HPV Infections: How Vaccination, Screening, and Prevention Stop Cervical Cancer

Human papillomavirus, or HPV, isn’t just another STD. It’s the leading cause of cervical cancer - and yet, it’s one of the most preventable cancers we have. Nearly all cervical cancer cases - 99% - are caused by persistent infection with high-risk HPV types, especially HPV 16 and 18. But here’s the thing: HPV infections don’t have to lead to cancer. With the right combination of vaccination, regular screening, and smart follow-up care, cervical cancer can be stopped before it starts.

How HPV Leads to Cancer - And Why It Takes Years

HPV is common. About 80% of sexually active people will get at least one type in their lifetime. Most infections clear on their own within one or two years. But for a small number of people, the virus sticks around. That’s when trouble begins.

High-risk HPV types damage the cells of the cervix. These changes don’t happen overnight. It can take 10 to 20 years for abnormal cells to turn into invasive cancer. That long window is our biggest advantage. It means we have time to catch and treat the problem before it becomes life-threatening.

That’s why screening isn’t about checking for cancer - it’s about finding those early cell changes. And that’s where HPV testing has changed everything.

The Shift from Pap Tests to HPV Testing

For decades, the Pap test was the gold standard. It looked at cervical cells under a microscope to spot abnormalities. But it wasn’t perfect. A 2018 study in JAMA showed Pap tests missed more than 44% of precancerous lesions. They were like trying to find a needle in a haystack using only your eyes.

Now, we have a better tool: HPV testing. Instead of looking at cells, it looks for the virus itself. The two FDA-approved tests - the cobas HPV Test from Roche Molecular Systems, which detects HPV 16 and 18 separately and groups the other 12 high-risk types and the Aptima HPV Assay from Hologic, which detects E6/E7 mRNA from 14 high-risk types - are far more sensitive. They catch 94.6% of lesions that could become cancer, compared to just 55.4% for Pap tests alone.

Because HPV testing is so accurate, we can space out screenings. The American Cancer Society now recommends primary HPV testing every five years for people aged 25 to 65. That’s a big shift from the old three-year Pap test schedule. And it’s safer. A 2023 study in the Journal of the National Cancer Institute found that people with a negative HPV test had a 0.23% risk of developing serious cervical disease over five years - lower than the 0.51% risk after a negative Pap test.

Who Gets Screened - And When

Guidelines vary slightly by organization, but here’s what most experts agree on as of 2026:

• Ages 21-29: Pap test every 3 years. HPV testing isn’t recommended as a first step here because infections are common and usually clear on their own.
• Ages 25-65: Primary HPV testing every 5 years is the preferred method. This is now the top recommendation from the American Cancer Society.
• Ages 30-65: You have three options: HPV test every 5 years, Pap test every 3 years, or both tests together (cotesting) every 5 years. HPV-only testing is slightly better at catching problems.
• Over 65: If you’ve had regular screenings with normal results, you likely don’t need more.

Even if you’ve been vaccinated, you still need screening. The vaccine doesn’t protect against all cancer-causing HPV types. And if you’ve had an abnormal result in the past, your doctor may recommend more frequent checks.

The Game-Changer: Self-Collected HPV Tests

One of the biggest barriers to screening? The pelvic exam. Many people avoid it because it’s uncomfortable, embarrassing, or they can’t access a clinic. That’s why self-collected HPV testing is a breakthrough.

In January 2024, Kaiser Permanente officially added self-collected HPV tests to its guidelines. You use a simple swab at home - no speculum, no doctor’s office. Studies show it’s almost as accurate as a clinician-collected sample: 84.4% sensitivity and 90.7% specificity. That’s close enough to trust.

Real-world data from Australia and the Netherlands show self-collection boosts screening rates by 30-40% among people who’ve never been screened. In the U.S., 30% of cervical cancers occur in women who’ve never had a Pap test. Self-testing could cut that number dramatically.

It’s not everywhere yet - only 40% of U.S. labs were ready for HPV testing in 2022 - but the tide is turning. More insurers are covering it. More clinics are offering kits. And with the WHO pushing for global access, it’s only a matter of time before this becomes standard.

Vaccination: The Best First Line of Defense

The HPV vaccine is one of the most effective cancer prevention tools ever developed. The first vaccine, Gardasil, was approved in 2006. Today’s versions - Gardasil 9 - protect against nine HPV types, including the two most dangerous (16 and 18) and five others that cause 90% of cervical cancers.

It works best when given before exposure. That’s why the CDC recommends routine vaccination for all kids at age 11 or 12. But it’s still effective up to age 45. Even if you’re older and sexually active, the vaccine can protect against types you haven’t caught yet.

Two doses are enough for kids under 15. Three doses are needed if you start after age 15. The vaccine doesn’t treat existing infections - but it stops new ones. And it doesn’t just prevent cervical cancer. It also protects against cancers of the anus, throat, penis, and vagina.

Global efforts are accelerating. The WHO’s 90-70-90 targets aim for 90% of girls vaccinated by age 15, 70% of women screened by 35 and 45, and 90% of abnormal cases treated. If we hit those goals, we could prevent 62 to 77 million cervical cancer cases over the next century.

What Happens If Your Test Is Positive?

A positive HPV test doesn’t mean you have cancer. It means the virus is there. Most of the time, your immune system clears it. But if it’s still there after a year, or if you test positive for HPV 16 or 18, your doctor will likely recommend a follow-up.

Here’s how triage usually works:

• If you test positive for HPV 16 or 18: You’ll get a colposcopy - a closer look at the cervix with a magnifying tool - even if your Pap test looks normal.
• If you test positive for other high-risk types: You’ll get a Pap test as a follow-up. If that’s abnormal, you’ll move to colposcopy.
• If both tests are normal: You’ll wait five years for your next HPV test.

These steps prevent over-treatment. Not every HPV infection needs intervention. The goal is to catch only the ones that are likely to become cancer.

Why Disparities Still Exist

Despite all this progress, cervical cancer isn’t equally preventable for everyone. Black women in the U.S. are 70% more likely to die from cervical cancer than White women. In low-income countries, only 19% of women have ever been screened - compared to 80% in high-income nations.

Access is the problem. Cost. Transportation. Fear. Lack of providers. Self-testing helps, but it’s not enough. We need clinics in rural areas. Mobile units. Community outreach. Insurance coverage without copays. And education that reaches people who’ve never heard of HPV.

The good news? We have the tools. We just need to deliver them.

What’s Next? AI, Longer Intervals, and Global Equity

The future of cervical cancer prevention is here. In January 2023, the FDA approved Paige.AI - an AI system that analyzes Pap smears faster and more accurately than human pathologists. It’s already being used in some hospitals.

Research also suggests we might be able to stretch screening intervals even longer. A 2023 study found that after two negative HPV tests six years apart, the risk of serious disease was so low, it might be safe to wait 10 years for the next screen.

And globally, the push for equity is gaining momentum. Countries like Rwanda have vaccinated over 90% of eligible girls. Australia is on track to eliminate cervical cancer by 2035. The U.S. has cut cervical cancer rates by half since the 1970s - but we’re not done.

The goal isn’t just to reduce cancer. It’s to erase it. And with the right combination of vaccination, screening, and access, we can.