Preventing HPV And Cervical Cancer In Women

Overview

Are you up to date on pap smears? A pap smear is a test that screens for cervical cancer. Pap smears, education and HPV vaccination are crucial to lowering your risk of developing cervical cancer. 

Cervical cancer is the fourth most frequent cancer diagnosed in women worldwide. Cervical cancer is the second most common cause of cancer death in developing nations. Approximately 84% of all cervical cancer cases occur in Africa, Latin American and the Caribbean underdeveloped areas. Around the globe, this type of cancer affects approximately half a million women annually, with about 270,000 women losing their lives. Because of screening, the number of new cases of cervical cancer has dramatically declined in North America.

We asked one of our OBGYNs, Dr Candice Fraser, to lend her medical insights on cervical cancer. 

What is the Role of the Cervix?

The cervix is located within the female reproductive system. It is located where the lower part of the uterus meets the vagina. 

The cervix comprises strong muscles and serves several vital functions within the female reproductive system. For example, each month, the cervix allows for the passage of menstrual blood from the uterus. It also helps direct sperm into the uterus to allow for successful fertilization. 

While the cervix’s opening is usually very narrow, during labor it will dilate to 10 cm to allow delivery of a baby. 

What is Cervical Cancer?

The cervix is covered by cells that make up a thin layer of tissue. When cells are healthy, they will grow, divide and be replaced. Cancer causes this healthy behavior to change. The cells begin to divide more rapidly. The cells may spread to other organs or grow into deeper cell layers. Eventually, the cells form a tumor which is a mass of tissue. 

Cervical cancer is the change from healthy cells to cancerous cells. Usually, cervical cancer is slow-growing but can proliferate and spread out of control in certain situations. 

The most common cervical cancer originates from the cells that lie on the surface of the cervix called squamous cells. When cancer develops from these cells, it is called squamous cell carcinoma. This type of cancer makes up about 80% of all cervical cancers. 

The second most common type of cervical cancer comes from the cells that make up the glands in the cervix. This type of cancer is called adenocarcinoma. Since the 1970s, the percentage of this type of cancer has risen, although researchers are unsure why. Rarely cervical cancer will have characteristics of both squamous and adenocarcinoma cells. This type of cancer is called adenosquamous carcinomas.

Do you have questions about HPV or cervical cancer? Talk to a doctor if you think you are experiencing symptoms of cervical cancer.

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How Common is Cervical Cancer?

Around 85% of women who die from cervical cancer reside in developing countries. This may be because of the unavailability of cervical screenings, prevention education, and HPV vaccination in their countries. 

In fact, North America, Europe, and Australia have the lowest incidences of cervical cancer. This is likely due to the availability of programs in those continents which promote cervical screenings through pap smears that can identify and treat precancerous cells. 

An estimated 1350 Canadian women and 13,170 US women will be diagnosed with cervical cancer in 2019. An estimated 410 and 4,250 respectively will die from it.

HPV and Cervical Cancer

One of the most critical risk factors for cervical cancer is infection with a virus called Human papillomavirus (HPV). HPV is found in about 99% of cervical cancers. However, there are over one hundred different types of HPV, most of which are considered low-risk and do not cause cervical cancer.

However, there are high-risk HPV types that may cause cervical cell abnormalities or cancer. Two strains of HPV, HPV-16 and HPV-18 can be attributed to more than 70 percent of cervical cancer cases.

While HPV is associated with most cervical cancer cases, only a small percentage of women with HPV will develop cervical cancer. 

HPV is a sexually transmitted infection that is common in the general population. Approximately 79 million Americans are infected with HPV. The majority of those infected are in their late teens and early twenties. 

The HPV virus can cause genital warts, anal warts and several types of cancer. In addition to cervical cancer, it can also cause cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).

How Do You Get HPV?

HPV is a sexually transmitted infection. You can get HPV by having vaginal,oral sex or anal sex with a person infected with the virus. You can be infected with the virus even if your sexual partner has no symptoms. 

The transfer takes place when an uninfected person’s skin or mucous membrane (ex. mouth, vagina) gets touched by or exposed to an infected person’s skin or mucous membrane. The infection doesn’t usually exhibit any symptoms. That’s why infected people having sex unknowingly transfer the infection to their partners.

There are more than 40 HPV strains that can be sexually transmitted. However, only a few of these HPV strains show manifestations. 

HPV is not spread through bodily fluids, and your partner does not need to have an orgasm for you to be at risk.

HPV is more commonly spread through vaginal and anal sex. However, recent research has indicated there is a possibility that HPV can be spread outside of sexual activity.

A study published in the journal Sexual Health looked at 51 HPV transmission studies. Researchers found HPV in the genital tract of 51 virgins. We know that HPV can be spread through the use of sex toys or oral sex, but this research also points to other possibilities. These include the spread from manual genital stimulation (several studies showed evidence of hand-to-genital HPV transmittance) and from hard surfaces.

The second possibility is that you could pick up the virus from an infected surface. While the research points to this possibility, it should not be considered a medical fact.

