In South Africa, in 2005-06, 100% of primary health care clinics in South Africa had health professionals trained to conduct Pap smears, yet the screening rate was only 1.3% and one in 26 women develop cervical cancer during their lifetime. Many women admitted to oncology wards are at such an advanced stage of disease that palliation is the only treatment option left. The purpose of this qualitative study in 2007, using semi-structured interviews with 15 women with advanced cervical cancer, was to understand the routes they followed from first signs and symptoms of disease to receiving treatment. The willingness of the women to be diagnosed was a positive finding of the study. The women did seek treatment, often more than once, and were not solely responsible for presenting late. The average number of months from first contact with a health care professional until diagnosis was 17.3, ranging from 11.8 months for urban participants to 28.4 months for rural participants, and three to seven months from diagnosis to referral for treatment. Lack of knowledge and awareness among health care professionals resulted in a low suspicion of cancer and misdiagnosis. A national cervical cancer strategy, including health education and re-training of health professionals, should be made a priority.