HPV & Cervical Cancer – What Every Woman Should Know I was eighteen years old when I had my first abnormal pap smear. I received a call from my OB/GYN’s office and was informed that I had the Human Papilloma Virus show up on my pap smear. This was the first pap smear I had ever had, and I was terrified. The news got worse. I researched this virus and learned that it was actually a sexually transmitted disease that could either cause cervical cancer, or genital warts! I didn’t understand, I had been with my boyfriend for five years and he was my first partner. How could I have contracted a sexually transmitted disease? I had a biopsy done to test my cervix for cancer.
The results were normal, and I was told I would need to have a pap smear done every three months. I followed the doctor’s orders, and within six months had a normal pap smear. At that point, I was nineteen years old. Things resolved and my annual pap smears were normal. That was up until a year ago. Once again, I had an abnormal pap smear.
This time however, I was 30. The same procedure was followed, another biopsy of the cervix. This showed no invasive cancer. Three months later I had yet another abnormal reading. This time the results were worse. I was puzzled, and I didn’t understand why after eleven years my problem came back.
After researching the Human Papilloma Virus (HPV) and cervical cancer, I finally found the answers to my questions. The Boston Women’s Health Book Collective, authors of Our Bodies, Ourselves indicates that cervical cancer is the second most common cancer of all women, and the most common cancer in younger women. Women between the ages of 35-55 are the highest group diagnosed. This type of cancer has been linked to the HPV virus. Other risk factors of cervical cancer include the younger your age of your first sexual experience, and the number of sexual partners one has. (634).
Cervical cancer can be prevented and treated early by finding pre-cancerous cell changes within the cervix. These cell changes can be found during routine pap smear exams. A pap smear is an exam where a medical instrument called a speculum is inserted into the vagina. The provider then collects cells from the cervix by gently swabbing it with a cotton swab. This procedure is quick and minimally painful.
Some women experience no pain at all. The cells are then sent out to a laboratory for testing. This generally takes two weeks. Most labs use the Bethesda System SIL to measure the amount of cell changes, if any. This system measures “normal” at one end of the chart, to “invasive cancer” at the other end. Generally it is difficult to determine the stage or grade of cell changes which occur.
This often means diagnosis and treatment are difficult to make. (623). The Boston Women’s Health Collective has estimated that 40% of all women tested will have at least one abnormal pap smear within their lifetime. Therefore it is recommended that women of all ages receive annual pap smears to find any pre-cancerous changes before they become invasive. (624). Recommendations: The American Cancer Society has made recommendations as to when women should be tested.
They are as follows: All women should begin having the Pap test about 3 years after they start having sex (vaginal intercourse), but no later than 21 years of age. The test should be done every year if the regular Pap test is used, or every 2 to 3 years if the newer liquid-based Pap test is used. Either test is OK. Beginning at age 30, women who have had 3 normal test results in a row may get the test every 2 to 3 years.
Another option for women over 30 is to have one of the Pap tests every 3 years PLUS the HPV DNA test. Women who have certain risk factors (HIV infection, weakened immune system) should have a Pap test every year. Women 70 years of age or older who have had 3 or more normal tests in a row (and no abnormal tests in the last ten years) may choose to stop having the test. But women who have had cervical cancer or who have other risk factors should keep on having the test as long as they are in good health. Women who have had a total hysterectomy (removal of the uterus and cervix) for reasons other than having cancer or a pre-cancerous lesion may also choose to stop having the test. (Courtesy of the American Cancer Society – web) Routine pap smear testing is critical to finding changes to the cervix before cancer begins to develop.
There are generally no symptoms for cervical cancer and the HPV virus is not visible. HPV initially presents with small, painless lesions on the cervix. Although some women report spotting between periods, or bleeding during intercourse prior to an abnormal pap, these are usually the only symptoms noted and go undiagnosed for a period of time. What is HPV? According to the Centers for Disease Control, HPV or Human Papilloma Virus is the name of a group of viruses that includes more than 100 different types. Thirty of these types are sexually transmitted.
