Smart Woman Online

HPV and Cervical Cancer

October 4, 2007
By Dr. Vicki A. Lucas, PhD, RNC

Cervical cancer is the second most common cancer in women worldwide, with 400,000 to 500,000 new cases reported annually. Last year, 3,700 women in the United States died from the disease — despite the performance of 50 million Pap smears, at a cost of $5 billion. The majority of cervical cancer is caused by the human papillomavirus, or HPV. Two-thirds of all cervical cancers are caused by HPV-16 and HPV-18. Overall, there are more than 30 genital HPV types.

The federal Centers for Disease Control and Prevention estimate that 20 million people in the United States are infected with HPV, including 9.2 million sexually active adolescents and young adults aged 15 to 24. Seventy-four percent of new HPV infections occur in this age group, and the virus’ prevalence in women under 25 is estimated at 28 percent to 46 percent. At least 80 percent of women in the United States will have been exposed to HPV by the time they reach age 50. For sexually active men and women, the lifetime risk of acquiring HPV is at least 50 percent. (Not everyone who is exposed to the virus actually acquires it.)

HPV and cervical cancer are sexually transmitted diseases, and difficult ones to spot at that. One problem is that victims are usually asymptomatic — they don’t know they’re infected or sick. There is also no reliable and relatively simple screening test, as there are for HIV and other sexually transmitted diseases. HPV cancer-related lesions are microscopic and test positive only when they are shedding the virus. (Refer to the table for a list of risk factors associated with HPV.)

That said, you can and should be screened for HPV. For women, the most important screening tests are Pap smears and virapaps. Both tests take a sampling of cells from inside the cervix, which are sent to a cytology lab for examination. Pap smears identify abnormal, precancerous or cancerous cervical cells. Virapaps reveal if HPV is present and, if so, which type it is. The tests are important. Unfortunately, many new cases of cervical HPV infection occur without detectable cytological abnormalities. In other words, a normal Pap smear and virapap do not guarantee that you are free of infection.

Prevention and early detection of HPV and cervical cancer are critical. Adolescent girls appear to be the most vulnerable to HPV infections. An adolescent’s cervix is more easily infected than an adult’s; adolescents also have immature immune systems. The education of adolescent girls is essential if we are to spare them a lifetime of fighting cervical cancer.

Women need to know that all sexual contact can lead to HPV infection. Sexually active women need to insist on protecting themselves with safe sex practices such as using condoms. They need to have annual Pap smears regardless of their age, even if they’re post-menopausal, have had a hysterectomy or have been sterilized. The same goes for women in long-term, monogamous sexual relationships. Many women in these categories are not compliant with annual Pap smears. Those who skip the test are taking a huge risk. HPV and cervical cancer are slow-growing and asymptomatic, which can give a false sense of security.

Last year, the U.S. Food and Drug Administration approved an immunization to prevent cervical cancer. The first HPV vaccine in the United States, it bears the trade name Gardasil and is recommended for all females aged 9 to 26. It has been proven 87.5 to 100 percent effective in preventing HPV types 6, 11, 16 and 18 and has minimal side effects. Gardasil is administered in a series of three shots in the arm: The second injection is given two months after the first, and the third one four months after that (six months after the first shot).

It is important to note that all girls and women need to have annual Pap smears even if they’ve had the injections, and that Gardasil does not protect against any other sexually transmitted disease.

No woman should ever die of cervical cancer: It is slow-growing and curable if detected early. Abstinence, safe sex, annual Pap smears and Gardasil are the keys to eradicating this disease in the United States.

For further information on HPV and cervical cancer, visit www.cdc.gov.

Dr. Vicki Lucas is a nationally known expert on women’s health. A speaker, writer and consultant, she has worked throughout the United States and abroad. She is also the co-editor of Women’s Health Nursing: Toward Evidence-Based Practice. Contact Dr. Lucas at www.vickilucas.com.

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