africa outcomes are often worse as diagnosis is frequently at a latter stage of disease. in a scoping review of publicly-available cervical cancer prevention and control plans from african countries, plans tended to emphasize survivorship rather than early hpv diagnosis and prevention. epidemiology age-standardized death from cervical cancer per 100,000 inhabitants in 2004 no data <2.4 2.4–4.8 4.8–7.2 7.2–9.6 9.6–12 12–14.4 14.4–16.8 16.8–19.2 19.2–21.6 21.6–24 24–26.4 >26.4 worldwide, cervical cancer is both the fourth-most common cause of cancer and deaths from cancer in women. in 2018, 570,000 cases of cervical cancer were estimated to have occurred, with over 300,000 deaths. it is the second-most common cause of female-specific cancer after breast cancer, accounting for around 8% of both total cancer cases and total cancer deaths in women. about 80% of cervical cancers occur in developing countries. it is the most frequently detected cancer during pregnancy, with an occurrence of 1.5 to 12 for every 100,000 pregnancies. australia in 2022, it is estimated that 942 new cases of cervical cancer will be diagnosed in australia. in 2022, it is estimated that a female has a 1 in 180 (or 0.56%) risk of being diagnosed with cervical cancer by the age of 85. in 2020, there were 165 women aged 25–74 who died from cervical cancer, which is a mortality rate of 2 deaths per 100,000 women in the population. over the 5 years 2016–2020, there were 62 aboriginal and torres strait islander women aged 25–74 who died from cervical cancer, which is a mortality rate of 7 deaths per 100,000 indigenous women in the population. over the 5 years 2016–2020, the age-standardised mortality rate among aboriginal and torres strait islander women was 3.8 times the rate of non-indigenous australians. the number of women diagnosed with cervical cancer has dropped on average by 4.5% each year since organised screening began in 1991 (1991–2005). regular twice-yearly pap tests can reduce the incidence of cervical cancer up to 90% in australia, and save 1,200 australian women from dying from the disease each year. it is predicted that because of the success of the primary hpv testing programme there will be fewer than four new cases per 100 000 women annually by 2028. canada an estimated 1,450 canadians will be diagnosed with cervical cancer in 2022. an estimated 380 will die from it. india in india, the number of people with cervical cancer is rising, but overall the age-adjusted rates are decreasing. usage of condoms in the female population has improved the survival of women with cancers of the cervix. european union as of 2022, the world health organization announced that "each year in the who european region more than 66 000 women are newly diagnosed with cervical cancer and more than 30 000 die from this preventable disease. " united kingdom cervical cancer is the 12th-most common cancer in women in the uk (around 3,100 women were diagnosed with the disease in 2011), and accounts for 1% of cancer deaths (around 920 died in 2012). with a 42% reduction from 1988 to 1997, the nhs-implemented screening programme has been highly successful, screening the highest-risk age group (25–49 years) every 3 years, and those ages 50–64 every 5 years. united states an estimated 13,170 new cervical cancers and 4,250 cervical cancer deaths will occur in the united states in 2019. the median age at diagnosis is 50. the rates of new cases in the united states was 7.3 per 100,000 women, based on rates from 2012 to 2016. cervical cancer deaths decreased by approximately 74% in the last 50 years, largely due to widespread pap test screening. the annual direct medical cost of cervical cancer prevention and treatment prior to introduction of the hpv vaccine was estimated at $6 billion. nigeria the nigerian institute of medical research (nimr) reports that 28 nigerian women lose their lives daily due to this disease. this alarming statistic underscores the pressing need for better awareness, prevention, and treatment efforts across the country. numerous nigerian women lack access to these preventive measures. in many regions of the country, screening tests such as pap tests and hpv tests are not easily accessible or affordable history 400 bce: hippocrates noted that cervical cancer was incurable. 1925: hinselmann invented the colposcope. 1928: papanicolaou developed the papanicolaou technique. 1941: papanicolaou and traut: pap test screening began. 1946: aylesbury spatula was developed to scrape the cervix, collecting the sample for the pap test. 1951: first successful in-vitro cell line, hela, derived from biopsy of cervical cancer of henrietta lacks. 1976: harald zur hausen and gisam found hpv dna in cervical cancer and genital warts; hausen later won the nobel prize for his work. 1988: bethesda system for reporting pap results was developed. 2006: first hpv vaccine was approved by the fda. 2015: hpv vaccine shown to protect against infection at multiple body sites. 