Even so, to be on the safe side, it probably makes sense to avoid contact with unknown surfaces. For example, cover your genitals completely in communal areas like the gym.

Understanding HPV Symptoms

Knowing what symptoms to look for is absolutely vital when living with HPV.

Genital Warts

Genital warts may be itchy or uncomfortable. They can resemble a cauliflower or they can be smooth and flat, affecting various areas of the genital region, including:

In Women:

• Inside the vagina
• On the cervix
• Inside the anus
• On the vulva

In Men:

• Scrotum
• Penis
• Inside or outside the anus
• Groin
• Thighs

Symptoms of Cervical Cancer

Most people will not experience symptoms during the early stages of cervical cancer. However, this is why it is so important to have regular cervical screenings for changes in the cells on the cervix. 

It’s better to detect and treat precancerous cervical lesions early. Usually, the symptoms become visible when the cancer cells have grown through the upper part of cervical tissue into the tissue underneath in the cervical canal.

This happens when the precancerous cells remain untreated. The condition will worsen into invasive cervical cancer. Sometimes women mistake these common symptoms as being harmless and non-cancerous.

• Irregular bleeding is the most typical and frequent sign of invasive cervical cancer. Bleeding could happen between your monthly periods or after having sex. It occasionally appears as a blood-streaked vaginal discharge and is often mistaken as just spotting. This could also happen to postmenopausal women who don’t get their periods. So when you suddenly have irregular bleeding, despite already having gone through menopause, consult your doctor immediately.
• Vaginal discharge, aside from irregular bleeding, women may also experience. Abnormal vaginal discharge may be white, transparent, watery, brown, fetid or rancid, and blood tainted.
• Advanced Symptoms that are more serious signs are more prominent during the later stages. These are back pain or pelvic pains, problems with going to the bathroom, enlargement of one or both legs, exhaustion, and losing weight.

 

Do you have questions about HPV or cervical cancer? Talk to a doctor if you think you are experiencing symptoms of cervical cancer.

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Risk Factors for Contracting HPV

• One risk factor for cervical cancer is having a sexually transmitted infection. Any risk factor for developing STIs can also be a risk factor for cancer cervicouterino. 

Other risk factors include:

• Becoming sexually active at an early age
• Having multiple male sexual partners
• Having multiple male partners who have high-risk factors (becoming sexually active at an early age and having multiple male partners) 
• Being diagnosed with any other sexually transmitted disease

Any condition that weakens the immune system can also increase your risk for cervical cancer. This includes being HIV positive, Hodgkin’s Disease and receiving an organ transplant. 

Smoking can also increase your risk. Smokers are twice as likely to develop cervical tumors than non-smokers. There is also a link between women living in poverty and death from cervical cancer. This link may be from an inability to access proper screening services. 

Risk factors do not accurately predict whether or not you are at risk for cervical cancer. Regular screenings are the best defense to protect yourself against cervical cancer. 

How Is Cervical Cancer Diagnosed?

Cervical cancer can be detected through screening tests. Screening tests can detect precancerous cells as well as cancerous cells. This allows for early intervention before the cells become cancerous. 

It is generally advised to begin screenings for cervical cancer at age 21. 

Screening tests include:

• Pap test: During a pap test, your doctor places a speculum inside your vagina, allowing them to see your cervix. They will then use a long brush and/or tiny spatula to collect cells from your cervix. The cells will be sent to a lab for abnormalities. 
• HPV DNA test: The HPV DNA test involves testing cells collected from the cervix for infection. This is used to screen for any types of HPV most likely to lead to cervical cancer.

What Happens if you Get an Abnormal Pap Smear?

If your doctor suspects you may have cervical cancer because of an abnormal pap smear result or your reported symptoms, you will likely need a pelvic exam. First, your doctor will likely need to examine your cervix thoroughly. A magnifying instrument called a colposcope is used to check for abnormal cells. 

Your doctor may also take a cell sample, called a biopsy, for laboratory testing. These samples can be taken through a punch biopsy which uses a sharp tool to remove small tissue samples. Your doctor may also use a thin, long instrument with a basket on the end, called a curette, to scrape a tissue sample from the inner layer of the cervix. 

The results of the colposcopy will determine the next steps. This may include repeating a pap smear in 1 year or performing a more extensive biopsy to remove the HPV-infected cells. Women diagnosed with cervical cancer will be referred to a GYN Oncologist for further management. 

A LEEP( Loop electrosurgical excision procedure)  uses a wire loop heated by an electric current to remove tissue in the lower genital tract. It is considered an effective way to prevent cervical cancer. The success rate for LEEP is great, with a 90% cure rate. 

What are the stages of cervical cancer?

• Stage I: Cancer is limited to your cervix. 
• Stage II: Cancer spreads beyond your cervix and uterus but hasn’t yet spread to your pelvic wall.
• Stage III: Cancer spreads to the lower part of your vagina, pelvic wall, and ureters and involves the lymph nodes.
• Stage IV: Cancer spreads to your bladder, rectum or other parts, including the bones or lungs.

