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Cervical Cancer & HPV: What You Need to Know

Last updated: Nov 12, 2018

Cervical Cancer & HPV: What You Need to Know

About 14 million women and men become infected with the human papillomavirus (HPV) each year in the United States, according to the Centers for Disease Control and Prevention. HPV accounts for 90 percent of cervical cancers and is associated with other malignancies, including vaginal, anal, head and neck cancers.

The HPV vaccine is an effective way to prevent HPV infection and related cancers.  It has been in use for cancer prevention in young person’s ages 9-26 and is now approved for men and women ages 27 to 45 by the Food and Drug Administration.

The following Q&A features comments by Dr. Darlene Gibbon, Medical Director of Gynecologic Oncology, Summit Medical Group, and Dr. Terri Febbraro, gynecologic oncologist, Summit Medical Group.


About Cervical Cancer and HPV
 

What is cervical cancer?

The cervix is a narrow opening to the uterus. A routine pelvic examination includes an assessment of the cervix.  Cervical cancer occurs when normal cells in the cervix begin to grow uncontrollably. 


What are the risk factors for cervical cancer?
 

  • Persistent HPV infection is a major risk factor for developing cervical cancer.
  • Having sex at an early age increases your risk of becoming infected with an HPV infection.
  • As the number of one’s sexual partners increases, so does the risk of exposure to HPV, which in turn, increases the risk of developing cervical cancer.
  • Having other sexually transmitted infections such as chlamydia, gonorrhea, syphilis and HIV/AIDS increases your risk of contracting an HPV infection.
  • If you have a weakened immune system due to a condition such as HIV, if you are a transplant recipient, or if you are on immune modulating medications, you may be more likely to develop cervical cancer.
  • Smoking is also associated with increased risk of cervical cancer.
     

How do people get HPV?
 

The HPV virus can be spread through sexual encounters. Barrier methods of birth control including a diaphragm, cervical cap, male or female condom, and spermicidal foam or sponges, do NOT protect against HPV entirely. It is estimated that 75-80% of individuals will acquire a genital HPV infection before the age of 50 with most individuals getting exposed between 15-25 years of age.  In 10-20% of women, HPV becomes a persistent infection which increases the risk of developing cervical cancer.

 

How are HPV and Cervical Cancer related?
 

There are many different strains of HPV, some of which are related to cancer.  Low risk HPV types 6 and 11 cause genital warts and high-risk types 16 and 18 cause precancerous changes, accounting for a majority of cancers of the cervix.

In some women persistent infection with the virus leads to changes in the cells of the cervix.  Initially these changes are precancerous, so the good news is that regular screening can not only catch early cancers but prevent cervical cancer from developing in the first place. When these precancerous changes are not treated, cervical cancer can develop as the cells in the cervix multiply.  Thus, it is important for women to get a Pap test and HPV screen on a regular basis.  


What are the symptoms of cervical cancer?

Symptoms include:

  • Abnormal vaginal bleeding
  • Vaginal bleeding after intercourse
  • Bleeding between periods
  • Vaginal bleeding after menopause
  • Watery, bloody vaginal discharge that may have a foul odor
  • Pelvic pain or pain during intercourse
  • Leg swelling in one leg
     

 

Prevention and Risk Factors
 

How can I lower my chances of getting cervical cancer?
There are many things that can be done to lower the risk of developing cervical cancer.

  • Practice safe sex
  • Get vaccinated with the HPV vaccine
  • Go for routine scheduled gynecologic exams and Pap and HPV testing 
  • If you have any symptoms, schedule an appointment with your gynecologist (or your primary care provider if they perform your usual gynecologic care) to be evaluated
  • If you smoke, STOP.

           

What should people know about the HPV vaccine?


The HPV vaccine is recommended for boys and girls at age 11 or 12. They should complete the two-shot series by age 13. The vaccine is given at this age because this is when it provides the best immunity.

The vaccine is available for males and females between the ages of 11 and 26. If you have not received the vaccine by age 26, new evidence shows that you may still benefit if you get the vaccine by age 45.  While insurance coverage for persons aged 27-45 is variable, the lowering of risk is clear, so talk to your doctor about getting vaccinated. The only HPV vaccine available in the United states is Gardasil-9 which protects against 9 HPV types including 6, 11, 16, 18, 31, 33, 45, 52 and 58. This vaccine, which is given at scheduled times, will protect against the development of genital warts and HPV-related cancers. For those under 14 years of age with a healthy immune system, the vaccine is given as two injections six months apart. People over the age of 14 or anyone with a compromised immune system require three injections; the second given two months after the first and the third dose given six months after the second.

The HPV vaccine is safe.  Side effects may include redness, tenderness, or swelling at the injection site. It should NOT be given to women who are pregnant. Ideally, individuals should be vaccinated before they are sexually active in order to minimize the effects of likely exposure to the virus.  While the vaccine does not eliminate any prior infection, it does prevent infection from other subtypes that an individual has not yet been exposed to.
 

When and how often should I be screened?


The most recent guidelines recommend:

  •  Pap testing should not begin before age 21. Women ages 21-29 should get a Pap test every three years. This involves looking at the appearance of the cells of the cervix under a microscope.
  • Women ages 30-65 should have Pap test along with HPV test every five years.
  • Women over 65 years of age do not need to be screened if they have gone for routine prior screenings and have not been diagnosed with precancerous cervical changes or cancers.
  • If a woman has had a hysterectomy with removal of the cervix and does not have a history of precancerous changes of the cervix or cervical cancer, further testing is not necessary. If there is a medical history of HPV or cervical cancer, screening must continue for 20 additional years.

 


Treatment

What are the treatments for cervical cancer?
 

Treatment for early stage disease consists primarily of surgery. Treatment depends on the extent of the cancer and whether you are still interested in having children when possible. Depending on the extent of your cancer, you may have a portion of the cervix removed. Some women will undergo a hysterectomy or removal of the uterus.  Surgical evaluation often includes removal of lymph nodes.

For large tumors or cancers that have spread outside of the cervix, treatment may include radiation and chemotherapy.
 

 

What are the latest advances in treating gynecologic malignancies?

 

In addition to standard treatment options, Summit Medical Group Cancer Center uses immunotherapy to treat cervical cancer.  Immunotherapy stimulates the patient’s own immune system to recognize and destroy cancer cells. Early clinical trials have demonstrated promising results with the use of immunotherapy in women with cervical cancer.   We also have learned that the addition of a targeted antibodies known as bevacizumab during chemotherapy, improves outcomes in women with recurrent or metastatic cervical cancer. Bevacizumab prevents tumors from developing blood vessels that are needed to get nourishment to grow.


Doctors are constantly looking for new ways to treat cervical cancers and improve survival.
 

What’s the bottom line?

  1. HPV related diseases, including cancers, can be prevented. 
  2. Follow the healthy lifestyle habits listed above, especially avoiding tobacco use.
  3. Boys and girls should receive the HPV vaccine between age 11 and 12 to reduce risk of HPV related cancers.  Those between ages 27 and 45 should check with their insurance company about coverage but consider getting vaccinated even if it is not covered.
  4. All women between ages 18 and 65 should get regular screening for cervical cancer with their gynecologist or primary care provider.  Screening can catch and prevent cancer before it starts!

 

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