Cervical cancer is the most common gynecologic malignancy worldwide and the third most common in the United States. While incidence and mortality rates have decreased significantly with improved access to screening and prevention methods in the United States, cervical cancer remains a significant cause of cancer morbidity and mortality in resource-limited countries. Human papillomavirus (HPV) infection is the cause of almost all cervical cancer and is associated with 99.7% of cervical cancer. Additional risk factors associated with HPV include early onset of sexual activity, multiple sexual partners, history of sexually transmitted infections, increased parity, and immunosuppression. Non-HPV-related risk factors include cigarette smoking, oral contraceptive use, and low socioeconomic status. Squamous cell carcinoma is the most common histologic subtype of cervical cancer, comprising around 70% of cases, and adenocarcinoma is the second most common histologic subtype, comprising approximately 25% of cases. Cervical cancer is staged clinically, and stage is the most important prognostic factor. Early-stage disease can generally be treated surgically with a hysterectomy. Fertility-sparing surgical options include cold knife conization and radical trachelectomy in select cases. Adjuvant therapy with chemotherapy, radiation, or chemoradiation may be required for early-stage disease with specific risk factors. Advanced-stage disease is primarily treated with chemoradiation. Using FIGO 2018 staging, five-year survival rates were 92−97% for stage IA tumors and 76−92% for stage IB tumors. Lymph node involvement is associated with worse prognosis with five-year survival rates near 40−60%. Routine screening with cervical cytology is recommended starting in young adulthood to identify and treat females with high-grade dysplasia. Routine HPV vaccination is recommended to protect against development of cervical cancer from persistent high-risk HPV infection.

On paper, eliminating cervical cancer looks doable. Given the effectiveness of the three pillars of prevention: primary, secondary, and tertiary, virtually no person with a cervix should die of the disease. HPV vaccination provides near-perfect protection, and for those who missed the vaccine’s age cut-off or who live in countries that can’t afford to provide it, cervical screening and follow-up resolve 90 percent of early cervical pre-cancer. Cancer can even be cured via treatment if it’s found early enough. And yet, despite the reliability of these prevention pillars, myriad obstacles stand in the way of providing consistent, well-attended programs – including widespread misunderstandings and misgivings about the HPV vaccine, a universal aversion to pelvic exams, and cultural restrictions against exposing women’s bodies to strangers. These underlying issues have long undermined efforts to eradicate the disease and diminished political will toward investing in this cause, particularly in countries or regions with meager health care budgets. Until these obstacles are addressed, simply throwing money at the problem will never be enough.