The virus can infect the genital area of men and women including the skin of the penis, vulva, anus, and the linings of the vagina, cervix or rectum. It is spread by sexual contact with an infected person. It may take several months or years for cervical lesions to develop. There are no common symptoms and HPV often goes undiagnosed for many years. Certain types of HPV are associated with cervical cancer, and other strains of HPV can cause genital warts. (“STD Facts”).
Approximately 20 million people are now infected with HPV. It is estimated that at least 50% of men and women will acquire the HPV infection at one point in their lives. By the age of 50, 80% of women have tested positive for the HPV infection. Each year, 6. 2 million Americans are diagnosed with a new HPV infection.
(“STD Facts”). The HPV virus lives in the skin or mucous membranes. Many people do not know they are infected, as there are generally no signs or symptoms. These infected individuals can transmit the virus to their sex partner. Pregnant women infected with HPV can pass this virus onto her baby during a vaginal delivery, but this is very rare.
Generally the baby does not develop symptoms. Some people do see visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus or penis. HPV infections can also result in genital and anal cancer, but this is also very rare. Most women are diagnosed with HPV during a routine pap smear test. There is no HPV test for men. There is also a new test specific for HPV called the HPV DNA test.
This test is generally used in women with mild cell changes detected on their pap smears. This test helps providers determine if any additional intervention is necessary. Many providers will also routinely test women by using the HPV DNA test. This can prove to be a useful diagnostic tool to assess risk factors and administer pap smears more frequently.
It is important to realize that all types of HPV can cause mild Pap test abnormalities. These mild abnormalities do not have serious consequences. Out of the 30 sexually transmitted types of HPV, ten of them can lead to the development of cervical cancer. Research conducted by the Center for Disease Control has shown that for 90% of women, the HPV infection of the cervix becomes undetectable within two years. Only a small proportion of women have persistent infection. This is considered high-risk” HPV, and continues to be the main risk factor for cervical cancer.
(“STD Facts”). With regular pap smear screenings, pre-cancerous cell changes related to HPV will not turn into invasive, life threatening cancer. U. S. cervical cancer screenings are responsible for reducing deaths from cervical cancer. The “Let No Woman be Overlooked” program offers free pap smears and breast exams for at risk women with no medical insurance.
In 2004, the American Cancer Society estimates that “about 10, 520 women will develop invasive cervical cancer and about 3, 900 women will die from the disease.” Most of the women who develop invasive cervical cancer failed to have routine pap exams. (“What Causes… .” ). The only fool-proof way to prevent the spread of HPV is to avoid genital contact with another person. If sexually active, it is best to stay in a mutually monogamous relationship. It is difficult however to determine whether a person has been exposed to HPV, especially if they are a man.
This is due to the lack of male HPV testing. Safe sex is the key to prevention, as well as limiting the number of sexual partners one has. It is also wise to choose a partner who has had a small amount of sex partners, and has practiced safe sex in the past. HPV & Cervical Cancer: Now that we know that HPV can lead to cervical cancer, it is important to recognize the different stages of this disease. The terms used to define abnormal pre-cancerous cells on or near the cervix include: Dysplasia / Cervical Dysplasia- Abnormal cell growth. Cervical Intraepithelial Neoplasia (CIN) Squamous Intraepithelial Lesion (SIL) All of the above terms mean that there have been abnormal cell changes to the cervix.
The Merck Manual of Medical Information references the different stages. They are listed below. Normal. Minimal cervical dysplasia (early changes that are not yet cancerous). Severe dysplasia (late changes that are not yet cancerous). Carcinoma in situ (cancer confined to the outermost layer of the cervix).
Invasive cancer. Diagnosis is made by the Pap test, which can detect up to 90% of cervical cancers even before symptoms develop. If there is a visible lesion on the cervix during an exam, the doctor may perform a procedure called a Colposcopy. This is a biopsy in which a viewing tube with a magnifying lens is used to collect the best cervical sample. It is then sent off to pathology for testing.
If the diagnosis is unclear, the doctor may perform a Cone Biopsy, where a larger portion of the cervix is removed for testing. The Cone Biopsy is performed by using the Loop Electro surgical Excision Procedure, or LEEP and is generally done in the doctor’s office. (Beers, 1110). Treatment Options: There are many different types of treatment for dysplasia.
