HCA Midwest Health - March 04, 2020

We’re hearing a lot these days about the link between human papillomavirus (HPV) and certain types of cancer, specifically cervical cancer. HPV infections are among the most common of sexually transmitted diseases, with approximately 14 million new cases occurring each year in the U.S. Some experts tell us that most sexually active women and men will be infected at least once in their lives, if not more.

Are all these people destined to develop cancer? No.

There are more than 100 different types of HPV, most of which do not cause problems. According to the World Health Organization (WHO), most of the time, HPV infection clears up within just a few months of contracting it, and about 80-90% of infections eventually go away on their own. Certain strains of HPV, however, can cause cervical changes that, if not detected early, can turn into cancer. Menorah Medical Center’s Nicole Niemann, MD, a board-certified family practice physician providing ObGyn care breaks down five important things we should know about HPV.

HPV infection is the leading cause of cervical cancer

According to WHO, cervical cancer is by far the most common HPV-related disease and nearly all cases of cervical cancer can be linked to it. The good news is, doctors say that most HPV infections clear up on their own, and most pre-cancerous lesions resolve themselves.

“If a woman tests positive for HPV, there’s no need to immediately panic,” shares Dr. Niemann. “Your body can be infected with the virus but then clear it without any cancerous changes to the cervix. Either your body will clear itself of the infection or it will not. It's not always clear why certain women are more apt to develop cervical cancer.”

Some risk factors for HPV progressing to cervical cancer:

  • The type of HPV – types 16 and 18 cause 70% of cervical cancers and precancerous lesions.
  • Status of immune system – those with compromised immune systems are more likely to have persistent HPV, and progression to precancer and cancer.
  • The presence of other STDs such as herpes, chlamydia and gonorrhea
  • Being young with a first birth
  • Cigarette smoking
  • Being overweight

HPV can lie dormant for years

Unless there are visible symptoms such as venereal warts, most people with HPV do not know that they are infected. Although the virus often heals on its own, in other cases, it lies dormant in the body and can trigger cancers years after infection. In fact, cervical cancer from HPV commonly takes 10 to 20 years or more to develop.

“The fact that it can lie dormant is why we still routinely screen for it even if new exposure is not a concern,” says Dr. Niemann.

Early detection is key for successful cervical cancer treatment

Cervical cancer is preventable if precancerous changes are identified and treated early. A routine screening such as a pap smear, also called a pap test, can actually prevent most cervical cancers by identifying abnormal cervical cell changes (pre-cancers) so that they can be treated before they turn into a cervical cancer. Like a pap smear, the HPV test involves collecting cervical tissue samples which are tested for the presence of the virus. Your doctor may order an HPV test if a pap smear comes back abnormal.

“A pap smear and HPV test will detect virtually all precancerous changes and cervical cancers,” says Dr. Niemann. “Women should talk with their doctors about what screenings are right for their age and sexual history, and the frequency of screenings.”

In general, guidelines say all women should be screened for cervical cancer with a pap smear starting at age 21. Women 30 and over should be have a pap smear and HPV screening together. If both are negative, testing is recommended every five years. A positive test for either HPV or the presence of abnormal cells leads to further evaluation.

“With a positive result, the next steps will depend on a patient’s age, the exact findings from the pap, and which HPV strain is present,” Dr Niemann explains. “In some instances, the pap/HPV test is repeated in six months to one year and in others, further examination of the cervix and possibly a biopsy may be the next step.”

In cases where treatment is necessary, the most common types of treatment to remove the tissue are:

  • Cold knife conization – a hospital procedure requiring anesthesia where the tissue is removed with a scalpel
  • Cryotherapy – an office procedure where the abnormal tissue is frozen off.
  • Laser therapy – a hospital procedure requiring anesthesia where a laser destroys the tissue
  • LEEP (loop electrosurgical excision procedure) – an office procedure with local anesthesia where a thin wire loop, through which an electrical current is passed, is used to remove abnormal tissue

HPV is linked to other cancers

More and more research now supports the direct connection of certain HPV strains to cancers of the anus, vulva, vagina, penis, and head and neck.

There is a safe vaccine for HPV

There are currently three vaccines that protect against some of the higher risk strains of HPV, specifically strains 16 and 18. The vaccine is considered the best defense against cervical, head and neck, anal and penile cancers.

Because the vaccine is most effective before someone is exposed to HPV, it is widely advised to vaccinate kids and teens aged 9-14, with the hope of protecting them before they become sexually active. The vaccine has for some time been available for adults up to age 26, and has recently been approved for men and women up to age 45.

“This is the very best defense against cancers caused by HPV,” stresses Dr. Niemann. “As a woman, you significantly decrease your risk of cervical cancer as well as other cancers. I always advise patients to get the vaccine and to vaccinate their kids. This gives them lifetime protection against HPV-causing cancers.”

Women’s care for the ages

When you’re looking for experienced and compassionate women’s care, HCA Midwest Health is there for you. Our women’s specialists offer expertise and personalized care in all aspects of obstetrics and gynecology, from routine well-woman care to prenatal and childbirth care to treatment for menopause symptoms, adolescent gynecology or other gynecologic health issues.

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