Cervical cancer is almost entirely preventable, yet WHO estimates it is the fourth most common cancer in women worldwide, and around 90% of deaths occur in low- and middle-income countries. Sub-Saharan Africa has some of the highest rates. In 2020, WHO launched a global strategy to eliminate cervical cancer as a public health problem. Nurses and midwives are at the heart of it: they vaccinate, screen and treat.
The 90-70-90 targets for 2030
- 90% of girls fully vaccinated against HPV by age 15.
- 70% of women screened with a high-performance test by age 35, and again by 45.
- 90% of women with pre-cancer treated, and 90% with invasive cancer managed.
The cause: HPV
Almost all cervical cancers are caused by persistent infection with high-risk types of human papillomavirus (HPV), a common sexually transmitted virus. Most infections clear on their own, but persistent infection can cause pre-cancerous changes that, over 10–20 years, may become cancer. Women living with HIV are around six times more likely to develop cervical cancer and need more frequent screening.
Prevention: HPV vaccination
WHO recommends HPV vaccination for girls aged 9–14, and since 2022 has said a single dose can provide comparable protection. Many African countries, including Nigeria (which introduced HPV vaccine in 2023), have rolled it out. Nurses can counter misinformation by explaining that the vaccine is safe, does not affect fertility, and prevents cancer.
Screening methods
| Method | How it works | Notes |
|---|---|---|
| HPV DNA testing | Detects high-risk HPV in a sample | WHO’s preferred primary screening test; can use self-collected samples |
| VIA (visual inspection with acetic acid) | Dilute vinegar applied to the cervix; abnormal areas turn white | Low cost, immediate result, done by trained nurses; less accurate than HPV testing |
| Cytology (Pap smear) | Cells examined under a microscope | Needs laboratory capacity and follow-up visits |
How often?
- General population: WHO suggests HPV DNA screening starting at age 30, every 5–10 years.
- Women living with HIV: starting at age 25, every 3–5 years.
Screen and treat
Where follow-up is difficult, WHO recommends a screen-and-treat approach: screen and, if positive (and eligible), treat on the same visit or soon after. Treatment of pre-cancerous lesions with thermal ablation or cryotherapy is quick, effective and can be done by trained nurses. Larger lesions may need LEEP (loop excision). Women with suspected cancer need urgent referral.
The nurse’s role
- Educate women in antenatal, family planning, HIV and outpatient clinics, and in communities, churches and mosques.
- Address fears: embarrassment, pain, cost, belief that screening is only for women with symptoms.
- Offer self-sampling where available: many women prefer it.
- Ensure privacy and dignity, and offer a female provider where requested.
- Track results and follow-up: screening only works if positives are treated.
Symptoms that need prompt referral
Bleeding after sex, between periods or after menopause; unusual or foul-smelling discharge; pelvic or back pain. These need examination, regardless of screening history.
Related: Breast cancer awareness · HIV care · How to become an oncology nurse
Based on the WHO Global Strategy to Accelerate the Elimination of Cervical Cancer (2020), WHO guidelines for screening and treatment of cervical pre-cancer lesions (2021), and WHO HPV vaccine position paper (2022). Educational content: follow national guidelines.