We have been open nearly a month now and already one issue is starting to stand out as being a hot topic of conversation among patients. That is the topic of HPV. There is a ton of confusion out there regarding HPV.
Let’s get down to the basics. HPV is an acronym for Human Papilloma Virus. There are over 100 strains of the HPV virus known to date. Some of these strains cause cervical cancer, some of these strains cause genital warts, and some of these strains we do not yet know if there is any effect on humans. There really is no overlap in those that cause cervical cancer also causing warts.
There are 2 most common strains of HPV that are associated with the majority of cases of cervical cancer, HPV 16 and 18. In addition, there are lesser common strains that can be associated with cervical cancer. These are the strains that we routinely test for when testing for HPV, we do not routinely test for genital wart causing strains.
HPV is a sexually transmitted virus. It can be found in both men and women, though is not routinely tested for in men as there is a much lower incidence of cancer associated with HPV in men. It is estimated that HPV will be found in up to 90% of sexually active people at some point in their lives. The problem with these infections is they can be easily transmitted between people because the infection is not associated with symptoms. In addition, these infections can appear dormant and pop up unexpectedly. This is an important fact because there is a lot of misconception that cervical cancer may be hereditary, it is not. Cervical cancer is due to a sexually transmitted virus.
If you have the HPV virus it is not a diagnosis of cancer. On average it takes 15 years to go from HPV infection to cervical cancer and there are several stages of pre cancer in between. This is why screening is so important, most cancers are caught before they ever become cancer.
In certain age groups HPV can be considered a “transient” infection, meaning that for young healthy women it is very likely that the body’s natural immunity will fight and remove the virus from the body given time. For women past the age of 24 we expect less likelihood of the body removing the virus on it’s own. This is really the crux of some of the changes that are occurring in screening and management of this virus.
A little history, after the discovery of cervical changes thatvpredate cervical cancer the decision was made to test every woman every year with the pap smear starting with the year of first sexual activity. For those of us over a certain age this meant a yearly pilgrimage to the most hated office around just to earn the right to birth control. As painful as it might have been the truth of the matter is that the pap smear has saved more lives than just about any other screening test in use today and has reduced the incidence of cervical cancer in the United States by greater than 60%.
Building on the work of Dr. Papanicolaou, the namesake of the pap smear, the HPV virus was identified in the 1980’s as the causative agent of cervical cancer. More recent work has shown how transient the HPV virus can be. It basically showed that a woman who had HPV at the age of 18 usually would not by the time she was 22. This was hugely important for those young women having their annual testing because unfortunately for that 18 year old by the time that she made it to 22 she had usually had a couple of procedures done to prevent progression of the virus. With the understanding that the virus could regress on it’s own these procedures become completely unnecessary. Armed with this knowledge the gynecology community decided that we shouldn’t be testing young women under the age of 21 to avoid some of this overreaction.
Further studies have since shown that for the rest of the female population HPV is even more important than the pap smear itself in determining the risk of cervical cancer, it is considered the “precursor” to pap smear changes. For these women we continue to test the pap but over the age of 30 we test for the top cancer causing strains of HPV. If HPV is negative it is a strong indicator that the cervix is healthy and that screening can be relaxed.
Finally, the HPV vaccine is a vaccination that is recommended between the ages of 11 and 26 but in reality is best given early. The vaccine can be given to boys or girls and currently protects against the 9 most common strains of HPV, covering a mix of both cancer and genital wart causing strains. The vaccine does not prevent every strain of HPV and it is not effective against those strains that you may have already been infected by but it is currently the only vaccine on the market that can prevent cancer.
So, the main things to gather from all of this talk is:
HPV is not cervical cancer but it does cause cervical cancer.
HPV is common, it does not mean that you have been promiscuous or should be treated as such. It also does not mean that a partner has been unfaithful..
3. HPV that causes cervical cancer is not the same as HPV that causes genital warts.
4. HPV will often go away on it’s own in very young women.
As a woman ages HPV becomes more concerning and less likely to disappear on its own and it does require closer follow up HPV vaccination is an effective way to prevent cervical cancer but does not prevent the strains that you have already been exposed to and does not prevent all strains of HPV
Cervical cancer is a slow process that takes on average 15 years to develop, routine screening and management prevents cancer before it develops.