HPV TEST: A NOVEL TECHNIQUE TO PREVENT CERVICAL CANCER

Posted in Health by woman2womenblog

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

Photo credits

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

29Mar2016

CONTRACEPTION: 14 COMMON MYTHS – BUSTED

Posted in Health by woman2womenblog

How good is your knowledge on contraception? Statistics show that even if contraception awareness is on the rise, there are still a lot of important gaps, and many misconceptions persist.

If you are like most young people, your “education” on birth control comes mainly from your friends, and the internet. And you may have learnt valuable things from them! But there is still a lot of misinformation going around, leading in many cases to misunderstandings and unpleasant surprises…

Following are some of the most common myths, rumours and misperceptions regarding birth control that you should know in order to avoid an unplanned pregnancy.

MYTH # 1: I won’t get pregnant if my partner pulls out before he comes

This is one of the most common misconceptions, responsible for many unwanted pregnancies. Also known as the withdrawal method, it has a high rate of contraception failure. This is because some pre-ejaculation fluid (or pre-come) may be released before the man actually ejaculates; this pre-come contains spermatozoids, and it takes only one sperm to get you pregnant! In addition, some men may not have enough self control to withdraw in time…

Keep in mind that pre-ejaculation fluid can also contain sexually transmitted infections, so pulling out will not prevent you from getting an infection.

MYTH # 2: I don’t get pregnant if I have sex during my period

The chances of getting pregnant while on your period are low, but it may happen, mainly in women with shorter cycle –i.e., if you get your period every 21-24 days. In such case, your ovulation occurs around the 10^th to 12^th day after the beginning of your period. Since sperm can live up to 5 days inside your body, if you have sex towards the end of your period, sperm can wait for the egg to be released and you may become pregnant.

But even in women with longer, regular cycles, the ovulation may eventually take place earlier… So remember, you can get pregnant at any time of the month if you have sex without contraception.

MYTH # 3: The morning after pill is dangerous, you can’t take it more than once or twice in your lifetime

It has been suggested (mostly by internet rumours) that it is dangerous to take the emergency contraception pill more than one or twice in your life. According to the World Health Organisation: “Emergency contraceptive pills are for emergency use only and are not appropriate for regular use as an ongoing contraceptive method because of the higher possibility of failure compared with non-emergency contraceptives. In addition, frequent use of emergency contraception can result in side-effects such as menstrual irregularities, although their repeated use poses no known health risks.” Emergency contraception pills are very safe and do not harm future fertility. Side effects are uncommon and generally mild. Read more about the morning after pill here.

MYTH # 4. I don’t get pregnant if I have sex standing up or if I’m on top

Some women believe that having sex in certain positions, such as standing up, sitting down, or if they jump up and down afterwards, they won’t get pregnant as sperm will be forced out of the vagina. In fact, sperm are very strong swimmers! It has been showed that within 5 minutes, sperm are able to reach the tube, where the fertilisation of the egg takes place, and this happens regardless of the position you have sex in.

There’s no such thing as a “safe” position if you’re having sex without a condom or another form of contraception. There are also no “safe” places to have sex, including the bathtub, the shower or the sea.

MYTH # 5. There are only 3 contraceptive options: the condom, the pill and the IUD

Although these three methods are the best-known, there are 15 different methods of contraception (the available options differ in each country). Unfortunately -for women- there are only two choices for men (the male condom and permanent sterilisation). Women have a choice of about 13 methods, including several of long-acting reversible contraception -this means you don’t need to remember to take it or use it every day or every time you have sex.

MYTH # 6. The IUD is not suitable for teenagers and women without children

In the USA, 44% of adolescent girls ages 15 to 19 have had sexual intercourse. Although most of them have used contraception, teenagers frequently use methods with high failure rates -such as withdrawal, or they incorrectly use more reliable methods -such as the pill. In fact, 8 out of every 10 adolescent pregnancies are unintended.

The intrauterine device (IUD), a small device that is inserted into the uterus, has been traditionally reserved to women who have had children. However, new guidelines issued by the American College of Obstetricians and Gynecologists have changed this old perception: the IUD, together with the contraceptive implant, are considered now first-line contraceptive options for sexually active adolescents and young women, as they are the most effective reversible contraceptives for preventing unintended pregnancy, with about 99% effectiveness.

Of course, the IUD and the implant do not protect against sexually transmitted infections, therefore you should also use condoms for that purpose.