Living with HPV: Being diagnosed with HPV does not mean you cannot live a normal life. Let our doctors guide your next steps. 

I have HPV. Does This mean I will get cancer?

The Good News

Certainly not! Contracting HPV does not necessarily mean you will get cervical cancer. There are over 200 strains of HPV, and only 40 -100 strains affect the genital area.

The strains that are not sexually transmitted can cause skin conditions such as warts on the hands or feet.

Only the 40-100 strains that affect the genitals (penis, scrotum, anus, rectum, vulva, vagina and cervix.) are sexually transmitted. However, some strains can lead to genital warts or cervical cancer.

According to Planned Parenthood, HPV infections are common. In fact, most sexually active adults who do not receive the HPV vaccine will come into contact with HPV at some point in their lives.

The good news is many HPV infections show no symptoms. Often, your body can fight off the infection on its own. This is why many are unaware they were ever infected.

The Bad News

Unfortunately, some strains of HPV will cause symptoms that require treatment.

Genital warts are usually caused by two types of HPV: type 6 and 11. Genital warts are considered low-risk HPV because they do not cause cancer. However, they do require treatment which can be uncomfortable. Genital warts don’t always require treatment. Your immunity may take care of the lesions. Although, as with all strains of HPV, you will never be able to clear the infection completely, it does become dormant and does not continue to cause symptoms.

Cancer: Most cancer caused by HPV is due to two strains: types 16 and 18. These are considered high-risk HPV. While many are aware that HPV can lead to cervical cancer, many are unaware that there is also a risk of cancer in the vulva, vagina, mouth, throat and anus.

Preventing HPV and Cervical Cancer

• Screening in the form of Pap tests is the best way of preventing cervical cancer whether or not you had a vaccination against the virus. The test is one of the most dependable cancer screening tests at hand. The tests detect irregular cells and precancerous changes on a woman’s cervix. Early detection of these deviations paves the way for treatment before these could progress into becoming a type of cancer. This test can be done while having a pelvic exam. Your doctor will swab the cervix to gather cells that will be examined under a microscope. An HPV test can also be done while having the exam. The gathered cells will be inspected for traces of HPV DNA aside from just being under the microscope.
• Vaccination is suggested for everyone up to age 26 and men up to age 22. This will only be effective on women and men who have not been infected with one of the strains in the vaccine. Therefore, boys and girls should receive the vaccine before becoming sexually active.

How can I avoid HPV and the health problems it can cause?

If you are sexually active:

• Use latex condoms the right way every time you have sex. Condoms don’t prevent HPV but can lower your risk of spreading the infection. 
• Be in a mutually monogamous relationship. Your risk is lower if you only have sex with someone who is only having sex with you. 

Who should get vaccinated?

HPV vaccination is recommended at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already.

It is suggested that you are vaccinated before becoming sexually active. However, some adults 27 through 45 may choose to get vaccinated after speaking to their healthcare provider. 

HPV vaccination in this age range provides less benefit as most sexually active adults are already exposed to the infection. At any age, having a new sex partner is a risk factor for getting a new HPV infection. 

According to the Center for Disease Control (CDC) the best way to protect against HPV is to get vaccinated before becoming sexually active. However, if your partner is not infected, they may want to consider having the vaccination even if they are sexually active.

It is important to note that the vaccination requires more than one dose and will not be fully active until your partner has received all their vaccinations.

In fact, even those with HPV can still benefit from the vaccine as it may offer protection from other strains they do not have. But unfortunately, the HPV vaccine cannot provide any treatment or protection from the HPV strain you already have.

Tell your partner and encourage them to get vaccinated for the virus. Understand that HPV symptoms like genital warts could arise in those with human papillomavirus types six and 11.

The FDA approved Gardasil to protect against both the high-risk strains,16 and 18, as well as the low-risk genital wart causing strains 6 and 11. In addition, as of 2016 Gardasil 9 has been available, which protects against 9 strains, including 16, 18, 6, 11, 31, 33, 45, 52 and 58.

Related: Chlamydia: symptoms, causes, treatment and prevention

Is There a Cure for HPV?

Unfortunately, there is no cure for HPV, but there are ways to manage your symptoms. Healthcare providers can remove genital warts. However, removal procedures may be uncomfortable, and warts can reappear.

Cervical cancer can be screened for with pap smears. Getting regular screenings is important, especially if you have HPV. Pap smears can identify precancerous as well as cancerous cells on the cervix.

Around 85% of women who die from cervical cancer reside in developing countries. This is likely due to an inability to receive cervical screenings, prevention education and the HPV vaccination in their countries.

When to Consult a Doctor 

Do you have questions about HPV or cervical cancer? Talk to a doctor immediately if you think you may have HPV or are experiencing signs or symptoms of cervical cancer. Connect with one of our doctors for 24-hour access to medical advice. 

Do you have questions about HPV or cervical cancer? Talk to a doctor if you think you are experiencing symptoms of cervical cancer.

Talk to a Doctor

FAQs About Cervical Cancer Answered By Your Doctor Online Team