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HPV TEST: A NOVEL TECHNIQUE TO PREVENT CERVICAL CANCER

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You have probably heard the term Pap test and know that you should be getting it regularly. Pap tests are important because they allow us to detect abnormalities in the uterine cervix before they turn into cancer. Thus, Pap tests have saved millions of women’s lives for more than 70 years now.

Nevertheless, as valuable as this test has been for so many years, new technology has come to improve even further our ability to find pre-cancer or early cancer of the cervix. This novel exam is called the HPV test.

In this article you will find all the information you need to know regarding this new technique, which is becoming a routine exam in most countries.

Background

  • Cervical cancer is the second-most-common cancer affecting women worldwide. It is a type of cancer that can easily be prevented, as its cause is known: the human papillomavirus (HPV, read more here).
  • Not all types of HPV are responsible for the development of cancer of the uterine cervix. Approximately 15 types of HPV are related to cancer, these are known as high-risk types or oncogenic viruses.
  • While most HPV infections resolve without treatment, infections with high-risk HPV strains that persist over time can cause precancerous changes in the cervix.
  • Precancerous conditions are not cancer, but if these abnormal changes are not treated, they may become cervical cancer. It may take 10 years or more for precancerous conditions to turn into cancer, but eventually this happens within a shorter time period.
  • Pre-cancer lesions of the cervix do not cause any symptoms. Symptoms only appear in advanced cancer. That is why all healthy women should undergo preventive exams.
  • The mainstay of cervical cancer screening for the last 70 years has been the Pap test (also called Pap smear or Test Papanicolaou). During the procedure, cells from the cervix are gently scraped away with a brush and then examined for abnormal growth, usually called cervical dysplasia,  CIN (cervical intraepithelial neoplasia), or SIL (squamous intraepithelial lesions).
  • More recently, newer technologies have become available to test for the cancer-causing types of HPV and determine if you may be at risk. This test is called the HPV test.

What is the HPV test?

  • The human papillomavirus (HPV) test detects the presence of the types of HPV virus that can lead to the development of cervical cancer.
  • The HPV test is available only to women. Although men can be infected with HPV and pass the virus along to their sex partners, no HPV test yet exists to detect the virus in men.

Why test for HPV?

  • The Pap test is a simple test that has saved uncountable women lives. However, it is not 100% accurate. The Pap test detects certain cervical abnormalities that will never progress to cancer; on the other hand, it may miss abnormal cells even when they are there.
  • Thus, knowing whether you have a type of HPV that puts you at high risk of cervical cancer will provide valuable information on the next steps in your health care, such as follow-up monitoring, further testing, or treatment of precancerous cells.
  • Recent studies have shown that HPV testing is more effective than Pap smears at detecting precancerous lesions.
  • A Pap test plus an HPV test (called co-testing) is the most effective way to find pre-cancer or early cervical cancer in women 30 and older.

Who should do the HPV test?

The HPV test is recommended if:

  • You are age 30 or older. The HPV test may be done alone or in combination with a Pap smear.
  • Your Pap test showed atypical squamous cells of undetermined significance (ASCUS). ASCUS is a common finding in a Pap test; it may be a sign of HPV infection, although many times it is just related to benign cervical polyps, a bacterial infection, or low hormone levels (menopause).
  • You had a surgical removal of a precancerous lesions, usually 6 months after the treatment. This is called “test of cure”.

Although recommendations vary in different countries, all women aged 30 to 65 years old should have the HPV test every 3 to 5 years.

Routine use of the HPV test in women under age 30 is not recommended, nor is it very helpful. HPV spreads through sexual contact and is very common in young women. Most of the times, HPV infections clear on their own within a year or two. Since cervical changes that lead to cancer take several years — often 10 years or more, younger women are usually advised to follow a watchful waiting instead of undergoing treatment for cervical changes resulting from an HPV infection.

What are the risks of HPV testing?

Although the HPV test is very accurate, it carries (like any other test) the risk of false-positive or false-negative results.

• False-positive. This means that the test showed a high-risk HPV when you really don’t have it. A false-positive result could lead to an unnecessary follow-up procedure, such as colposcopy or biopsy, and undue anxiety over the test results.

• False-negative. A false-negative test result means you really do have an HPV infection, but the test indicates that you don’t. This might cause a delay in appropriate follow-up tests or procedures.

How should I prepare for an HPV test?

The HPV test is usually done at the same time as the Pap test. You can take these measures to make both tests as accurate as possible:

  • Avoid intercourse, douching, or using any vaginal medicines or spermicidal foams, creams or jellies for two days before the test.
  • Try not to schedule the test during your menstrual period. The test can be done, but a better sample of cells can be collected at another time in your cycle.