MYTH # 7. You can’t get pregnant if it’s the first time you have sex, or if you don’t have an orgasm

These persistent misconceptions are, unfortunately, still responsible for many unplanned pregnancies. If the intercourse takes place during your fertile period, you may become pregnant, whether it’s the first or the hundredth time you’ve had sex, whether you liked it or not.

MYTH # 8. Two condoms are better than one

Condoms may occasionally break. Many people think that using two condoms (also known as “double bagging”) is safer than using one. Actually, it’s exactly the opposite: using two condoms causes friction between them, increasing the risk of breakage. Thus, two condoms should not be used, neither for pregnancy prevention or for safer sex; this is also true for using a male and a female condom at the same time. When used properly, a male condom is 98% effective at preventing pregnancy, a female condom is 95% effective.

MYTH # 9. I can use any lubricant together with the condom

During intercourse, adding lubricant may ease penetration, so sex is pleasurable and not painful. This is important when, for many reasons (such as stress, medications, taking the pill, etc) the natural wetness of the genital area is reduced.

Lubricants can be made from water, oil, petroleum or silicone; however, when using condoms, water-based lubricants should be used: oil-based products such as petroleum jelly, creams, or baby oil and can damage the latex and make the condom more likely to split, resulting in no contraceptive protection.

Silicone-based lubricants are a newer form of lubrication; they are safe to use with condoms. However, they can be harder to wash off and may cause irritation.

MYTH # 10. If you take the pill for many years, you won’t be able to have children in the future

This is another very common misconception. After stopping the oral contraceptive pill you may get pregnant immediately, but sometimes it may take two or three cycles for your fertility to fully return, no matter how long you have been using it. Some studies have shown that, within a year after going off the pill, 80% of women trying to get pregnant will get pregnant – exactly like women who were never on the pill.

MYTH #11. You don’t get pregnant if you douche right after sex

Vaginal douching (washing out the vagina) after sex won’t help to prevent a pregnancy. Again, this has to do with spermatozoa being fast swimmers. By the time a woman starts douching, sperm are already well inside the uterine cervix, where no douching solution can reach them.

In fact, you should never douche: douching can lead to many health problems, including problems getting pregnant, vaginal infections and sexually transmitted infections.

MYTH #12. I’m breastfeeding so I can’t get pregnant

While you’re less fertile when breastfeeding, you may become pregnant; there is no accurate way to predict when fertility returns, even if you breastfeed exclusively. You may not menstruate for several months after giving birth, but at some point you will have your first ovulation -where you can get pregnant- and this will occur two weeks before you get your first period.

Thus, when nursing you should use birth control if you wish to avoid pregnancy.

MYTH # 13. You’re only fertile one day a month

If you have a regular cycle of 28 days, the ovulation usually occurs the 14^th day of your cycle. But it’s not only that day that you are fertile. As said before, sperm can live in the cervix for up to 5 days, waiting for the egg to be released. Studies have shown that most pregnancies result from intercourse that takes place during a six-day period ending on the day of ovulation. Once the egg leaves the ovary, in about 24 hours it dies, and the fertile period is over.

However, even in women with a perfectly regular cycle, the hormonal balance involved in the ovulation process can be disrupted by many factors: stress, medications, etc, leading to an earlier or delayed ovulation. Thus, trying to avoid a pregnancy by just having intercourse on the “safe” days can be difficult and may eventually result in an unwanted pregnancy.

MYTH # 14. I don’t need a condom because I’m taking the pill

A survey conducted in France showed that “…one in ten young women ages 15 to 20 is not aware that the pill does not protect against HIV and sexually transmitted infections”. In fact, the only contraceptive method that offers protection against STIs is the condom. Even other barrier methods, such as the diaphragm, do not to keep bacteria out of the vagina, and the pill and IUD offer no STI protection at all.

The bottom line:

Don’t be afraid to talk to a doctor about birth control! True, discussing contraception and sexual practices with a healthcare professional may be embarrassing… but it’s better to discuss ways to prevent an unintended pregnancy rather than dealing with one after it happened!

You can do your research before scheduling an appointment -there are many good sites to learn useful information about birth control – but a doctor will help you decide which is the best contraceptive method for you, and how to use it in a proper way.

Knowledge is empowerment! Learn your choices, be aware of the dangers of irresponsible sexual practices, be the advocate for your own sexual health!

Find out more about contraception here:

Centers for Disease Control and Prevention, USA. Contraception

National Health System, UK. Your contraception Guide

FPA UK. My contraception tool