Silence, stigma, and survival: The hidden face of cervical cancer

When I first told my mother about the subject of this story — cervical cancer — she innocently asked if it meant cancer of the neck. Her question left me stunned, as it reflected the lack of awareness about a disease that threatens the lives of women despite not being caused as a result of their choices or failings. I sat frozen, looking at my laptop screen, where the statistics stared back at me. Among Pakistani women of all ages, cervical cancer is the third most common cancer, and the second most common among those aged 15 to 44.

That brief exchange with my mother was a demonstration of both the lack of discussion and knowledge surrounding women’s health in Pakistan. It was only a few years ago that the word menstruation surfaced in mainstream conversations. Cervical cancer, by contrast, still lurks in the shadows.

According to the National Institutes of Health, the cancer develops in the cervix — a narrow, lower part of the uterus — and is primarily caused by the Human Papillomavirus (HPV), a sexually transmitted infection. Symptoms like irregular bleeding or pelvic pain appear only after the cancer has advanced, which is why, as Dr Rozilla Khan — gynecological oncologist at the Aga Khan University Hospital — explains, "Almost 40% to 60% of patients cannot be cured, as the disease has already spread elsewhere.”

Every year, more than 5,000 Pakistani women are diagnosed with cervical cancer and nearly 3,200 of them die as a result, as stated in the Human Papillomavirus and Related Cancers, Fact Sheet 2023. However, as with many other women’s health issues, the urgency to address this condition remains minimal, with stigma, financial burden, and geographical gaps contributing to the silence around it.

There is a profound lack of awareness among women in our country regarding their own health, as reflected in my interaction with my mother. According to a study — conducted from December 2021 to March 2022 at a public sector hospital in Karachi and published by the South Asian Journal of Cancer — found that while 41.2% of women hadn't even heard of cervical cancer, only 1.8% knew about the HPV vaccine. Another research — published by ecancermedicalscience in April 2025 and held across Pakistan and Afghanistan — showed a similarly dismal state of knowledge: merely 22.6% women answered basic questions on cervical cancer correctly, and only 15.5% possessed knowledge about the vaccine.

Public health experts warn that these numbers may be understatements. "The official data is unreliable," says Dr Sharaf Shah, executive director at the Bridge Consultants Foundation. "Women often hide their suffering because of stigma, preferring to see a hakim rather than a doctor."

In Pakistan, conversations around sexual health rarely leave hospital corridors. Hence, much of the stigma tied to cervical cancer arises from where it occurs in the body and its link to sexual transmission

“Once a woman’s married life begins, so does her sexual history — and that’s when HPV risk begins,” notes Dr Sheeba Irum, consultant gynaecologist and medical director at DSI Hospital. “But in public hospitals, many women don’t know what HPV is, what a Pap smear does, or even which doctor they should go to. Poverty makes it worse. They wait at home until symptoms become unbearable.”

In a 2008 study published by the Asian Pacific Journal of Cancer Prevention, revealed that only 2.6% of women had ever undergone a Pap smear, compared with over 80% of women in the United States within a three-year span. Alarmingly, 95% of the Pakistani women — surveyed at the Fatima Memorial hospital in Lahore for the aforementioned study — said a doctor had never even suggested they undergo one.

Seventeen years later, little has changed. “The invasive nature of the test itself often discourages women,” explains Dr Khan. The procedure involves placing a small medical instrument to gently open the vaginal area and then using a brush or spatula to collect a few cells from the cervix.

Often, however, patients presenting with irregular bleeding — a prominent symptom of cervical cancer — are prescribed only medication, bypassing essential screening. "I've had patients who've come from rural parts of Sindh, Gilgit Baltistan and other under-developed areas who've never had this test done," she adds.

The HPV test may also be done to detect the actual virus responsible for cervical cancer, especially the high-risk strains like HPV 16 and 18. But in Pakistan, Dr Khan says, very few women have access to it.

"The test itself costs around Rs4,000 to Rs6,000, which is beyond the reach of most patients, and our healthcare system is already overburdened. In busy clinics, doctors often don’t even perform basic pelvic exams, let alone recommend an HPV test.”

The public health sector in Pakistan has long been marred by the perils of class differences that not only exist between urban and rural communities, but also within the urban class itself. Lack of resources for diagnosis and screening exacerbates the persistent stigma in rural areas. Meanwhile, the monopoly on the scarce availability of tests in urban cities reinforces the delay in diagnosis due to cost constraints.

Once the disease has been acquired, various treatments are available to address different stages. Early cancers may be removed with surgery on the cervix, but later stages require radical hysterectomy — the removal of the uterus and surrounding tissues — or a combination of chemotherapy and radiation. “Chemo and radiation bring their own suffering: weak bones, chronic pain, loss of fertility,” Dr Khan notes. For recurrent disease, even parts of the bowel or bladder may be removed.

Vulnerable populations

Nevertheless, the gaps in access and awareness do not just affect women in rural or lower-income urban settings — they also leave certain high-risk groups especially vulnerable. As founder of a non-profit, Dr Shah highlights how the risk of infection extends beyond conventional patient populations to transgenders and sex workers.

To understand the burden of HPV, six staff members at the Bridge Consultants Foundation screened about 250 female sex workers, identifying 35 as high-risk and referring them for further investigations.

