HPV and Cervical Cancer

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Though usually harmless, some types of HPV cause cervical lesions that, over a period of time, can develop into cancer if untreated. The majority of women with an HPV infection will not develop cervical cancer, but regular screening is crucial. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops. These changes are typically detected through a Pap test.

When a female gets Pap test, she is being screened for to make sure that there are no abnormal or precancerous changes in the cells on her cervix. If the Pap test results show these cell changes, this is usually called cervical dysplasia. Other common terms the healthcare provider may use include:


All of these terms mean similar things - it simply means that abnormalities were found. Most of the time, these cell changes are due to HPV. There are many types of HPV that can cause cervical dysplasia. Most of these types are considered "high-risk" types, which means that they have been linked with cervical cancer.

Just because a female has cervical dysplasia, it does not mean she will get cervical cancer. It means that her healthcare provider will want to closely monitor her cervix every so often - and possibly do treatment - to prevent further cell changes that could become cancerous over time if left unchecked. Cervical cancer is a slow-growing condition that usually takes years to progress. This is why getting screened on a regular basis is important; screening can catch any potential problems before they progress.

You Can Prevent Cervical Cancer

FAQs

When and how do I screen for cervical cancer?

According to the American College of Obstetricians and Gynecologists (ACOG), a female should not have Pap tests before age 21.

Many women are used to getting screened once a year. However, newer research has found that it is not necessary to screen this often, especially if newer tests are being used. So now you and your healthcare provider have a few options available on screening methods.

  • If a conventional Pap test is used (the cell sample taken is put on a glass slide) and the result is normal, then screening should be done once a year.
  • If a liquid-based Pap test is used (the cell sample taken is put in a container filled with liquid) and the result is normal, then screening should be done once every two years.
  • If a combination Pap-HPV DNA test is used (only approved for women over age 30) and the result is normal/negative, then screening should be done once every three years.
  • Also with women over 30, healthcare providers may also use a new "genotyping" test that checks specifically for the HPV types found in most cervical cancers. If you have questions about which tests are right for you, ask your healthcare provider.

Even though screening for cervical cancer can occur less often, it is still important for you to see your healthcare provider annually for other female-related health care needs - ask your provider what he or she recommends.


How do I prepare for a Pap or HPV test?

  • Try to schedule the test on a day when you do not expect to be on your menstrual period. If your period begins unexpectedly and will be continuing on the day of your test, try to reschedule the appointment.
  • Avoid sexual intercourse 48 hours before the test.
  • Do not douche 48 hours before the test.
  • Do not use tampons, or vaginal creams, foams, films, or jellies (such as spermicides or medications inserted into the vagina) for 48 hours before the test

What about abnormal test results?

The term "abnormal Pap" is broad and not very specific. There are many different systems that health care providers use to classify a Pap test. Within each system, there are different degrees of severity or abnormalities. The various classification systems and degrees of severity include:

CLASSIFICATION SYSTEM

DEGREES OF SEVERITY

EXPLANATION

Descriptive System

Mild dysplasia, Moderate dysplasia, Severe dysplasia

 

CIN System

CIN 1, CIN 2, CIN 3

CIN stands for cervical intraepithelial neoplasia

Bethesda System (2001)

ASC-US (Atypical Squamous Cells of Undetermined Significance)

ASC-H (Atypical Squamous Cells-can not exclude HSIL)

Low-Grade SIL (LSIL)

High-Grade SIL (HSIL)

Means the results look borderline between “normal” and “abnormal” - often not HPV-related

Borderline results, but may really include High-Grade lesions

SIL stands for squamous intraepithelial lesion

Class System

Class 1, Class 2, Class 3, Class 4

This system is no longer widely used.


Women with abnormal Pap test results are usually examined further for cervical problems. This may involve coming back for a colposcopy and biopsy, or coming back in a few months for another Pap test. If the Pap result is “ASC-US,” then a HPV-DNA test may be done in the lab to see whether HPV is causing this borderline “normal-abnormal” Pap result.


Are the Pap test, HPV test, and biopsy the same?

A Pap test, or Pap smear, is a screening to find abnormal cell changes on the cervix (cervical dysplasia) before they ever have a chance to turn into cancer. During a pelvic exam, a small brush or cotton tipped applicator will be used to take a swab of cervical cells. These cells are then put either on a glass slide or in a container with liquid, and sent to the laboratory for evaluation. The most common commercially available liquid-based Pap test is called ThinPrep®.