How is the HPV test done?

  • The HPV test, alone or in combination with the Pap test, is performed at the doctor’s office and takes only a few minutes.
  • While you lie on your back with your knees bent, your doctor will gently insert an instrument called a speculum into the vagina.
  • The speculum allows the visualisation of the cervix. Samples of the cervical cells are taken using a soft brush.
  • Usually this doesn’t hurt, sometimes it may cause a mild discomfort.
  • After the procedure, you can do your normal daily activities without any restrictions.
  • Ask your doctor about when you can expect to receive your test results.

What do the results mean?

Results from your HPV test will come back as either positive or negative.

  • Positive HPV test. This means that you have a type of high-risk HPV that is linked to cervical cancer. While most women who are infected with HPV will never develop cervical cancer, it’s a warning sign that cervical cancer could develop in the future.
  • Negative HPV test. A negative test result means that you don’t have any of the types of HPV that cause cervical cancer, and you will continue with normal monitoring.

Depending on your test results, your doctor may recommend one of the following as a next step:

  • Normal monitoring. If you’re over age 30, your HPV test is negative and your Pap test is normal, you will follow the generally recommended schedule (differences apply for each country).
  • Colposcopy. In this follow-up procedure, your doctor uses a special magnifying lens (colposcope) to more closely examine your cervix.
  • Biopsy. Done in conjunction with colposcopy, a sample of cervical cells (biopsy) is taken to be examined more closely under a microscope.
  • Removal of abnormal cervical cells. To prevent abnormal cells from developing into cancerous cells, your doctor may suggest a procedure to remove the areas of tissue that contain the abnormal cells.

The bottom line…

It is true that a visit to the gynaecologist may sound frightening. You may be too busy, and feel that you don’t have the time. You may believe that you are not at risk for cancer. While all this may be true, you should know that every sexually active woman is at risk for cervical cancer, the HPV test is a simple, painless test that takes 5 minutes to be done, and will prevent some serious issues in the long run. Have your HPV test! Five minutes of your time can save your life!

References

  1. The HPV DNA test – American Cancer Society
  2. Gynecological Cancers – Centers for Disease Control and Prevention
  3. Cervical Cancer Screening: Pap and HPV tests – National Cervical Cancer Coalition
  4. Cervical Screening – National Health System UK

Photo credits

telegraph.co.uk; cmdrc.com; twitter.com; erewashccg.nhs.uk; everydayhealth.com; healthxchange.sg; margaretmccartney.com

HPV: ALL YOU NEED TO KNOW

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You got your Pap test result: “HPV”. What do you do? What most of us do: you google it! You go from one site to the other, from forum to forum … and you get really confused: I have what?!? How did I catch it? Will I have cancer? Is my partner cheating on me? A lot is being said and written about HPV, a great part of it being contradictory! The truth is, many things about HPV are still a mystery, even for physicians… Let’s try to get things straighten out and answer the most common questions regarding HPV….

  • Getting to know HPV

HPV stands for human papillomavirus. It’s a virus and is transmitted from person to person through skin-to-skin contact. HPV is in fact a very large family, comprising more than 120 subtypes; of those, only 30 infect the genital area.

  • How common is HPV infection?

Very common! It is estimated that 80% of women will contract the virus at some point in their lives. Most of the times, the immune system will be able to get rid of the virus, but a small percentage will keep it for life. It seems that many women will catch it and fight it several times in their lifetimes…

  • How did I get HPV? Who gave it to me?

The primary source of transmission is sexual contact, including vaginal, oral or anal. Actually, sexual intercourse is not required to get infected, as HPV can be spread by skin-to-skin contact. Although some research suggests that HPV could be transmitted through items such as towels or underwear, this is not yet clear. On this subject, the opinions are divided between experts, and many (including myself) feel that it is extremely unlikely, if not impossible, to catch the virus this way. Α pregnant woman, in rare instances, may transmit HPV to her baby, but the transmission route (vaginal the moment of delivery, or through the placenta during pregnancy) is not yet clear.

  • Is there any way of knowing how long I’ve had HPV?

Once you get infected with HPV, it may either show itself (usually 1 to 3 months after), or lay dormant and undetectable. Then the virus may be later cleared completely by the immune system, or remain present in the cervical cells for years. Because it can last long in your body before any cell changes occur, it is difficult to know who transmitted HPV to you or how long you’ve had it. So the answer to this question is: NO.

  • I got HPV! What will happen to me now?

