“Having sex at an early age can double the risk of developing cervical cancer; it exposes the woman to the HPV infection more than women who get the infection later in life.”
Dr Olumide Ofinran is a consultant gynaecologist, sub-specialist in gynaecological oncology and advanced laparoscopic and robotic surgeon. The specialist in colposcopy who is with the National Health Service, United Kingdom, talks about cervical cancer
What is cervical cancer?
Cervical cancer is the abnormal growth of cells from the cervix (neck of the womb) that have the ability to invade tissues or spread to other parts of the body.
What are the causes and risks of cervical cancer?
The main cause of cervical cancer is the presence of the human papillomavirus infection. HPV is a common viral infection, which is transmitted through sexual contact, including skin-to-skin contact.
However, most women who have HPV infection do not develop cervical cancer. There are over 100 different types of HPV, and while some cause warts, others can cause different types of cancer (cancers of the cervix, vagina, vulva, anus, penis and back of the throat).
Over 80 per cent of sexually active people would have had HPV infection at some time in their life but majority will get rid of it via their body’s immune system. Persons with persistent HPV infection have an increased chance of acquiring precancerous cell abnormalities and subsequently developing cancers if left untreated.
Vaccines can help protect against the strains of HPV most likely to cause genital warts or cervical cancer.
Other risk factors act together with HPV to increase the risk for cervical cancer.
These include cigarette smoking, having sex from an early age, having multiple sexual partners, having children early and having a lot of children; weak immune system, low income or education and taking the contraceptive pill.
Cervical cancer typically develops over 10 to 20 years. Also, there is an increased risk of cervical cancer if other women in the immediate family (mother, sister or daughter) have had cervical cancer.
Research is ongoing to find out if this is because of faulty genes or other reasons.
How is it different from other forms of cancer?
Cervical cancer is one of the cancers considered to be preventable because there is a precancerous stage, which is a stage of abnormality that exists before the development of the cancer. This stage can be detected early and treated through screening, lifestyle changes and vaccination against HPV. Other cancers that fall into this category include breast, colorectal, anal, vulval, vaginal and testicular cancers.
What are the symptoms of the disease?
Cervical cancer in its early stage may not cause any symptoms but, if present, may include abnormal vaginal bleeding, bleeding after sexual intercourse or unusual discharge, back or pelvic pain, tiredness, weight loss or loss of appetite. More severe symptoms may appear in advanced stages.
How can it be detected?
Cervical cancer can be detected early through screening (Pap smear, a method of cervical screening used to detect potentially precancerous and cancerous processes in the cervix) or diagnosed clinically by a physical pelvic examination and colposcopy.
How do contraceptives put a woman at risk of cervical cancer?
Research has shown that prolonged use of the oral contraceptive pills (for more than five years) increased the risk of cervical cancer by up to four times, but only in women with the human papillomavirus infection.
The increased risk reduces as soon as the pill is stopped; and after 10 years of stopping it, the risk is the same as if the pill was never used.
Though prolonged use of the pill can also slightly increase the risk of breast cancer, it is important to note that the overall chance of getting cervical cancer is low. The benefits of using oral contraception outweigh the risks for the majority of women and using the pill can help reduce the risk of uterine and ovarian cancers.
Is it true that women may live with cervical cancer for years without knowing?
Cervical cancer is one of the cancers that we know how it behaves and progresses. Typically, it develops slowly over several years. Women may have the precancerous cells, which don’t cause any symptoms in their cervix for years before development of cancer. That is why cervical screening is very important for early detection and treatment of this abnormality before it develops into cancer.
Is it also true that girls who have sex before the age of 16 or within a year of beginning their menstrual cycles are at a high risk of developing cervical cancer?
Having sex at an early age can double the risk of developing cervical cancer; it exposes the woman to the HPV infection more than women who get the infection later in life. Read more.
Immunization Action Coalition
What is HPV?
Human papillomavirus (HPV) is a common family of viruses that causes infection of the skin or mucous membranes of various areas of the body.
There are over 100 different types of HPV viruses. Different types of HPV infection affect different areas of the body.
For instance, some types of HPV cause warts in the genital area and other types can lead to abnormal cells on the cervix, vulva, anus, penis, mouth, and throat, sometimes leading to cancer.
How common is HPV?
HPV is very common. According to the Centers for Disease Control and Prevention (CDC), most sexually active American men and women will contract at least one type of HPV virus during their lifetime. HPV is considered the most common sexually transmitted infection in the United States.
It is the cause of almost all cervical cancers in women and has been linked to the rise of oral cancers in young people in the United States.
How serious is HPV?
HPV is extremely serious.
Approximately 79 million Americans are currently infected with HPV, and about 14 million more become infected each year. In the United States, there are nearly 13,000 new cervical cancer cases diagnosed annually, and more than 4,000 women die from cervical cancer every year. Men are affected too. An estimated 11,500 HPV-associated cancer cases occur in American men each year.
How is HPV spread?
The most common ways to get an HPV infection is from vaginal or anal sex with an infected person; however, this is NOT the only way to get HPV.
]Infection can also be acquired from oral sex and any skin-to-skin contact with areas infected by HPV. It is possible to have HPV and not know it, so a person can unknowingly spread HPV to another person. continued on next page
Why vaccinate against HPV at 11 or 12 years of age?
- The vaccine produces better immunity to fight infection when given at younger ages compared with older ages.