A biopsy is similar to a Pap test, but a larger cluster of cells is removed from the cervix to see if there are abnormal cell changes. It is a good way to confirm the earlier Pap smear result and to rule out cancer. If a biopsy is done, it will be performed at the same time as the colposcopy.

An HPV test is different than a Pap test or biopsy. This test checks directly for the genetic material (DNA) of HPV within cells, and can detect the "high-risk" types connected with cervical cancer. The test is done in a laboratory, usually with the same cell sample taken during the Pap test.

Four tests are currently available for clinical use to check for “high-risk” types of HPV:

  • The digene Hybrid Capture II ™ HPV test, produced by Qiagen
  • The Hologic/Gen-Probe Corporation's Cervista™ HPV High-Risk (HR) test
  • The Roche cobas® HPV test
  • The APTIMA® HPV mRNA Assay, produced by Hologic/Gen-Probe

When is an HPV test used?

Four tests are currently available for clinical use to check for “high-risk” types of HPV:

  • The digene Hybrid Capture II ™ HPV test, produced by Qiagen
  • The Hologic/Gen-Probe Corporation's Cervista™ HPV High-Risk (HR) test
  • The Roche cobas® HPV test
  • The APTIMA® HPV mRNA Assay, produced by Hologic/Gen-Probe

A word about genotyping: two “high risk” HPV types (also called “genotypes), HPV 16 and HPV 18, are responsible for about 70% of cervical cancers worldwide. Two tests on the market – the Roche cobas HPV test and Hologic’s Cervista HPV 16/18 Genotyping test - both check directly for HPV 16 and HPV 18. Gen-Probe’s APTIMA assay checks for three types, HPV 16 and HPV 18/45. Knowing if a woman has these types of HPV gives health care providers more insight into her risk for developing cervical cancer. 

 

When is an HPV test not used?

  • If the Pap result shows dysplasia or precancerous changes. This is because these cell changes are almost always associated with HPV.
  • In women under age 30, unless they have had an ASC-US Pap test result.
  • The HPV test is not approved for use with males. It is only FDA approved to be used on the female's cervix.

Can a man be tested?

Research has shown that the HPV test may lead to inconsistent results with men. This is because it is difficult to get a good cell sample to test from the thick skin on the penis. Most people will not have visible symptoms if they are exposed to HPV. Therefore, for most, the virus is subclinical (invisible). This is especially true for males. If a male is exposed to the cell-changing types of HPV, he would be unlikely to have symptoms. If there are no symptoms for males, it is hard to test for it. Most of the time, men will not have any health risks such as cancer with the "high-risk" types of HPV. It is the female's cervix that needs to be monitored.


How is cervical dysplasia treated?

Currently, there is no treatment to cure HPV; there is no cure for any virus at this point. However, there are several treatment options available for treating the abnormal cells.

Sometimes treatment may not even be necessary for mild cervical dysplasia. These cells can heal on their own and the health care provider will just want to monitor the cervix. HPV may then be in a latent (sleeping) state, but it is unknown if it totally gone or just not detectable. The goal of any treatment will be to remove the abnormal cells. This may also end up removing most of the cells with the HPV in them.

If the abnormal cells are treated, or if they have healed on their own, it may possibly help reduce the risk of transmission to a partner who may have never been exposed to the cell-changing types of HPV.

When choosing what treatment to use, the healthcare provider will consider many things:

  • location of the abnormal cells
  • size of the lesions on the cervix
  • degree or severity of the Pap test results
  • degree or severity of the colposcopy and biopsy results
  • HPV test results (if this test was needed)
  • age and pregnancy status
  • previous treatment history
  • patient and healthcare provider preferences

There are a variety of treatments for cervical dysplasia:

  • Cryotherapy (freezing the cells with liquid nitrogen)
  • LEEP (Loop Electrosurgical Exision Procedure)
  • Conization (also called cone biopsy)
  • Laser (not as widely used today due to high cost, lack of availability, and not all doctors are well-trained with using it. LEEP is more commonly used)

No treatment at all since even mild abnormal cell changes may resolve without treatment. The health care provider may just monitor the cervix by either doing a colposcopy, repeat Pap testing, or a test for HPV.


What about HPV and pregnancy?

For some pregnant women, cervical dysplasia may increase. This may be due to hormone changes during pregnancy, but this is not proven.

If a woman has an abnormal Pap test during pregnancy, even if it's severely abnormal, many healthcare providers will not do treatment. The reason that many healthcare providers do not want to do treatment during pregnancy is because it may accidentally cause early labor. They will just monitor the cervix closely with a colposcope during the pregnancy.

