Worldwide, cervical cancer is one of the leading causes of death from cancer in women; most deaths occur in low to middle-income countries.

Cervical cancer accounts for 1% of all new cancer cases in females in the UK, and is, generally, a preventable disease.

The primary cause of cervical abnormalities and cancer is persistent or chronic infection with one or more of the high-risk (oncogenic) types of HPV.

HPV is a common virus, usually passed on through sexual contact. There are more than 200 types, with around 40 of these affecting the genital area.

• High-risk types, like HPV 16 and 18, are linked to cervical cancer.
• Low-risk types, like HPV 6 and 11, can cause genital warts but not cancer.
• Around 80% of unvaccinated women will be infected with HPV at some point.

HPV infections are usually cleared naturally by the immune system, but some persist and may cause abnormal changes in the cervix, which can lead to cervical cancer over time. Genital warts do not cause cervical cancer.

HPV spreads through:

• genital skin-to-skin contact
• vaginal, anal or oral sex
• sharing sex toys.

HPV often shows no signs and can only be diagnosed through specific tests.

The UK HPV vaccination programme began in 2008 for girls and in 2019 for boys, usually offered at age 12–13 (school year 8).

• The current Gardasil 9 vaccine protects against the main high-risk types and some that cause genital warts.
• Vaccination does not protect against all HPV types, so regular cervical screening is still essential.
• Vaccination is available on the NHS up to the age of 25 if missed in school.
• Some men who have sex with men can get the vaccine through sexual health clinics.

While high-risk HPV is responsible for nearly all cases of cervical cancer, other factors can increase a person's risk. One such factor is exposure to diethylstilbestrol (DES), a synthetic form of oestrogen that was prescribed to pregnant women between 1945 and 1970 to prevent miscarriage.

Research has shown that daughters of women who took DES—especially during the first trimester—are at greater risk of developing a rare vaginal cancer called clear cell adenocarcinoma.

According to the NHS Cervical Screening Programme guidance, women exposed to DES in the womb should have an initial colposcopic examination. If no abnormalities are found, they can continue with routine cervical screening as outlined in national screening protocols.

Other factors that increase the chance of HPV developing into cancer:

• smoking
• having many sexual partners or early sexual activity
• weakened immune system (for example, HIV infection)
• long-term use of hormonal contraception
• not attending regular screening
• not having the HPV vaccine.

Cervical screening is a test that helps prevent cancer by identifying abnormal cells early. In the UK:

• offered to women and people with a cervix aged 25 to 64
• the test checks for high-risk HPV first
• if HPV is found, the sample is checked for abnormal cells
• if abnormal cells are detected, the person is referred for colposcopy.

Screening intervals:

• Every 3 years: age 25–49.
• Every 5 years: age 50–64 (or younger, depending on country and results).

HPV primary testing is now standard in England, Wales, and Scotland. Northern Ireland joined in 2023.

Vaccinated people still need screening. The vaccine doesn’t cover all HPV types.

Who can take cervical samples?

• In England, registered nurses, midwives and nursing associates can be trained to take samples. They must:
• complete approved training
• be supervised by a registered nurse or doctor
• maintain ongoing competence.

Cervical screening can be a sensitive procedure. It’s important to:

• ensure privacy, dignity, and a calm setting
• offer a chaperone
• use clear, plain language and avoid jargon
• make women feel safe, listened to and supported.

Some groups may need extra support:

• survivors of abuse or trauma
• people with physical or learning disabilities
• trans men and non-binary people with a cervix
• homeless, traveller, or marginalised women.

• the purpose and process of the test
• possible results and what happens next
• risks and benefits of screening
• that consent can be withdrawn at any time.

All practitioners must be trained, confident, and respectful when carrying out screening. Poor technique can reduce test accuracy.

Main types:

• Squamous cell carcinoma (SCC): Approximately 90-95% of cases.
• Adenocarcinoma: Harder to detect early.

Stages:

• Stage 0: Abnormal cells, otherwise known as cervical intraepithelial neoplasia (CIN), not cancer yet.
• Stage 1: Cancer is only in the cervix.
• Stage 2–4: Cancer has spread beyond the cervix.

Symptoms:

Often no early symptoms, but may include:

• unusual bleeding (after sex, between periods, after menopause)
• vaginal discharge or pain during sex.

A colposcopy is a follow-up procedure if screening shows abnormal cells. A specialist examines the cervix with a microscope.

• sometimes includes a LLETZ procedure (removal of abnormal tissue with a wire loop)
• treatment is usually effective, and most people return to normal screening afterwards.

This term is used to describe cervical screening where all women who have been treated for CIN, have a cytology test six months after their treatment.

Women treated for abnormal cells will have a follow-up HPV test at 6 months.

• If HPV is not detected → return to routine screening.
• If HPV is still present → return to colposcopy.

Cervical screening is one of the most effective cancer prevention tools.

• It saves thousands of lives every year.
• It detects problems early when they are easiest to treat.
• Access and uptake remain essential—some groups still face barriers.

All professionals should help raise awareness and encourage participation.

The full PDF explores this topic in more detail. The publication may include case studies, images, tables, good practice checklists, glossaries and suggested questions to ask patients. You’ll also find a concise list of references and links to useful organisations and websites.