- Vaccination for HPV is much more effective at preventing disease and cancer if all doses in the series are administered before someone’s first sexual contact.
- Most American men and women who become sexually active will contract at least one type of HPV virus in their lifetime. Vaccination can reduce their risk of HPV infection.
- Most people who become infected with HPV do not even know it.
- HPV is easily spread by skin-to-skin contact during sexual activity. Even if someone does not have sexual intercourse, they can still get HPV.
- People who choose to have only one lifetime sex partner can still get HPV if their partner has had previous partners who were infected.
- The vaccine has been tested in thousands of people around the world and has been proven to have no serious side effects.
- The vaccine is highly effective against HPV types that cause most cervical cancers and also protects against 90 percent of HPV-associated genital warts.
Can HPV infection be treated?
There is no treatment for HPV infection; there are only treatments available for the health problems that HPV can cause, such as genital warts, cervical changes, and cancer. In some cases, the body fights off the virus naturally.
In cases where the virus cannot be fought off naturally, the person is at risk for serious complications, including cancer.
What is HPV vaccine?
Gardasil 9 is the only HPV vaccine currently being distributed in the United States.
Gardasil 9 protects against cervical cancers in women and also against genital warts and cancers of the anus, penis, vagina, vulva, mouth, and throat. For preteens, HPV vaccine is given in two shots, separated by 6 to 12 months. It is important to get all the recommended doses to get the best protection.
At what age should my son or daughter get HPV vaccine?
Routine vaccination with HPV vaccine is recommended for all 11- and 12-year-old boys and girls.
The vaccine can be given as early as 9 years of age. If your son or daughter did not receive the two doses of vaccine at the recommended age, they should still start or complete their HPV vaccine series. Your son can be given the vaccine through the age of 21 (and also certain males through age 26 years), and your daughter can be given the vaccine through the age of 26.
If the vaccine series is started at age 15 years or older or, if the person has problems with their immune system, three doses are necessary. Check with your healthcare provider to make sure your child is up to date with HPV vaccination.
For HPV vaccine to work best, it is very important for preteens to get all the recommended doses before any sexual activity begins. It is possible to get infected with HPV the very first time they have sexual contact with another person, even if they do not have intercourse. Also, the vaccine produces better immunity to fight infection when given at the younger ages compared to the older ages.
Are HPV vaccines safe?
HPV vaccine has been shown to be very safe. Every vaccine used in the United States is required to go through rigorous safety testing before licensure by the FDA. The HPV vaccine has been extensively tested in clinical trials with more than 28,000 male and female participants.
Since the first HPV vaccine was licensed for use in 2006, more than 50 million doses of HPV vaccine have been distributed in the United States. Now in routine use, the vaccine is continually monitored for safety. In the years of HPV vaccine safety monitoring, no serious safety concerns have been identified. Like other vaccinations, most side effects from HPV vaccination are mild, including fever, headache, and pain and redness in the arm where the shot was given.
Is HPV vaccine effective?
The vaccine has been shown to be highly effective in protecting against the HPV types targeted by the vaccine.
A study looking at HPV infections in girls and women before and after the introduction of HPV vaccines shows a significant reduction in vaccine-type HPV in U.S. teens since the vaccine was introduced. A Parents Guide to Preteen and Teen HPV Vaccination
Talk to your healthcare provider today about protecting your son or daughter from HPV infection!
Resources for more information
- Your healthcare provider or local health department
- CDC’s information on vaccines and immunization: www.cdc.gov/ vaccines
- Immunization Action Coalition’s vaccine information website: www.vaccineinformation.org
- Vaccine Education Center at the Children’s Hospital of Philadelphia: www.chop.edu/vaccine
- CDC’s Vaccines For Children (VFC) program: www.cdc.gov/vaccines/ programs/vfc/index.html sources American College of Obstetricians and Gynecologists (ACOG) Committee on Adolescent Health Care.
Fact Sheet: Human Papillomavirus. ■ www.acog.org Centers for Disease Control and Prevention (CDC). National Center for Chronic Disease Prevention and Health Promotion. HPV and Cancer. ■ www.cdc.gov/hpv/parents/cancer.html CDC. National Center for Emerging and Zoonotic Infectious Diseases. Vaccine Safety: Human Papillomavirus Vaccine. ■ www.cdc.gov/vaccine safety/Vaccines/HPV-vaccine.html CDC. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Genital HPV Infection Fact Sheet. ■ www.cdc.gov/std/HPV/ STDFact-HPV.htm CDC. National Center for Immunization and Respiratory Diseases. HPV Vaccine-Questions and Answers. ■ www.cdc.gov/hpv/parents/ questions-answers.html CDC. National Center for Immunization and Respiratory Diseases. Preteens and Teens Need Vaccines Too! ■ www.cdc.gov/Features/Preteen Vaccines/index.html Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003- 2010. J Infect Dis. 2013 Aug 1; 208(3):385-93.
Adapted from a publication developed by the Michigan Department of Community Health, Division of Immunization www.immunize.org/catg.d/p4250.pdf • Item #P4250 (1/17) Immunization Action Coalition Saint Paul, Minnesota • 651-647-9009 • www.vaccineinformation.org • www.immunize.org
Technical content reviewed by the Centers for Disease Control and Prevention www.immunize.org/catg.d/p4250.pdf • Item #P4250 (1/17) Immunization Action Coalition Saint Paul, Minnesota • 651-647-9009 • www.vaccineinformation.org • www.immunize.org