Furthermore, human immunodeficiency virus (HIV) is a prevalent infection among sex workers as they often have a higher number of sexual partners. When present alongside HPV, it significantly increases the risk of cervical cancer because the immune system cannot clear HPV infections effectively, according to Dr Shah.

Tragically, cervical cancer is almost entirely preventable, while the silence around it is harrowing. It makes us complicit in every case that sees a patient succumbing to the disease, as it speaks to the little significance we place on research around women’s health, shrouded in the lack of awareness, access, and timely care.

Cervical cancer and other HPV-related diseases can be prevented by vaccination — yet in our culture, even this life-saving measure remains hush-hush. Stigma surrounds not just the disease, but its prevention, and sadly, the latter is far worse. With awareness, the disease could often be avoided entirely, but cultural and religious myths around vaccination continue to drag our healthcare system back into the dark ages.

The HPV vaccine, first approved by the US Food and Drug Administration (FDA) in 2006, was quickly adopted in many high-income countries, becoming a standard part of national immunisation programmes for girls and, later, boys. Cervarix followed in 2009, expanding protection against the highest-risk strains.

"Cervical cancer is a terrible blow for women. Prevention is always better than cure, and vaccination offers that chance," notes Dr Khan.

HPV vaccination campaign

Almost two decades later, Pakistan is set to kick off its first HPV vaccination campaign across all provinces from September 15 to 27. The scope is still limited, though — it currently aims to reach girls aged nine to 14, with the ambitious goal of vaccinating 90% of them — roughly 3.7 million — in just 12 days. "The target is based on census data, and vaccines will be supplied to districts accordingly," explains Suneel Raja, urban immunisation officer at UNICEF.

The safety of the vaccine can be determined by its successful rollout in developed countries, which have documented a dramatic reduction in cervical cancer cases following vaccination. Sweden reported a 90% reduction among women vaccinated before age 17; US data shows an 80% decline in precancerous lesions among young women.

However, when a vaccine is linked to a sexually transmitted infection, it could be seen as suspicious, unnecessary, or even immoral. This is why Dr Khan urges revising the framing of the disease to curb hesitancy. "My professor always stressed that HPV must be de-stigmatised from sexual behaviour – it spreads through skin-to-skin contact, and the way we deliver that message matters just as much as the message itself," she shares.

Speaking to Geo.tv, Dr Raj Kumar, project director of the Expanded Programme on Immunisation, admits to stigma associated with the infection and how it translates into their struggles for a successful vaccine roll-out. "This is a new initiative, so naturally, people have questions. Many haven’t even seen cervical cancer patients up close. To promote vaccination, we need to involve all stakeholders and engage communities at every level,” calling on cooperation from teachers, district teams, and civil societies.

“People need to understand why the vaccine is necessary, what the consequences of the disease are, and how it can be prevented,” he adds.

WHO consultant Dr Afshan Isani doubles down on the importance of advocacy, which she still believes is “[the campaign’s] weak point.”

“With immunisation programmes, we don’t usually address sexual and reproductive health directly, but HPV is part of that conversation whether we acknowledge it or not,” she adds.

Dr Shah advocates for active involvement of NGOs and general physicians to spread awareness among mothers, fathers, and out-of-school girls due to the already existing trust factor. “A lot of things cannot be done without NGOs. If you want to work with sex workers, there are legal, moral, and religious issues that cannot be addressed without [our intervention].”

Why women carry weight of reproductive health alone?

While the campaign to vaccinate young girls is undoubtedly a landmark step, its framing of HPV as a distinctly female burden is telling. By focusing exclusively on adolescent girls, the programme implicitly positions women as the sole carriers of responsibility for prevention, while leaving men — often the asymptomatic transmitters of the virus — entirely out of the equation. This gendered approach risks reinforcing an old narrative: that women must shoulder the weight of reproductive health, even when the disease in question is spread by both sexes.

“For this, awareness is key. We need to launch campaigns, go into schools and universities, even set up camps in local communities,” Dr Sheeba notes. “And it shouldn’t just be girls — we must reach boys’ colleges as well. Wherever we are, we should be talking about it. People need to understand that this is an important issue.”

Thus, Dr Raj reassures that from January 2026, HPV vaccination will be integrated into routine immunisation and eventually expand into vaccinating boys as well. “The more the community goes into a preventive mode, the less the economic burden will be. The load of infectious diseases on hospitals will be reduced. We are going to campaign for all these things. God willing, it will be beneficial,” he says.

“This campaign is the trigger point,” Dr Afshan notes. “We cannot stop after the campaign. Awareness must happen at every level — healthcare workers, teachers, communities, and allied departments like education and religious affairs. We need teacher champions, schoolgirl champions, and our medical fraternity to speak openly. That’s how we normalise these conversations.”

For the WHO rep, the mission is personal as well as professional: “Being a mother of two daughters, this issue is very close to my heart. I look forward to vaccinating my own girls — what I practice, I should preach.”

Cervical cancer is not a death sentence — and it shouldn’t be framed as such. It is preventable, treatable, and yet devastatingly common in Pakistan. The silence around it has already cost too many lives. Breaking that silence, through awareness, vaccination, and inclusion of both women and men in prevention, is not just a medical necessity but a moral one.

Bazigah Murad is a journalist passionate about uncovering societal issues, cultural dynamics, and the nuanced portrayal of women in South Asia. She can be reached via email at [email protected]

Header and thumbnail illustration via Canva