precancer need more frequent monitoring.

Strong EvidenceMultiple large RCTs and updated ASCCP/ACS guidelines provide strong evidence for HPV-based cervical cancer screening strategies.

Primary HPV testing (without concurrent Pap smear) is increasingly recommended as the optimal screening strategy. The ACS 2020 guideline identifies primary HPV testing every 5 years starting at age 25 as the preferred approach when available. This is supported by multiple large randomized trials showing HPV testing provides 60-70% greater detection of CIN 3+ compared to cytology alone, with the added benefit of longer screening intervals. Several FDA-approved HPV tests are available for primary screening.

Management of abnormal results follows the 2019 ASCCP (American Society for Colposcopy and Cervical Pathology) risk-based management guidelines, which use both current results and prior history to estimate CIN 3+ risk and guide management decisions. Low-risk results (e.g., HPV-negative ASCUS) warrant surveillance, while higher-risk results (HPV 16/18 positive or HSIL cytology) prompt immediate colposcopy with biopsy. Treatment of confirmed CIN 2/3 by LEEP (loop electrosurgical excision) or cold knife conization is highly effective, with cure rates exceeding 90%.

Multiple large randomized trials show HPV testing provides 60-70% greater detection of CIN 3+ compared to cytology

Frequently Asked Questions

Who should get the HPV vaccine?

The CDC recommends HPV vaccination for all individuals ages 11-12 (can start at age 9), with catch-up vaccination through age 26. Adults ages 27-45 may receive the vaccine after shared clinical decision-making. The vaccine is most effective before HPV exposure, but provides benefit even for those already sexually active. Two doses are needed if started before age 15; three doses if started at 15 or older.

Can HPV go away on its own?

Yes, approximately 90% of HPV infections are cleared by the immune system within 1-2 years. Persistent infection with high-risk HPV types (especially HPV 16 and 18) is what leads to precancerous changes. The progression from HPV infection to cervical cancer typically takes 10-20 years, which is why regular screening is so effective at catching and treating precancerous changes.

How often do you need a Pap smear?

Ages 21-29: Pap smear every 3 years. Ages 30-65: Pap smear with HPV co-testing every 5 years, Pap alone every 3 years, or primary HPV testing every 5 years. After age 65 with adequate prior screening: no further screening needed. After total hysterectomy for benign reasons: no screening needed. These apply to average-risk women.

What does an abnormal Pap smear mean?

An abnormal Pap smear indicates cervical cell changes that may need further evaluation but does not mean you have cancer. Most abnormalities are caused by HPV and resolve on their own. ASCUS (atypical squamous cells) is the most common and least concerning. LSIL and HSIL indicate low-grade and high-grade changes respectively. Your doctor will recommend follow-up based on the specific finding, your age, and HPV status.

Is the HPV vaccine safe?

Yes. The HPV vaccine (Gardasil 9) has an excellent safety profile established through clinical trials with over 29,000 participants and post-marketing surveillance covering over 300 million doses worldwide. The most common side effects are injection site pain, mild fever, and dizziness. Multiple large studies have confirmed no association with serious adverse events. The WHO considers HPV vaccination extremely safe.

Sources

1.
Vaccination against HPV and prevention of cervical cancer in Scotland — Palmer T, Wallace L, Pollock KG, et al. BMJ (2019) DOI
2.
Randomised controlled trial of HPV testing in primary cervical screening — Ronco G, Dillner J, Elfström KM, et al. The Lancet (2014) DOI
3.
ACS Guideline for Cervical Cancer Screening 2020 — Fontham ETH, Wolf AMD, Church TR, et al. CA: A Cancer Journal for Clinicians (2020) DOI
4.
2019 ASCCP Risk-Based Management Consensus Guidelines — Perkins RB, Guido RS, Castle PE, et al. Journal of Lower Genital Tract Disease (2020) DOI

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