Sometime (a few weeks) after delivery of the baby, the provider will look at the cervix again and do another Pap smear or another biopsy. Many times after pregnancy, the cell changes will have spontaneously resolved - and no treatment will be necessary.

The types of HPV that can cause cell changes on the cervix and genital skin have not been found to cause problems for babies.


What about HPV and other cancers?

Anal dysplasia and anal cancer:

  • Anal cancer is a rare occurrence that has been strongly linked to "high-risk" types of HPV.
  • Abnormal cell changes in the anal area (anal dysplasia or anal neoplasia) are more common among individuals who engage in receiving anal sex.
  • Anal cancer rates in men who have sex with men are 17-fold higher than in the general population. However, anal dysplasia has also been reported in some females who have a history of severe cervical dysplasia.
  • Treatment is available for anal dysplasia and anal cancer

Head and neck cancer:

  • "High risk" HPV is linked with some types of head and neck cancer, primarily oropharyngeal cancers found in the base of the tongue, tonsils, and soft palate.
  • Oral sex may be a risk factor for acquiring oral HPV.
  • While HPV is very common, oropharyngeal cancers are rare. Most of these cancers are not related to HPV.

Penile Intraepithelial Neoplasia (PIN) and penile cancer:

  • Cancer of the penis is extremely rare in the United States, and HPV is not always the cause.
  • There are some cases of cell changes (neoplasia) on the penis, which are caused by "high-risk" types of HPV.
  • Most males do not ever experience symptoms or health risks if they get one or more "high-risk" types of HPV.
  • Penile neoplasia can be treated. There is not a cancer screening for the penis because cancer of the penis is extremely rare, and because it is difficult to get a good cell sample from the penis.

Vaginal Intraepithelial Neoplasia (VAIN) and vaginal cancer:

  • HPV has been linked with some, but not all, cases of cell changes in the vagina and with vaginal cancers.
  • Various treatment options are available for vaginal neoplasia, depending on how mild or severe the cell changes are in this area.
  • Vaginal cancers are rare.

Vulvar Intraepithelial Neoplasia (VIN) and vulvar cancer:

  • HPV has been linked with some, but not all, cases of cell changes on the vulva (outside female genital area) and with vulvar cancers.
  • Various treatment options are available for vulvar neoplasia, depending on how mild or severe the cell changes are in this area.
  • Vulvar cancers are rare.

Is it normal to feel upset about HPV?

Yes, it is normal. Some people feel very upset. They may feel ashamed, fearful, confused, less attractive or less interested in sex. They feel angry at their sex partner(s), even though it is usually not possible to know exactly when or from whom the virus was spread. Some people are afraid that they will get cancer, or that they will never be able to find a sexual partner again. It is normal to have all, some or none of these feelings. It may take some time, but it is important to know that it is still possible to have a normal, healthy life, even with HPV.

To help cope with HPV emotionally, talk to someone you can trust such as a friend or loved one, or go to an HPV support group.


How can I reduce my risk?

Any one who is sexually active can come across this common virus. Ways to reduce the risk are:

  • Abstinence (not having any kind of sex with anyone)
  • Having sex only with one partner who has sex only with you. People who have many sex partners are at higher risk of getting other sexually transmitted infections (STIs).
  • If someone currently has abnormal cell changes, he or she should not have sexual activity until after the cells have been treated or have self resolved. This may help to lower the risk of transmission.
  • Condoms used the right way from start to finish each time of having sex may help provide minimal protection - but only for the skin that is covered by the condom. Condoms do not cover all genital skin, so they don't give 100% protection.
  • Spermicidal foams, creams, jellies (and condoms coated with spermicide) are not proven to be effective in preventing HPV and may cause microscopic abrasions that make it easier to contract STIs. Spermicides are not recommended for routine use.
  • If someone was exposed to the types of HPV that can cause abnormal cell changes, it would be unlikely that he or she will become re-infected with those same types since immunity will be set-up at some point.
  • Realize that most people are exposed to one or more HPV types in their lifetime, and most will never even know it because they will not have visible symptoms.
  • It is important for partners to understand the "entire picture" about HPV so that both people can make informed decisions based on facts, not fear or misconceptions.

National Cervical Cancer Coalition (NCCC)

The National Cervical Cancer Coalition (NCCC) was originally founded in 1996 as grassroots organization dedicated to serving women with, or at risk for, cervical cancer and HPV disease. NCCC now operates as a program of ASHA and continues to help women, family members and caregivers battle the personal issues related to cervical cancer and HPV and to advocate for cervical health in all women by promoting prevention through education about early vaccination, Pap testing and HPV testing when recommended.