What Is Human Papillomavirus and What Is Its Link to Cervical Cancer?

Human papillomaviruses, or HPVs, are a collection of related viruses, some of which are linked to certain types of cancer, including cervical cancer. HPV infections are the most common sexually transmitted infections in the U.S. Currently, there are approximately 79 million Americans infected, and 14 million new genital HPV infections will be diagnosed this year. In 2014, the Centers for Disease Control and Prevention (CDC) estimated that nearly 85% of women and 91% of men will acquire an HPV virus at some point in their lives. This means that more than 80% of men and women will acquire an HPV by the time they reach 45 years of age. It is estimated that 50% of these infections are considered high-risk HPVs, meaning they are viruses that have been directly linked to certain cancers. The CDC states that there are 12,000 new cervical cancer diagnoses every year in the United States and that, even with screening and treatment, 4,000 women will die from cervical cancer this year. Researchers believe that the majority of HPV infections occur shortly after the onset of sexual activity according to the World Health Organization. In the same report, WHO also states that 270,000 women died from cervical cancer in 2012, the latest statistics available to date. Cervical cancer is responsible for 7.5% of all female cancer deaths. The truth is that the leading causes of cervical cancer are the human papillomaviruses. If you are diagnosed with HPV, regular screenings must be a priority.

What Are Human Papillomaviruses?

Human papillomaviruses are a group of more than 200 related viruses. There are two types:

• Low-risk HPV: These viruses aren’t known to cause cancer. Low-risk HPVs cause warts in areas where the virus has entered the skin.
• High-risk HPVs: These viruses are considered high-risk because they do cause cancer, but generally do not cause warts. Two of the viruses, HPV 16 and HPV 18, are responsible for the majority of HPV-related cancers.

How Is HPV spread?

The human papillomaviruses are spread through intimate skin-to-skin contact, typically a result of sexual contact. HPVs can be spread from the skin or the mucous membranes. The frightening thing is that most high-risk HPV infections don’t cause symptoms, which means you can carry viruses that cause cancer, and spread them, without knowing you have an HPV infection. HPVs are most commonly spread through vaginal or anal sex, but they can also be passed on to a partner through oral sex. Due to how widespread HPVs are today, it is virtually impossible to protect yourself entirely from an HPV infection if you are sexually active. However, it is wise, nonetheless, to employ safe sex practices.

Dangers of HPVs

The majority of HPVs are considered low-risk and are not linked to cancer. However, high-risk HPVs cause 5% of all cancers worldwide according to researchers from the International Agency for Research on Cancer in Lyon France.

HPV Testing

As symptoms may not occur, it is essential to have regular STD screenings and sexual health examinations. When skin changes or warts appear, it is important to be screened as soon as possible. HPV infections are detected by testing cells to determine if they contain viral DNA or RNA. For women, during annual pelvic examinations, if an abnormal result is detected from a Pap test, further cervical cancer screenings will be conducted. For men, currently, there are no FDA-approved tests to detect HPV infections according to the National Cancer Institute.

Treating HPV Infections

If you are diagnosed with an HPV infection, unless abnormal cell changes appear, there isn’t a conventional medical treatment protocol. However, genital warts, precancerous changes in the cervix, benign tumors, and cancers caused by human papillomaviruses can be treated—often quite successfully. If there are abnormal cell changes, meaning cancerous tissue, conventional treatments for HPV infections may include surgical removal of tissue. Today, there are several ways in which abnormal tissue can be removed, and your doctor will recommend the best option for your case. Lasers, cryosurgery, excision, or a more traditional surgical path may be taken.

How HPVs Cause Cancer

The human papillomaviruses infect epithelial cells that cover the skin, anus, genital tract, and the throat. Epithelial cells cover the skin, and they line the throat, organs, intestines, and blood vessels. Once an HPV enters an epithelial cell, the virus makes proteins that then interfere with normal cell functions. This allows the cells to grow abnormally, and in some cases, uncontrollably. If you have a strong immune system, your body will often effectively fight the virus and naturally eliminate the infected cells. However, if the immune system isn’t successful in the fight, a persistent HPV infection can occur. When the infection becomes persistent, the cells may mutate and actually start to promote abnormal cell production, which can lead to the growth of precancerous cells, and eventually a cancerous tumor according to the National Cancer Institute. If you are infected with a high-risk HPV and you have a healthy immune system, it can take 15 to 20 years for cervical cancer to develop. However, if your immune system is compromised or weakened, cervical cancer can appear in 5 to 10 years according to the World Health Organization. Certain factors may increase the risk of HPV infections developing into cancer.

