An average of 30 women in the United States are diagnosed with cervical cancer each day. Here‚ is what you need to know about the disease to protect yourself:
Q: What is cervical cancer? What is HPV?
A: Cervical cancer is cancer of the cervix (the lower part of the uterus that connects to the vagina). Cervical cancer is caused by certain types of HPV. When a female becomes infected with certain types of HPV and the virus doesn’t go away on its own, abnormal cells can develop in the lining of the cervix. If not discovered early and treated, these abnormal cells can become cervical precancer and then cancer. HPV is short for human papilloma virus (pap-uh-LO-muh). HPVs are a group of over 100 related viruses. Each HPV virus in the group is given a number, which is called an HPV type. HPVs are called papilloma viruses because some of the HPV types cause warts or papillomas, which are non-cancerous tumors. Of the more than 100 strains of HPV, about 60 HPV types cause warts on non-genital skin, such as on the hands and feet. These are the common warts. The other 40 HPV types are mucosal types of HPV. The mucosal HPV types are also called the genital (or anogenital) type HPVs because they typically affect the anal and genital area. The mucosal HPVs prefer the moist squamous cells found in this area. They do not grow in the skin of the hands and feet. Low-risk HPV types Some types of genital HPVs can cause cauliflower-shaped warts on or around the genitals and anus of both men and women. In women, warts may also appear on the cervix and vagina. These low-risk types can also cause low-grade changes in the cells of the cervix that do not develop into cancer. High-risk HPV types Other genital type HPVs have been linked with genital or anal cancers in both men and women. These types are called “high-risk” because they can cause cancer. They also cause low-grade and high-grade changes in the cells of the cervix and pre-cancers. Doctors worry more about the high-grade changes and pre-cancers, because they are more likely to grow into cancers. In 90% of cases, the body’s immune system clears the HPV infection within 2 years. This is true of both high-risk and low-risk HPV types. In summary, low-risk HPV types can cause genital warts and low-grade changes in the cells of the cervix. High-risk HPV types can cause low-grade changes, high-grade changes, pre-cancer, and cancer in the cells of the cervix. Here is a diagram showing the different groups of HPV types and the problems each group can cause.
Q: Who can get cervical cancer?
A: Women remain at risk for developing HPV infection throughout their lives. Approximately 80 percent of women will have been infected with genital HPV in their lifetime. Most infections clear on their own, but for an estimated 30 women a day in the United States who don’t clear certain types of HPV, cervical cancer develops. About half of all females diagnosed with cervical cancer are between 35 and 55 years old. What many of these women may not realize is that they could have been exposed to HPV as early as their teens or 20s.
Q: How do you get cervical cancer?
A: Almost all cases are caused by the human papillomavirus, or HPV. Genital HPV is spread mainly by direct genital contact during vaginal, oral, or anal sex. It is not spread through blood or body fluids. HPV is passed from one person to another during skin-to-skin contact. It is a sexually transmitted disease, but it’s nothing to be ashamed of‚ HPV is so common that three out of four people will get it at some point in their lives. In one study, more than 50% of college-aged women were found to have gotten an HPV infection within 4 years of first having sex. (There are more than 100 types of HPV, a handful of the most dangerous strains lead to cervical cancer. Some strains also cause genital warts.) In the majority of cases, HPV is no big deal since your immune system can usually fight off the virus before it causes any ill-health effects.
Q: Who gets Cervical Cancer or HPV Infection?
A: Genital HPV is a very common virus. Some doctors think it is almost as common as the common cold virus. In the United States, over 6 million people (men and women) get an HPV infection every year. Almost half of the infections are in people between 15 and 25 years of age. About one-half to three-fourths of the people who have ever had sex will have HPV at some time in their life.
Q: Are there any signs or symptoms I should be looking for?
A: That’s where cervical cancer gets tricky: Many women don’t have any symptoms until the disease progresses. (Even then, symptoms like vaginal bleeding after sex or between periods and pelvic pain or pain during intercourse may be overlooked.) Most people will never know they have HPV because they have no symptoms and the body’s immune system causes the virus to become inactive. A small number of people with HPV will have the virus for a longer time. These people can develop cell changes that over many years may lead to cervical or other genital or anal cancers. That’s why doctors say routine Pap tests are so important.
Q: Who is at high risk of getting Cervical Cancer / HPV Infection?
A: People with the following risk factors are more likely to have genital HPV:
- having many sex partners
- being younger than 25 years of age
- starting to have sexual intercourse at age 16 or younger
- having a partner who has had several different sex partners.
Still, a person who has had sex with only one partner can get HPV if that partner already has the virus. HPV can also be picked up from having sex with an infected person at any age.
Q: How do you test for cervical cancer?
A: A Pap smear can detect abnormal cells in the cervix that could be a precursor to cervical cancer and is your best bet for catching the disease at an early stage.
Q: My Pap test came back normal. Am I off the hook?
A: For now. But cervical cancer is so slow-growing that it may take years for abnormal cells to show up on your Pap test or become cancerous. It’s yet another reason to get tested regularly.
Q: My Pap test was abnormal. Does this mean I am going to get cervical cancer?
