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Topics in Gynecology - HPV and Cervical Cancer Risk

Updated on July 8, 2017
Drjacki profile image

Jacqueline Thompson is a practicing physician currently residing in North Carolina.

Human Papilloma Virus in Women's Health

Who would imagine that a virus was the cause of certain types of cancer? It’s beyond conjecture now because research has shown that the connection is definite. Human papilloma virus, or HPV for short, has been identified as the major player in cervical cancer, and women all over the world can benefit from new knowledge about this most common sexually transmitted disease. For many years, medical researchers have known about the connection between HPV and cancer, but until recently, there was little ability to impact the disease process. Now, with a targeted vaccine to immunize against specific strains of HPV known to be most responsible for cervical cancer, there is finally a weapon with which to fight. But what is this virus exactly, and why will a vaccine decrease the incidence of cervical, vaginal and vulvar cancers?

HPV is actually a group of common skin viruses of which there are over 100 known strains. Most people are familiar with plantar warts, and these are caused by a specific HPV strain. Genital warts are caused by at least four different strains, and cervical cancer is linked most strongly with two particular strains, HPV 16 and 18. These are known as “high risk” forms of the virus, and they are the specific targets of the currently available vaccines.

The virus is passed from person to person through skin-to-skin contact, and the cervix is particularly vulnerable to attack. Once the virus injects its DNA into the cervical cells, a sequence of events can lead, over months to years, to precancerous changes. These changes can only be detected on a Pap test or cervical biopsy, but the changes are otherwise silent. There is no telltale vaginal discharge or pain to herald the viral activity, and therefore, both male and female partners are generally unaware of its presence. Condoms are not fully protective since there is incomplete coverage of all potentially vulnerable genital skin.

In some cases, the virus does not become active right away and can literally hide inside the cells. There are known risk factors such as smoking or immunosuppression that can hasten (and worsen) the viral effects, but for the most part, it seems random as to which individuals will express the HPV changes and when.

The two commercially available HPV vaccines ideally target young males and females before they become sexually active. It would not be effective enough to only vaccinate girls and women; however, females definitely bear the brunt of the adverse affects of this infection. Health care providers will need to counsel patients regarding the limitations of these vaccines including the fact that they will not prevent any other sexually transmitted diseases such as HIV. There would the need for several injections required over the course of months similar to the hepatitis B vaccine in order to confer immunity, but the effort will be well worth it.

Approximately 60 to 80 percent of Americans have been/will be infected with HPV by age 50; however, only a very small percentage of women will develop cervical disease. Most of those, perhaps as many as 90%, will consist of mild changes that are cleared by the immune system over the course of a few years. That leaves 10% of women who can develop persistent disease that may progress to severe precancerous changes and ultimately to cervical cancer.

Women with a history of multiple sex partners, sexual activity at a young age, smoking, poor nutrition and substance abuse have a higher propensity to develop HPV infection and cervical disease. The effect of multiple partners is obvious, but the relationship of tobacco use and the development of cervical disease are complex and relates to damaged DNA. But even with the elimination of all the known risk factors, it only takes one sexual partner to impart a high-risk strain. For this reason, all women should avail themselves of the simple screening tool known as the Pap test.

Since it’s development in the late 1940’s, the Pap test has certainly saved many lives from invasive cervical cancer. It meets all the criteria for a great screening test including affordability, sensitivity to disease detection and specificity to cervical cell abnormalities. The Pap test has become a routine part of a woman’s GYN exam, and over the years, more accurate methods of specimen collection and analysis have been developed. Still, like any test, it has occasional lapses in accuracy, so putting it off for years at a time is unwise.

The exact interval of screening and when to start screening may vary slightly from woman to woman depending upon her individual risk factors. All women should begin screening at age 21 but not before. This is a relatively new recommendation based on the fact that cervical cancer is extremely rare in women younger than age 21 and testing too early leads to overly aggressive treatment for a precancerous disease process that will ultimately resolve on its own with time in this age group.

CBS News

Effects of HPV on the cervix
Effects of HPV on the cervix | Source

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    • profile image

      SarahBodo 

      6 years ago

      Thank you so much for the info. At least, there are vaccines available now.

    • Jennifer75 profile image

      Jennifer75 

      7 years ago from India

      Very good information.

    • imatellmuva profile image

      imatellmuva 

      7 years ago from Somewhere in Baltimore

      What a well read, informative, and eye-opener hub! There is so much information available on this topic, but never before have I read an article that laid-it-on-the-line as you have!!! Thanks Drjacki!!

    • Drjacki profile imageAUTHOR

      Drjacki 

      7 years ago from North Carolina

      You got that just right. There is a lot of confusion out there when women read about HPV because of the many strains of this common skin virus. Only about a dozen cause potentially serious precancerous/cancerous changes in the female genital tract, and the vaccines out there cover two of the worst strains. But if you've already had exposure to those strains, the vaccine cannot undo the damage - only your immune system can do that. Smoking or even inhaling second-hand smoke is a significant risk factor in having precancerous cervical disease due to HPV effects.

    • kimh039 profile image

      Kim Harris 

      7 years ago

      very informative - and good information to "get out there." So, a person might have HPV on the cervix without noticing warts in the genital area, and only some strains of HPV lead to cervical cancer. Did I get that right? Thanks, drjacki.

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