Cervical Cancer Screening

It can take anywhere from 5 to 30 years from initial HPV infection to a cervical cancer diagnosis depending on your immune system. Annual pelvic examinations are more important than ever, as virtually everyone in the United States will contract an HPV at some point in their lives. Regular screenings can detect precancerous lesions, and when caught early, they can be effectively treated and cancer may be avoided. Regular screenings can save your life.  If you are diagnosed with cervical cancer, additional tests will be required. X-rays, CT scans, PET scans, MRIs, and other laboratory tests will need to be conducted to determine the stage of the cancer. The CDC recommends that all women with an increased risk for either type of cancer should have regular screenings. For breast cancer, this means that women between the ages of 50 and 74 should get a mammogram every two years. And for cervical cancer, women should have a Pap test by the age of 21 and continue to be screened every three years until they reach 65, or later if they are in a high-risk category. For women in the United States who are low-income, uninsured, or underinsured, the National Breast and Cervical Cancer Early Detection Program sponsored by the CDC provides free breast cancer screening and cervical cancer screenings. Available tests in this program include:

• Clinical breast examinations
• Mammograms
• Pap smears
• Pelvic examinations
• HPV tests
• Diagnostic testing
• Referrals for treatment

Cervical Cancer Symptoms

Symptoms of cervical cancer may only appear at an advanced stage. That is why it is essential that every woman undergo regular pelvic examinations and Pap tests. The World Health Organization provides the following list of possible cervical cancer symptoms:

• Irregular, abnormal, or inter-menstrual cycle vaginal bleeding after sexual intercourse
• Back, leg, or pelvic pain
• Unexplained fatigue
• Unexpected weight loss
• Loss of appetite
• General vaginal discomfort
• Odorous vaginal discharge
• A single swollen leg

Cervical Cancer Stages

There are five primary stages of cervical cancer:

• Stage 0: referred to as Carcinoma in Situ (CIS). This is often considered pre-cancer as the cancerous cells have not penetrated deeply into tissue.
• Stage I: Cancer is confined to the cervix.
• Stage II: Cancer is in both the cervix and the upper part of the vagina.
• Stage III: Cancer is present in the cervix and the upper portion of the vagina, and it has spread to the lower part of the vagina or attached to the pelvic wall.
• Stage IV: Cancer has spread to surrounding tissue like the bladder or rectum, or to other organs in the body like the lungs, liver, or bones.

Cervical Cancer Treatments

If you are diagnosed with cervical cancer, your oncologist will discuss your options and make recommendations for a treatment protocol based on the stage of the cancer and whether you want to maintain fertility. According to the Mayo Clinic, cervical cancer treatments may include:

• Cone biopsy (preserves fertility)
• Cone biopsy with lymph node removal
• Total hysterectomy
• Radical hysterectomy
• Radical hysterectomy + removal of lymph nodes in pelvis
• Radical trachelectomy
• Radical trachelectomy with lymph node dissection
• EBRT—External beam radiation therapy
• Surgery
• Radiation
• Radiation with chemotherapy
• Brachytherapy
• Brachytherapy with chemotherapy

Preventing Cervical Cancer

With the rates of HPV infections so high—it is difficult to guard against the most common STI in the United States. However, safe-sex practices can reduce your risk. This includes limiting the number of sexual partners, using condoms, and considering the HPV vaccine. The CDC recommends the HPV vaccine for both girls and boys before they reach sexual maturity, typically around the age of 11 or 12. Multiple vaccinations are necessary, with subsequent doses being referred to as boosters. While the FDA considers Gardasil 9 to be generally safe, severe, and in some cases catastrophic, side effects have been reported. If your child is allergic to yeast, amorphous aluminum hydroxyphosphate sulfate, polysorbate 80 or has had an adverse reaction before, they should not receive the vaccination. It is also vital, according to the manufacturer, to report any of the following conditions to your doctor before receiving the HPV vaccination.

• If your child has a fever
• Has an immune system disorder
• Has cancer
• Has HIV/AIDS
• Takes any medications, including supplements
• Is/may be pregnant, or planning a pregnancy

Breaking News: The FDA approves Gardasil 9 HPV vaccine for use up to age 45!

Recognized Gardasil 9 Side Effects

The most common side effects of the HPV vaccine and Gardasil 9 are:

• Pain, swelling, itching, bruising, redness, bleeding, or a prominent lump at the injection site.
• Headache
• Fever
• Dizziness
• Tiredness
• Diarrhea
• Sore throat
• Generalized abdominal pain
• Fainting

Additional side effects, classified as rare, have been reported with the HPV vaccine—some of them very severe and even catastrophic. They include:

• Anaphylaxis
• Appendicitis
• Asthma
• Blood clot in the extremities
• Bronchospasm
• Cellulitis
• Guillain-Barre Syndrome
• Inflamed spinal cord
• Inflammation of the stomach and intestinal linings
• Life-threatening allergic reaction
• Low platelet count and bleeding
• Lung embolism
• Multiple sclerosis induced by Gardasil
• Obstruction in a blood vessel caused by a blood clot
• Pancreatitis
• Pelvic inflammatory disease (PID)
• Seizures
• Transverse myelitis
• Venous thromboembolic events

It is important to note that many of the severe side effects of the HPV vaccine can occur in the hours, days, weeks, or even months after the vaccination has been administered. During the following weeks and months, it is vital that any side effect listed above is immediately reported to your physician.

You can click here if you’d like to read more about ways to stay healthy!