Real-World Evidence: HPV Vaccination Is Driving Down Cervical Cancer

Why it took twenty years to see this

The HPV vaccine was introduced in 2006. Almost immediately, studies showed it prevented the infections it targets. Then studies showed it prevented precancerous cervical changes.

What nobody could show for a long time was the thing that matters most: fewer deaths. That is not a weakness in the evidence. It is arithmetic. An HPV infection takes years, often decades, to become cervical cancer. Girls vaccinated in 2006 were not old enough to appear in cancer death statistics until recently.

That gap has now started to close.

What the JAMA study found

Researchers at the Medical University of South Carolina's Hollings Cancer Center looked at cervical cancer deaths in U.S. women under 25 — the age group most likely to have been vaccinated, and old enough that some deaths do occur.

MUSC reported their finding: a 62% drop in cervical cancer deaths in that group over the last decade. Senior author Ashish Deshmukh said the team could not identify another reason that would produce a decline that sharp.

The raw counts are small, which is what you would expect for a rare cancer in young women, and they are stark. In the 1992 to 1994 block there were 55 cervical cancer deaths nationally in women under 25. By 2013 to 2015 there were 35. In the 2019 to 2021 block there were 13.

The study covered 1992 to 2021 and was published in JAMA. A woman who was 25 in 2021 would have been 10 years old when the vaccine arrived — which is the point of choosing that age group.

How the vaccine works

HPV is a family of more than 200 related viruses. About 40 spread through direct sexual contact, and roughly a dozen of those can cause cancer — of the cervix, anus, oropharynx, penis, vulva, and vagina.

NCI describes Gardasil 9, the vaccine used in the United States, as covering nine types. Two of them, HPV 16 and 18, cause about 70% of cervical cancers and a higher share of some of the other HPV-driven cancers. Two more, types 6 and 11, cause about 90% of genital warts. Five further high-risk types make up the rest.

The vaccine is built from virus-like particles: the outer shell of the virus, assembled without any viral DNA inside. They cannot cause infection, but they look enough like the real virus that the immune system produces antibodies against them. Those antibodies block HPV from infecting cells later.

Two consequences follow. Protection is best given before exposure, because the vaccine prevents infection rather than treating one. And, as NCI puts it, the vaccine does not treat existing HPV infection or disease.

NCI reports that protection against the targeted types has now lasted more than a decade in follow-up.

Who it is recommended for

NCI relays the CDC's recommendations. HPV vaccination is routinely recommended at age 11 or 12 and can begin at 9. It is recommended for everyone through age 26 who was not adequately vaccinated earlier.

For adults aged 27 through 45, the vaccine is FDA-approved but not routinely recommended. NCI's explanation is direct: it provides less benefit in that age range because more people have already been exposed. It remains a conversation worth having with a clinician.

NCI also notes that researchers have reported evidence that a single dose gives protection against vaccine-type infection that is not inferior to two doses.

When to get checked

Vaccination and screening do different jobs, and one does not replace the other. NCI is explicit: because the vaccine does not cover every cancer-causing HPV type, vaccinated women should follow the same cervical screening recommendations as everyone else.

Separately, see a clinician about any of these, whatever your vaccination or screening history:

• Bleeding between periods, after sex, or at any time after menopause.
• Vaginal discharge that is new, persistent, watery, or bloody.
• Pelvic pain, or pain during sex, that keeps recurring.
• Any abnormal screening result you have not had followed up.

Bleeding after menopause is the one to act on quickly. It has several possible causes, most of them not cancer, and all of them worth identifying. Our page on cervical cancer screening sets out the tests and intervals.

The gap that is still open

The American Cancer Society projects about 13,490 new cervical cancers in the United States in 2026 and about 4,200 deaths; SEER publishes that forecast alongside its own measurements, which put the median age at diagnosis at 50. About 41% are found while still confined to the cervix, where five-year relative survival is 91.8%. That falls to 64.0% when the cancer has reached nearby nodes and 20.5% once it has spread further. Across all stages it is 68.8%.

Those are group averages from women diagnosed years ago, and they describe a population rather than a person. They also describe a generation largely unvaccinated at the age when it would have counted.

Coverage is the live problem. MUSC's report notes the Healthy People 2030 target of 80% HPV vaccination, and that the CDC reported only about 60% of 13-to-15-year-olds had received the recommended doses. Deshmukh called the post-pandemic decline in uptake troubling, because falling coverage means smaller gains ahead.

What this does not mean

• A 62% fall in deaths among women under 25 is a striking result in a very small number of deaths. It is consistent with vaccination working, and it is one study of one age group in one country.
• Ecological studies compare populations over time. They cannot prove that any individual death was prevented, only that the pattern shifted after the vaccine arrived.
• It does not mean cervical screening can stop. The vaccine misses some cancer-causing types, and most adults today were not vaccinated in time.
• And it does not mean cervical cancer is over. It kills thousands of women in the United States every year, most of them well past the age group this study looked at. Our pages on the HPV vaccine and HPV and cancer cover the rest.

Sources

• JAMA: Cervical Cancer Mortality Among US Women Younger Than 25 Years, 1992-2021, PMID 39602175 — record retrieved via NCBI eutils
• MUSC Hollings Cancer Center: Cervical cancer deaths in young women plummet after introduction of HPV vaccine
• NCI: Human Papillomavirus (HPV) Vaccine Fact Sheet
• NCI SEER Cancer Stat Facts: Cervical Cancer

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

Cancer Explained is published by the National Cancer Information Foundation. It is not medical advice and does not suggest a test or treatment.

See an error, old source, or unclear wording? Tell us.