The amount of treatment will also depend upon how severe the dysplasia is. Generally the first step is watchful waiting. Many practitioners have preferred treatment methods that vary drastically. Therefore it is important to obtain second opinions if you feel that treatment is too invasive. Repeat Pap smears every three months following an abnormal test is the general rule of thumb. The next step of treatment is the Colpolscopy which was described in the previous paragraph.
Following Colpolscopy the destruction of abnormal cells through cryotherapy or laser removal. Both of these procedures are done in the doctor’s office. The Cone Biopsy is typically performed when consecutive Pap smears have confirmed severe dysplasia or carcinoma in situ. The Cone Biopsy is also used when the abnormal cells reach into the cervical canal where cryotherapy is not effective. With Cone Biopsy, the cone shaped piece of tissue is removed. This procedure may be painful and can weaken the cervix.
It may be harder to carry a pregnancy to term after a Cone Biopsy. If the pathology returns as invasive cancer, diagnostic tests will be performed to see how far the cancer has spread. The Merck Manual of Medical Information states that “cervical cancer can penetrate deep beneath the surface of the cervix and enter into the lymphatic vessels that line the inside of the cervix. Once this happens the cancer can easily spread to other areas of the body.” (Beers, 1110). If the cancer has spread, or “metastasized” it is important to find how far it has spread. Chest x-rays, MRI’s and CT scans are routinely done to stage the cancer.
Radiation therapy is highly effective for treating advanced cervical cancer, as long as it has not spread beyond the pelvic region. Risks involved include damage to the bladder or rectum, and the ovaries almost always stop functioning. If the cancer is more advanced a hysterectomy may be necessary. Hysterectomy is the removal of the cervix and uterus.
A radical hysterectomy includes the removal of the ovaries and lymph glands surrounding the uterus. In addition to hysterectomy, chemotherapy may be necessary if the cancer has spread beyond the pelvis. It is estimated that only 25-30% of those treated can expect any response, and the response is usually temporary. (Beers, 1111). In summary, HPV is a fast-growing STD that can have long term effects with no symptoms. As I have illustrated, the HPV virus can lie dormant in the body for many years before producing symptoms.
It is critical to have yearly Pap smears to reduce the risk of HPV or cervical cancer. The American Cancer Society has proven that routine Pap smears has drastically reduced the number of women diagnosed with cervical cancer. Many women have the perception that annual exams aren’t necessary if they are not sexually active, or are no longer of childbearing age. We need to educate women about the risks of cervical cancer and of the dangers of HPV. In my opening page, I noted that I thought my Pap smears had returned to normal after 10 years of routine testing. It would have been easy to believe that my Pap smears were normal and followed the two year rule.
I didn’t follow this rule, and I am thankful because they became abnormal again. Since I continued to have annual exams, my Pap was caught early. It was moderately abnormal after a Colpolscopy, and I am currently watching and waiting. My next step is a 3 rd Pap smear which will be done in November. If that Pap is abnormal, I fear that I will have a Cone Biopsy.
My wish is to have another baby, and if I have this procedure my chances of carrying a baby to term are slim. I am angry at myself for not being more careful when I was younger. Although I was not promiscuous, and I did participate in safe sex with my first boyfriend – I learned the hard way that it only takes one time of unprotected sex to contract HPV. Now, eleven years later I am paying the price for my carelessness. It is my hope that women will learn the seriousness of HPV before they become infected and suffer the consequences for a lifetime.
Bibliography American Cancer Society. “What Causes Cancer of the Cervix?” 22 Aug 05. web Mark H. MD.
, Berk ow, Robert MD. , and Bog in, Robert M. MD. eds. The Merck Manual of Medical Information.
New York: Pocket Books, 1997. Boston Women’s Health Book Collective, The. Our Bodies, Ourselves – A New Edition for a New Era. New York: Touchstone, 2005.
United States. Center for Disease Control. STD Facts – Human Papilloma Virus HPV). Washington: 2005.
22 Aug 05. web.