2018: evidence for single-dose protection with hpv vaccine. epidemiologists working in the early 20th century noted that cervical cancer behaved like a sexually transmitted disease. in summary: cervical cancer was noted to be common in female sex workers. it was rare in nuns, except for those who had been sexually active before entering the convent (rigoni in 1841). it was more common in the second wives of men whose first wives had died from cervical cancer. it was rare in jewish women. in 1935, syverton and berry discovered a relationship between rpv (rabbit papillomavirus) and skin cancer in rabbits (hpv is species-specific and therefore cannot be transmitted to rabbits). these historical observations suggested that cervical cancer could be caused by a sexually transmitted agent. initial research in the 1940s and 1950s attributed cervical cancer to smegma (e.g. heins et al. 1958). during the 1960s and 1970s it was suspected that infection with herpes simplex virus was the cause of the disease. in summary, hsv was seen as a likely cause because it is known to survive in the female reproductive tract, to be transmitted sexually in a way compatible with known risk factors, such as promiscuity and low socioeconomic status. herpes viruses were also implicated in other malignant diseases, including burkitt's lymphoma, nasopharyngeal carcinoma, marek's disease and the lucké renal adenocarcinoma. hsv was recovered from cervical tumour cells. a description of human papillomavirus (hpv) by electron microscopy was given in 1949, and hpv-dna was identified in 1963. it was not until the 1980s that hpv was identified in cervical cancer tissue. it has since been demonstrated that hpv is implicated in virtually all cervical cancers. specific viral subtypes implicated are hpv 16, 18, 31, 45 and others. in work that was initiated in the mid-1980s, the hpv vaccine was developed, in parallel, by researchers at georgetown university medical center, the university of rochester, the university of queensland in australia, and the u.s. national cancer institute. in 2006, the u.s. food and drug administration (fda) approved the first preventive hpv vaccine, marketed by merck & co. under the trade name gardasil. in november 2020, the world health organization, under backing from the world health assembly, set out a strategy to eliminate cervical cancer by 2050. the strategy involves vaccinating 90% of girls by the age of 15, screening 70% of women by the age of 35 and again by the age of 45, and treating 90% of women identified with cervical disease. society and culture australia in australia, aboriginal women are more than five times more likely to die from cervical cancer than non-aboriginal women, suggesting that aboriginal women are less likely to have regular pap tests. there are several factors that may limit indigenous women from engaging in regular cervical screening practices, including sensitivity in discussing the topic in aboriginal communities, embarrassment, anxiety and fear about the procedure. difficulty in accessing screening services (for example, transport difficulties) and a lack of female gps, trained pap test providers and trained female aboriginal health workers are also issues. the australian cervical cancer foundation (accf), founded in 2008, promotes 'women's health by eliminating cervical cancer and enabling treatment for women with cervical cancer and related health issues, in australia and in developing countries.' ian frazer, one of the developers of the gardasil cervical cancer vaccine, is the scientific advisor to accf. janette howard, the wife of the then-prime minister of australia, john howard, was diagnosed with cervical cancer in 1996, and first spoke publicly about the disease in 2006. united states a centers for disease control and prevention public service announcement about cervical cancer health disparities in the united states. a 2007 survey of american women found 40% had heard of hpv infection and less than half of those knew it causes cervical cancer. over a longitudinal study from 1975 to 2000, it was found that people of lower socioeconomic census brackets had higher rates of late-stage cancer diagnosis and higher morbidity rates. after controlling for stage, there still existed differences in survival rates. lgbtq populations transgender men and gender-diverse people who have a cervix (even if partially intact) or have a prior history of cervical cancer or precancerous conditions, and are age 21 or older who has ever had sex with anyone need to get screened for cervical cancer. transmasculine people are just as likely as cisgender women to have cervical cancer, but are less likely to undergo cervical screening, because of dysphoria, gender disaffirmation or disempowerment of the individual by healthcare providers, or being misinformed of hpv and cervical cancer risks as well as many healthcare providers perceiving transmasculine individuals to be at low risk of cervical cancer. transgender women who have not had bottom surgery have no risk of cervical cancer, as they do not have a cervix. trans women who have had bottom surgery to create a vagina (vaginoplasty) and possibly a cervix, are at a very small risk to develop cancer in the tissues of their neo-vagina or neo-cervix as these tissues are made up of different cells than a cervix in a cisgender woman cervical cancer screening is not necessary in trans women who have undergone vaginoplasty because they do not have a cervix. intersex people with a cervix are also able to have cervical cancer.