HPV and Cervical Cancer

The human papilloma virus (HPV) is a very common infection. Most women will get the virus at some time in their life. Over 100 different types of HPV have been identified and most of these are harmless. Each type is known by a number and affects different parts of the body.

• HPV types 1, 2 and 4 are associated with the common warts that can arise on the hands and fee
• HPV types 6 and 11 cause genital warts
• Some HPV types, most commonly types 16 and 18, can cause abnormalities of the cervix (neck of the womb) called cervical intra-epithelial neoplasia (CIN)

For many women HPV infection is temporary and therefore CIN can clear up once the virus has gone. Other factors such as cigarette smoking or a lowered immune system (your body’s mechanism for fighting infections) can also encourage cell changes in the cervix.

HPV is a very common infection in people who have ever been sexually active. It is spread through skin contact during sexual activity. The virus can affect both men and women. Many people are unaware that they have HPV as it has no symptoms. For some people with particular types of HPV, (as described earlier) visible warts may occur which can be easily treated. HPV is more easily passed on to another person when there are visible warts present. For this reason, whilst warts are present and for at least three months after treatment, it is advisable to avoid touching the affected area during sex.

How Will I know if I Have HPV?

A woman may be told that she has HPV when she receives her cervical screening result. If an HPV infection is present, changes in the appearance of the cells of the cervix can sometimes be seen when they are looked at under a microscope during cervical screening. Some women with particular types of HPV may notice visible warts on the genital area which appear as flat smooth small bumps, or larger cauliflower-like lumps. Most warts do not lead to cancer and may appear on their own or in groups; however, should you notice any, it is important that you seek medical advice.

Genital warts are usually diagnosed from their appearance and no test is required. However, the HPV is not always visible externally and there are tests available to detect the types of HPV that cause cancer. A sample is collected from the cervix at the same time as a smear. HPV testing is now widely used and can provide useful extra information. Studies are currently ongoing on to find out whether these tests should routinely be part of the NHS national screening program to prevent cervical cancer.

If You Have Had a Normal Smear

Cervical smears do not always pick up every abnormality. Up to one quarter of all smears may be incorrect. The HPV test provides extra information that can help your specialist decide on the frequency of screening required. For example, if you have a positive test for HPV then your Specialist may advise more frequent screening with cervical smears than if you have a negative test.

If You Have Had An Abnormal Smear

Cervical smears detect abnormalities in the cells on the cervix. Unfortunately they cannot tell us which abnormalities may turn to cancer at a later date and which may not. The HPV test however, is able to indicate which abnormalities are more likely to turn into cancer if left untreated, by identifying the presence of 'high risk' HPV.

If your smear result suggests that you have a moderate or severe abnormality then you will be referred for further assessment and treatment. In this situation, a HPV test is unlikely to influence the medical management you receive. However, if you only have a mild abnormality of the cervix, then the result of an HPV test can help decide about further management. A mild abnormality of the cervical smear and a positive test means that you are more likely to be referred for further assessment and treatment by colposcopy than if you had a negative HPV test. A colposcopy is a way of looking closely at the cervix to see whether you need any treatment. (link to HPV price and smear)

In most people, HPV disappears without treatment.

Prevention

There are things that you can do yourself to help your immune system (your body’s mechanism for fighting infections) to fight the virus:

• stop smoking
• if you have more than one sexual partner, use condoms during sex. Condoms may help to prevent the spread of HPV, although using them does not guarantee protection
• have regular cervical smears

Vaccination

Vaccines have been developed to prevent HPV infection. The Department of Health has agreed to introduce HPV vaccination for girls aged 12-13. Routine vaccination will be introduced in the UK from September 2008 for girls aged 12-13 as part of the national immunisation programme. There will also be a two year catch up campaign, due to start in Autumn 2009, which will include all girls who are up to 18 years of age (but not including those who are aged 18).

There are 2 vaccinations available to protect against some types of the virus.

• Cervarix is a vaccination which can offer protection against HPV 16 and 18, which cause 70% of cervical cancer cases.
• Gardasil is a vaccination which can offer protection against HPV 16 and 18 (as above) and HPV 6 and 11, which cause 90% of genital wart cases.

The vaccination is a course of 3 injections given at 0, 2 and 6 month intervals. Trials continue to establish the length of time the vaccines work and whether or not boosters will be needed in due course.

The best time to be vaccinated is before becoming sexually active but even if a woman has already come into contact with the virus (through sexual intercourse) it is still worth considering vaccination. Unlike other viruses, being infected once doesn’t mean you are necessarily protected against a future infection.

The vaccination does not protect against all types of HPV or any other sexually transmitted infections. The best way to do this is to use barrier contraception (eg condoms). The vaccinations do not replace the need to have cervical smears undertaken at regular intervals.