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Human Papillomavirus

HPV is so common that most people get it at some time in their lives and is usually asymptomatic making it often difficult to tell whether you have it. For most women, HPV will go away on its own; however, if it does not there is a chance that over time it may cause cervical cancer.

There are many types of sexually transmitted human papillomaviruses:

• High-risk HPV types can infect cervical cells and cause cervical cancer. They can also infect certain other cells to cause anal cancer, penile cancer, vaginal cancer, vulvar cancer, and oropharyngeal cancer (cancer in the middle of the throat, including the tonsils and the back of the tongue).

• Low-risk HPV types can cause genital warts. These are warts on the external and internal sex organs and glands. Genital warts do not turn into cancer.

Smoking may increase the risk that an PV infection will persist and develop into cervical cancer. So if you smoke and have an abnormal Pap or HPV test result, it is especially important to stop smoking.

HPV infections are common and most people who are sexually active will have an HPV infection at some point and never know it. HPV infections can be spread through skin-to-skin contact, including vaginal, anal, and oral sex. Although condoms can lower the risk of an HPV infection, they do not protect against them completely.

Most HPV infections, even with high-risk types, go away on their own without causing problems. They are fought off by the body’s immune system. However, sometimes infections with high-risk HPV types do not go away. When a high-risk HPV infection of cervical cells lasts many years, the cells can become abnormal. These changes can get worse over time and may become cervical cancer. Although there is currently no way to treat and HPV infection, cervical cancer can be prevented by detecting and removing abnormal cervical cells before they become cancer.

The most important thing you can do to help prevent cervical cancer is to get vaccinated early and have regular screening against HPV. The HPV vaccine protects against the types of HPV that most often cause cervical, vaginal, and vulvar cancers.

• HPV vaccination is recommended for preteens aged 11 to 12 years, but can given starting at age 9

• HPV vaccine also is recommended for everyone through age 26 years, if they are not already vaccinated

• HPV vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit, as more people have already been exposed to HPV.

If vaccination is started before age 15, a two-dose schedule is recommended, with the doses given 6 to 12 months apart. For people who start the series after their 15th birthday, the vaccine is given in a series of three shots.

HPV vaccination prevents new HPV infections, but does not treat existing infections or diseases. This is why the HPV vaccine works best when given before any exposure to HPV. You should get screened for cervical cancer regularly, even if you received an HPV vaccine.

Symptoms of Cervical Cancer

Early on, cervical cancer may not cause signs and symptoms. Advanced cervical cancer may cause bleeding or discharge from the vagina that is not normal for you, such as bleeding after sex. If you have any of these signs, see your doctor. They may be caused by something other than cancer, but the only way to know is to see your doctor.

Screening for Cervical Cancer

Two screening tests can help prevent cervical cancer or find it early:

• The pap test (or pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.

• The HPV test looks for the virus (human papillomavirus) that can cause these cell changes.

Both tests can be done in a doctor’s office or clinic. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to widen the vagina. This helps the doctor examine the vagina and cervix, and collect a few cells and mucus from the cervix and the are around it. The cells are sent to a laboratory.

• If you are getting Pap test, the cells will be checked to see if they are normal

• If you are getting an HPV test, the cells will be tested for HPV.

When to get screened

Screenings such as the Pap test should start at age 21. If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test. For those age 30 to 65, talk to your doctor about which testing option is right for you:

• A Pap test only. If your result is normal, your doctor may tell you that you can wait three years until your next Pap test

• An HPV test only. This is called primary HPV testing. If your result is normal, your doctor may tell you that you can wait five years until your next screening test.

• An HPV test along with the Pap Test. This is called co-testing. If both of your results are normal, your doctor may tell you that you can wait five years until your next screening test.

For those age 65 and older your doctor may tell you that you don’t need to be screened anymore if:

• You have had normal screening test results for several years or

• You have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids.

Preparing for your Pap or HPV Test

You should not schedule your test for a time when you are having your period. If you are going to have a test in the next two days -

• You should not douche (rinse the vagina with water or another fluid)

• You should not use a tampon

• You should not have sex

• You should use a birth control foam, cream, or jelly

• You should not use a medicine or cream in your vagina.

Screening Results

It can take as along as three works to receive test results from a routine Pap or HPV screening. For a Pap test, results can be normal, unclear, or abnormal. A normal (or negative) result means that no cell changes were found on the cervix. This is good news, but screening should still be conducted regularly as new cell changes can still form in the future. Your doctor may tell you that you can wait three years for your next screening test if you received a Pap test only. If you also received an HPV test, and the result is negative, your doctor may tell you that you can wait five years for your next screening.

An unclear test result is common, and simply means that your cervical cells look like they could be abnormal, however it is not clear if it’s related to HPV or cervical cancer as other life changes like pregnancy, menopause, or infection can also produce in an unclear test result. The HPV test can help find out if your cell changes are related to HPV and your doctor will often order an HPV test in response to an unclear test result.

An abnormal result means that cell changes were found on the cervix. This usually does not mean that you have cervical cancer as abnormal changes on your cervix are likely caused by HPV. The changes may be minor (low-grade) or serious (high-grade). Most of the time, minor changes go back to normal on their own, however more serious changes can turn into cancer if they are not removed. The more serious changes are often called “precancer” because they are not yet cancerous, but they can turn into cancer over time. In rare cases, an abnormal Pap test can show that you may have cancer. You will need other tests to be sure, and the earlier you find cervical cancer, the easier it is to treat.

HPV Screening

An HPV test result can be positive or negative. A negative HPV test means there is no evidence of HPV and your doctor may tell you that you can wait five years for your next screening. A positive HPV test means that there was HPV detected, however it is important to note that this does not mean you have cervical cancer.

Common Treatment Procedures

When a woman has high-grade cervical cell changes that have a high risk of developing into cancer, healthcare providers will recommend a treatment based on the type of cervical cell changes that are found.

Treatments that remove abnormal cells are excisional treatments:

• Cold knife conization (also called cold knife con biopsy): a scalpel or laser knife is used to remove a cone shaped section of abnormal tissue. This procedure is done at the hospital and require general anesthesia.

• LEEP (Loop electrosurgical excision procedure): A thin wire loop, through which an electrical current is passed, is used to remove abnormal tissue. Local anesthesia is used to numb the area. This procedure is done in your health care provider’s office. It takes only a few minutes, and you will be awake during the procedure.

Treatments that destroy abnormal cells are called ablative treatments:

• Cryotherapy: a special cold probe is used to destroy abnormal tissue by freezing it. This procedure is done in your health care provider’s office. It takes only a few minutes and usually does not require anesthesia.

• Laser therapy: a laser (narrow beam of intense light) is used to destroy abnormal tissue. This procedure is done at the hospital and general anesthesia is used.

Sources:

• CDC - Cervical Cancer Awareness
• American Cancer Society - Cervical Cancer Key Statistics
• American Cancer Society - ACS Guidelines for Prevention and Early Detection of Cervical Cancer
• National Cervical Cancer Coalition
• CDC - Guam — National Breast and Cervical Cancer Early Detection Program (NBCCEDP)