A: Not necessarily. The most common abnormal Pap is known as ASC-US or atypical squamous cells of undetermined significance. That doesn’t mean you have cancer‚ it is just that there are some changes in the cells that deserve a second look. Often, doctors will take a wait-and-see approach and have you come back in six months.
Q: What if I go back, and my Pap is still abnormal?
A: If you are not in the clear at your next exam, your doctor may recommend a colposcopy, a simple in-office procedure that makes it easier to spot cancerous changes of the cervix. Should the test pick up changes, your gynecologist will do a biopsy to detect cancer. If the lab finds any traces of cancer, your doctor will freeze or cut away the affected area of your cervix during an in-office procedure. In some cases, doctors recommend a hysterectomy, which is the removal of the cancer, the cervix and the uterus, and possibly radiation and chemotherapy. Any time you get an abnormal Pap test result, ask your doctor if she uses the new HPV DNA test, which detects high-risk strains of the virus from the same sample as your Pap. This test is not recommended for all women, but it can determine whether your Pap results are due to a high-risk strain of HPV.
Q: Is there any way to prevent cervical cancer?
A: Getting the HPV vaccine before being exposed to HPV will prevent some HPV. Limiting the number of sex partners and avoiding sex with people who have had many other sex partners decreases a person’s risk of exposure to HPV. HPV infection is so very common, though, that even these measures are no guarantee that a person will not get HPV. Still, these measures may help reduce the number of times a person is exposed to HPV. Condoms provide some, but not total, protection against HPV. Since nothing is a failsafe, it is crucial to get routine Pap tests if you are sexually active.
Q: Is there a vaccine to prevent HPV Infection/ Cervical Cancer?
A:In 2006, the Food and Drug Administration (FDA) approved a vaccine that prevents the 2 types of HPV (HPV 16 and 18) that cause 70% of all cervical cancers. The vaccine also prevents 2 types of HPV (HPV 6 and 11) that cause 90% of all genital warts. This vaccine is named Gardasil. There is another vaccine that is still being studied to see if it safely prevents HPV 16 and 18. It is called Cervarix, and it is not yet approved by the FDA for use in the United States. Unlike Gardasil, it does not target the wart-causing HPV types.
Q: Is the HPV vaccine safe?
A: Before it was approved, the HPV vaccine was tested in more than 21,000 girls and women in many countries around the world. There were no deaths due to the vaccine, and almost no serious side effects reported during those trials. The most common side effect was brief soreness at the injection site. The FDA has determined that the vaccine is safe and effective for females aged 9 to 26 years. However, CDC and FDA doctors and scientists continue to review all reports of serious side effects reported to watch for potential new vaccine safety concerns that may need further study.
Q: Who should be vaccinated and when?
A: To be most effective, the HPV vaccine should be given before a female has any type of sexual contact with another person. It is given in a series of 3 doses within 6 months. Here are the recommendations for each age group:
girls ages 11 to 12 - The vaccine should be given to girls ages 11 to 12 and as early as age 9.
girls ages 13 to 18 - Girls ages 13 to 18 who have not yet started the vaccine series or who have started but have not completed the series should be vaccinated.
young women ages 19 to 26 - Some authorities recommend vaccination of women ages 19 to 26, but the American Cancer Society experts believed that there was not enough evidence of the benefit to recommend vaccinating all women in this age group. It is recommended that women ages 19 to 26 talk to their doctors or nurses about whether to get the vaccine based on their risk of previous HPV exposure and potential benefit from the vaccine.
Q: What about women over 26 years of age? Should they get the vaccine?
A: Women over 26 years of age were not included in the studies that were done to test the vaccine. That means the FDA could not approve the vaccine for this age group. Studies are now being done in women ages 27 to 55. When those study results are known, a decision can be made about whether to vaccinate women in this age group. Keep in mind to HPV that the risk of HPV exposure is highest soon after women become sexually active. So it is likely that women over 26 have already been exposed, and would not benefit much from the vaccine.
Q: Are there some girls or women who should not get the HPV vaccine or who should wait?
A: Yes. Anyone who has ever had a life-threatening allergic reaction to yeast or anything else in the HPV vaccine, or anyone who has had a reaction to an earlier dose of HPV vaccine should not get the vaccine. Tell the doctor if the girl getting the vaccine has any severe allergies. Pregnant women should not get the vaccine. Even though it appears to be safe for both mother and the unborn baby, it is still being studied. If a woman who is pregnant does get the vaccine, this is not a reason to consider ending the pregnancy.
Q: What are the benefits of the vaccine?
A: The vaccine will prevent the 2 types of HPV that cause most cervical cancers (about 70%) and the 2 types of HPV that cause most genital warts (about 90%), but only in women who have not already been exposed to these types of HPV. It also helps prevent vulvar and vaginal cancers related to these 2 types of HPV. The vaccine will not prevent HPV in women who have already had these HPV types.
Q: Will women and girls who have been vaccinated still need Pap tests?
A: Yes. People who get vaccinated will still need Pap tests because the vaccine will not prevent all types of HPV that can cause cervical cancer
Q: What can you do?
A: Thanks to the availability of Pap tests, and the vaccine, cervical cancer is one of the most preventable cancers. It is important for every woman to know her cervical cancer facts! Talk to your health care professional today about ways to help protect yourself from the disease.
Sources: American Cancer Society, Mayo Clinic