Can we eliminate cervical cancer?

A whole lot of hope, and some work.

Cancer finds all of us. A name or an experience has probably already popped into your mind. It’s the second leading cause of death in the U.S., and progress feels like it’s coming in inches.

But what if we could eliminate one cancer?

After 40 years of slow progress, it’s starting to happen with cervical cancer. It could become the first cancer we drive from a major public health threat down to something rare—what the WHO calls elimination, fewer than four cases per 100,000 women.

Last week, the world got the news that, between 2020-2024, researchers could not find one woman aged 20–24 who died of cervical cancer in England. A finding like this has never happened before.

Age-specific scatter plots of crude mortality rates by year of death, including smoothed curves and predicted rates for unvaccinated women. Figure from Sasieni and Falcaro, The Lancet

Here are five reasons this news is miraculously hopeful, and why it still comes down to us.

1. We finally have proof at the bar that matters most

The cervical cancer story began with Harald zur Hausen’s then-radical 1980s claim: a virus (not lifestyle) causes cervical cancer. This prompted researchers to design a vaccine. It won him a Nobel Prize.

For decades, the vaccine trials could only measure persistent human papillomavirus (HPV) infection and pre-cancer, because cancer itself takes decades to develop. But it was highly effective against these markers. As soon as we learned this, it would have been indefensible to keep a placebo group from receiving the vaccine for decades in order to measure the vaccine’s impact on cancer. But the lack of a trial to demonstrate a direct effect on mortality led to doubt, falsehoods, and rumors among some.

Now the evidence is in: the HPV vaccine prevents mortality. And thankfully, we didn’t delay a placebo group all these years, as it would have resulted in millions of preventable deaths worldwide.

2. This virus hands us a winnable fight

Most cancers are caused by a tangle of genes, environment, age, and bad luck. Cervical cancer is the rare exception because nearly all cases (99%) trace back to one thing: persistent infection with high-risk strains of HPV.

That single-cause structure is what makes elimination thinkable at all. Block the virus and you block the cancer, years before it could ever start. And because HPV is so common—roughly 80% of unvaccinated people will catch it at some point—vaccinating an entire generation also starves the virus of hosts, protecting even people who weren’t vaccinated.

3. Evidence holds up from every angle

A claim this big has to survive every challenge. This one does.

1. “Increased survival is from screening rather than the vaccine.” Screening does save lives. However, in 2004, England raised the routine screening age by five years, from age 20 to age 25, thereby reducing screening among young women. The study found zero deaths anyway.

2. “It’s a statistical fluke.” There truly were zero cases of cervical cancer in this group, but researchers noted not to expect zero cases every year because of statistical uncertainty. Regardless, the “worst case” scenario is an 85% reduction in mortality. The vaccine’s impact is not a statistical fluke.

3. “It’s just less sex.” If changes in sexual behavior could explain away these findings and it were true people were having less sex, one would expect that other sexually transmitted infections would also be disappearing. However, as the researchers point out, England at this time saw only modest changes in other STIs in this exact age group.

4. One dose may be all it takes

For years, the vaccine was given in two or three doses. But mounting evidence, now spanning trials and long-term follow-up across multiple countries, shows that a single dose provides protection comparable to multi-dose schedules for cervical cancer. (For other HPV-related cancers, maybe, but we need more data.)

The evidence is so compelling that WHO has now endorsed single-dose schedules partly for these reasons, and several countries have switched. The hardest part of HPV vaccination has been getting adolescents, especially in the countries that bear most of the cervical cancer burden, to come back for repeat visits. A one-shot schedule with comparable effectiveness eases access and makes eliminating cervical cancer a real possibility for many countries.

5. What we’ve seen is a fraction of what’s coming

This study modeled that about 23 deaths should have occurred in that youngest group, and across all young women, the program has already prevented close to 200 cervical cancer deaths in England. This seems small, but what we are seeing is the leading edge of a wave that builds for decades. Cervical cancer rarely strikes women in their early 20s; the disease takes decades to develop and normally peaks in a woman’s 30s, 40s, and 50s.

This is also bigger than cervical cancer. HPV drives cancers of the throat, anus, and elsewhere—and HPV-related throat cancers are rising, particularly in men. That’s why vaccination now includes boys, too. The fact that one virus causes nearly all cases of cervical cancer is exactly what makes it so beatable.

Now comes the hard part

Equally important to celebrating progress is realizing that the hard work is not done. Having a vaccine does not mean everyone gets vaccinated.

England reached this milestone on roughly 90% uptake. As of 2024, 79% of adolescent girls and 77% of boys in the U.S. have received at least one dose. This seems high (it is high), but those numbers hide enormous gaps. For example, adolescent girls with at least one dose range from 85% in Massachusetts to 57% in Mississippi. Adolescents living in rural areas, uninsured children, and those from lower-income families are all vaccinated at significantly lower rates. The HPV vaccine can only eliminate cancer for these individuals if it reaches them.

Source: https://www.kff.org/womens-health-policy/the-hpv-vaccine-access-and-use-in-the-u-s/

Vaccine hesitancy is rising, and the policy environment is unstable. Communities with the lowest vaccination rates often have the least access to professionals who build confidence to vaccinate and catch cervical cancer early. This is a problem that compounds without action.

If you are a parent or have kids or adolescents in your life, ask about the HPV vaccine. If you work in health care, remember your recommendation remains the most important predictor of vaccine acceptance. And if you live in a community with low uptake, advocate for better access, talk to your leaders and policymakers to ensure everyone has the opportunity to be vaccinated.

Bottom line

Cancer finds everyone, whether directly or through a loved one. But now, for cervical cancer, it doesn’t have to. This is a huge win for women’s health, with extraordinary potential. But it still comes down to us.

Love, YLE and DH

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David Higgins, MD, MPH, is a practicing pediatrician and public health physician whose work focuses on vaccine delivery, health policy, and communication. He publishes the newsletter Community Immunity, where he writes about vaccines and public health. When he’s not seeing patients or writing, he’s coaching youth soccer or exploring the outdoors with his family. Find him on LinkedIn and Instagram.

Your Local Epidemiologist (YLE) comprises a team of experts, ranging from physicians to immunologists to epidemiologists to nutritionists, working together with one goal: to “translate” ever-evolving public health science so that people are well-equipped to make evidence-based decisions. YLE suite of newsletters reaches over 475,000 people across more than 132 countries. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below: