Cervical Cancer Stigma Threatens Screening and Diagnosis

Over the decades, the number of cervical cancer diagnoses and deaths have decreased, thanks to screenings through the Pap test and HPV test. Yet for many women, stigma around cervical cancer and its causes remains a barrier to screening and support.

Stigma around HPV, a Sexually Transmitted Virus

“I think the main reason there’s a stigma around cervical cancer is because of its known association with HPV,” explains Anjalika Gandhi, MD, with ProMedica Physicians Gynecology | Oncology – Sylvania. “HPV is a sexually transmitted virus that most people have been exposed to if they’ve been sexually active.”

Most people with HPV will clear the virus. But sometimes, the virus does not clear, or it lingers. It may also resurface and cause problems, particularly in those who are immunosuppressed.

“As the HPV infection stays, it causes changes in the cell’s DNA that ultimately get integrated into the normal tissue. Once those DNA changes happen, the normal tissues transform into precancerous tissues, and then cancerous tissues,” says Dr. Gandhi.

This doesn’t happen quickly. In fact, it takes years of chronic HPV infections for the tissues to become precancerous. That’s why cervical cancer screenings are so successful at catching changes early and preventing the development of cervical cancer.

According to the Centers for Disease Control and Prevention (CDC), HPV is spread through vaginal, anal or oral sex with someone who has the virus, even if they don’t have signs or symptoms. The CDC says that HPV is so common that nearly everyone will get it at some point in their lives.

“HPV is more ubiquitous than I think women realize,” says Dr. Gandhi. “It’s time to just accept that this is something that affects many people and that patients should feel comfortable sharing it with their physicians. Our physicians and health care providers also need to empower women to share that with them, too.”

Talking about Female Reproductive Health

“Cervical cancer is also related to a female reproductive organ, and I think women are often reluctant to talk about issues related to their female reproductive health,” shares Dr. Gandhi.

Stigma related to women’s bodies contribute to misinformation around cervical cancer screenings.

“There’s a misconception that if you’re not sexually active or you’re not having problems, that you don’t need to go to the gynecologist or an associated women’s health provider, which is absolutely not true,” Dr. Gandhi clarifies.

The American College of Obstetricians and Gynecologists states that how often a person be screened and with which tests depend on the individual’s age and health history. The organization does make these general recommendations:

• Women who are 21 to 29 should have a Pap test alone every 3 years. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred.
• Women who are 30 to 65 have three options for testing. They can have a Pap test and an HPV test (co-testing) every 5 years. They can have a Pap test alone every 3 years. Or they can have HPV testing alone every 5 years.

After 65, the recommendation for screening depends on the woman’s health history, including having had cervical cancer, abnormal cervical cells, and Pap and HPV test outcomes. It’s a decision that should be made after a discussion with a health care provider.

Screening for Cervical Cancer

In addition to stigma around women’s reproductive health, other stigmas can affect cervical cancer screenings. Poor body image and weight stigma can prevent some women from routine exams and screenings. Stigmas around health conditions, such as HIV, can also be a barrier. Some women may even be hesitant to see their provider during their period, even though pelvic exams and cervical cancer screenings can still be performed.

Samples for the HPV test and Pap test are collected the same way, and can be collected at the same time. The health care provider uses a spatula or brush to gently remove cells from the cervix.

An HPV test determines whether a person has an HPV infection. It can also detect if a person has a high-risk HPV strain that is more likely to cause cervical cancer. A Pap test collects a sample of cervical cells to be examined by a pathologist. 

“I like to call it a Pap screening, because it’s not a test with a ‘yes’ or ‘no’ answer. It’s a broad screening that looks at cervical cells for abnormalities,” says Dr. Gandhi.

In addition to looking for precancerous cells, pathologists examine the sample for other abnormalities. Sometimes, an abnormal Pap test result can be reflective of uterine problems or, rarely, even fallopian tube problems. The results of the screening will determine the type of work up that is needed for further evaluation.

The Potential To Eradicate Cervical Cancer

While early stage cervical cancer is decreasing nationwide, the rate of advanced stage cervical cancer has stayed about the same.

“I think that comes down to the fact that we’re stilling having a hard time reaching some people,” says Dr. Gandhi. “We know that people of lower socioeconomic status and people of ethnic minorities do have lower frequency of screenings. That means that if they are diagnosed with cervical cancer, that they’re diagnosed at later stages, which carries a worse prognosis.”

“Most of our efforts at reducing the rates of cervical cancer have been at targeting women who are not coming as frequently for their Pap smears, no matter what that reason may be,” shares Dr. Gandhi. “It may be access to health care, it may be mistrust or a history of bad experiences in the medical system. It may be location.”

Self-collection in a health care setting for HPV tests was approved in May 2024 by the Food and Drug Administration. It certainly can’t replace a medical exam, but may help reduce cervical cancer, particularly in remote areas.

HPV vaccinations, which promote HPV immunity for all genders, can also decrease rates of cervical cancer. The vaccine is recommended for those ages nine to 45, but is most effective in the age range of nine to 26, before the onset of sexual activity.

“Cervical cancer is such a preventable cancer. We can eradicate it because we have vaccination and we have screening,” assures Dr. Gandhi.

How Stigma Hurts Cervical Cancer Patients

For cervical cancer patients, stigma can create a devastating barrier to much-needed support. 

Cervical cancer warning signs include unexpected bleeding, bleeding after intercourse, and bleeding with pelvic pain. These symptoms can be difficult to talk about with medical professionals but especially friends and family. Cervical cancer treatment also has many challenges. A woman may experience toxicity with radiation treatment, have problems with sexual function, and experience a loss of well-being.

“If you've gone through something as rigorous as cervical cancer treatment, you need support. And if you're not comfortable discussing your diagnosis because of the associated stigma, then you're going to be isolated from some of the more social supports that are out there,” says Dr. Gandhi.

Eliminating stigma around women’s reproductive health, HPV and cervical cancer is beneficial for everyone, especially those living with cervical cancer.

“It’s going to help promote more conversations among patients, between patients and their loved ones, and among patients and providers,” says Dr. Gandhi. “We have to accept that HPV and cervical cancer affects a lot more people than we realize. We need to treat it and talk about it like any other chronic health issue.”