-Most of the times, absolutely nothing. The majority of HPV infections will be cleared by your immune system without you even noticing it.

-Of the over 100 types of HPV, about 12 subtypes (mostly subtypes 6 and 11) may cause genital warts (also known as condylomas). These are growths that may appear on the external genitalia, but also around the anus, inside the vagina or on the uterine cervix. Genital warts are very common: 1 out of 10 persons will have condylomas at some point in their lives (the frequency varies according to different countries between 0,3 and 12 %). It is important to remember that genital warts are benign and do NOT evolve to cancer.

-Approximately 15 types of HPV (most commonly types 16 and 18) are related to cancer. All these types are known as “high risk types”. While cervical cancer is the most common cancer related to HPV, and HPV seems to be almost the exclusive cause of cervical cancer, this virus can also cause other, less frequent cancers: vulvar, vaginal, anal and oropharyngeal (means throat and tongue). Because a lot has been said lately about the possibility of getting cancer of the throat with oral sex, it is important to clarify that: Yes, HPV is related to throat cancer, BUT this is a not a very common cancer and only half of all throat cancers are caused by HPV!

-Low-risk types can also cause a rare condition called recurrent respiratory papillomatosis, in which warts grow in the throat.

  • What about men?

Things are less clear for men, as HPV is more difficult to test than in women. It is accepted that men are carriers of the virus and contribute to its widespread presence, so it can be assumed that HPV infection is as frequent in men as in women. What is sure is that men are much more rarely affected by the virus, with the exception of genital warts (same as women). Although rare, men may develop HPV-related anal or oropharyngeal cancer. HPV may be also related to penile cancer, but this type of cancer is extremely unusual.

  • I got infected with a high risk-type HPV. Will I have cancer?

When we get infected with a high risk-type virus, it may enter the cells and damage their DNA, causing then to grow abnormally. These cellular changes may progress to what is called dysplasia or cervical intraepithelial neoplasia (CIN). Most of the times, the immune system will destroy the abnormal cells before they become cancer. But sometimes they are not cleared by our body’s defense, allowing them to evolve, first to a mild lesion, then to a moderate, then to a severe lesion, which in turn, after several years may result in cancer. The transformation of these cells into cancer has to do with a balance between the aggressiveness of the virus and how strong our immune system is: the stronger will prevail…

  • Can we stop the virus before going into cancer?

Yes! Thanks to a Greek scientist, Dr. Georges Papanicolaou, we learnt that cervical cancer can be found before becoming cancer, that is, at its precancerous state. The Pap test (named after him) can detect early signs of abnormal cell changes of the cervix, allowing early treatment so they do not become cancer. There are other, more sophisticated tests, such as HPV testing and colposcopy that can be used as complementary exams t to the Pap test.

  • How can I avoid HPV infection?

That’s a difficult question. A sexually active person will never be 100% protected against HPV. We can though take some measures to reduce the chances of infection:

-Limit the number of sexual partners: although you may get HPV even if you had only one sexual partner in your lifetime, the more partners you have, the more the changes of getting infected.

-Use condoms. Condoms offer only partial protection against HPV infection as the virus can also be passed by touching infected areas not covered by a condom. The protection of condoms is estimated to be around 60%, that’s something, though ! and in fact is the only mean we have to be protected. Condoms should be used for vaginal, anal or even oral sex.

-Get vaccinated. Two vaccines are available to protect against certain types of HPV. This topic deserves further analysis in a future post…

  • What can I do to fight HPV?

There is no treatment for HPV itself, only for the problems that the virus can cause. These are some measures you can take to help your body get rid of the virus or at least prevent it from evolving into more severe lesions:

-Boost your immune system. The virus takes profit of a low defense system to progress. To help your immune system eat healthy, sleep well, avoid stress (if that is possible…), exercise, do activities that make you feel relaxed…Read more here.

-Quit smoking. Some chemical contained in cigarette will help the virus to progress into cancer.

-Get off the pill. Although the pill protects against uterine and ovarian cancer, it doubles the risk of cervical cancer…

In conclusion, if you got HPV:

First of all: don’t panic!

Second: get always good quality information on the subject. Don’t rely on rumors or on “what someone told you”. Knowledge is power!

Last, but not least, visit regularly your gynecologist. It takes 5 minutes to have a Pap test done. These 5 minutes can save your life!

References

http://www.cdc.gov/std/hpv/stdfact-hpv.htm

http://www.acog.org/~/media/For%20Patients/faq073.pdf?dmc=1&ts=20140707T0129049372

http://www.biomedcentral.com/1471-2334/13/39