April 9, 2018
HPVs (human papillomaviruses) are a group of common viruses for which some are easily sexually transmitted. Several of these viruses cause genital warts while the high-risk HPV types are responsible for the majority of HPV caused cancers.
The National Cancer Institute reports that HPV infects epithelial cells, which cover the inside and outside surfaces of the body, including the skin, the throat, the genital tract, and the anus. HPV related cancers include cervical cancer, vulva cancer, vaginal cancer, penile cancer, anal cancer as well as cancer in the back of the throat including the base of the tongue and tonsils.
HPV is very common with most individuals becoming infected once they first become sexually active. Often, the HPV virus is without symptoms, and many people don't know that they even have it. A person's immune system can generally fight off and eliminate infected cells. However, some people, especially those with a weakened immune system, will have a persistent infection which may cause genetic mutations that can cause precancerous cells, and eventually cancer. HPV cancers are usually symptomless until the cancer has advanced, making it more difficult to treat the cancer effectively.
No clearly defined screening recommendations for all of the HPV associated cancers currently exist. It is important to have routine visits with a dentist and a primary care physician including open and honest discussions about any concerns you may have, and about your sexual history. However, cervical cancer can be detected with routine screening.
Cervical cancer, which occurs in the lower, narrow part of the uterus, was the leading cause of cancer death for women in the United States before screening and early detection. The American Cancer Society estimates that annually in the United States almost 13,000 women will be diagnosed and over 4,000 women will die from the disease.
Risk factors for cervical cancer include:
- sexual activity at an early age
- multiple partners
- tobacco use
- history of sexually transmitted diseases
- weakened immunity
Women, with an HPV infection, who have many children and use oral contraceptives for a long time, are also at an increased risk of cervical cancer.
More than 90% of cervical cancers can be detected early through the use of two screening tests. The Pap test (smear) involves brushing or scraping the cervix and examining these cells to find precancerous and early cancerous lesions. The HPV DNA test evaluates cells collected from the cervix for infection with HPV. This test looks for HPV strains known to cause cervical cancer.
Patients with early cervical cancer may not have symptoms. Women with symptoms of cervical cancer may report abnormal vaginal bleeding or spotting, watery vaginal discharge, bleeding after sex or painful intercourse. With advanced cervical cancers, patients may experience pelvic pressure, unintentional weight loss, pain or leg swelling.
For women with cervical cancer, an initial assessment includes a physical examination, which may involve examining the cervix to look for abnormal cells. However, a punch or cone biopsy is required to establish the diagnosis.
Once a pathologic diagnosis is made, staging studies are performed to determine the extent of tumor spread from the primary site (cervix). In the United States, the pre-treatment evaluation may include a physical examination (office-based or exam under anesthesia), colposcopy (examination of cervix using magnification), laparoscopy (to evaluate lymph node involvement or to transpose ovaries to preserve hormonal function in premenopausal women), cystoscopy or proctoscopy (visualization of the bladder or rectum for suspected involvement) and laboratory assessment. Imaging studies (ultrasound, CT, MRI or PET scans) are useful in delineating the extent of disease and guiding treatment decisions.
Standard treatment options for cervical cancer can include surgery, radiation, chemotherapy and targeted therapy. The types of treatment and combinations of treatment will depend on the location and extent of the cancer.
Doing Your Part
While cervical cancer can be highly curable when the disease is detected earlier, there are still interventions to be maximized to increase the odds. According to the Centers for Disease Control (CDC), nearly half the women diagnosed with cervical cancer never had a cervical cancer screening. Many women cite fear of pain, embarrassment and the lack of knowledge about both the screening and the cancer as reasons why they haven’t had their screening.
The American Cancer Society guidelines recommend a Pap every three years for women ages 21 – 29 regardless if they are sexually active or not. The preferred screening method for women ages 30-65 is the HPV DNA test together with a PAP every five years. An acceptable alternative method for this age group is a Pap every three years. Most women over the age of 65 who have had regular screenings with negative findings will be able to stop screenings; a discussion with their provider can help determine this. Women who have had a hysterectomy, that includes the removal of the cervix, no longer need to be screened if the hysterectomy was not a part of treating previous cervical cancer. Vaccinated women should continue cervical screening. Positive findings may need to be further investigated and change the frequency of testing.
To prevent the spread of HPV, it is essential for parents to vaccinate their minor children and educate their young adult children. HPV vaccines can protect against HPV infections that cause most cervical cancers and are highly effective when given prior to an individual becoming sexually active. Within 6 years of the introduction of the HPV vaccine in 2006, a 64% reduction in vaccine-type HPV infections among teen girls ages 14 to 19 had occurred and a 34% decrease in young women ages 20-24 was observed. The CDC recommends that all boys and girls, beginning at the age of 11 or 12 years old begin receiving the HPV vaccine. The vaccine is currently available to children as young as age 9 through young adults age 25-26 years.
To continue making a positive impact on cervical cancer incidence and mortality as well as HPV related diseases requires understanding and action. Talk to your provider about your health risk factors to make an informed decision about health prevention and maintenance.
Authors: Bruce W. Porterfield, MD, PhD & Sherri Porterfield, RN, MSN
-  https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html
-  Markowitz et al. (2016). Prevalence of HPV After Introduction of the Vaccination Program in the United States. Pediatrics, Volume 137,pp.1-9.
Categories: Cervical Cancer