HEALTH EDUCATION

HPV, pap tests and cervical cancer Q&A

What is HPV?
HPV stands for human papilloma virus. There are more than 100 types of HPV. Some types produce warts — plantar warts on the feet and common hand warts. Some affect the genital sex organs.
About 40 types of HPV can infect the genital area — the vulva, vagina, cervix, rectum, anus, penis, or scrotum.

• Some types may cause genital warts. These are called low-risk types.

• Some types may cause cell changes that sometimes lead to cervical and certain other cancers. These are called high-risk types. They do not usually have visible symptoms.

• Most types seem to have no harmful effect at all.
This page is about the HPVs that are associated with cervical cancer.

How many people have genital HPV infections?
Genital HPV infections are very common among sexually active people. At any time about 20 million people in the U.S. have them. Between 10 and 15 million have high-risk types that are associated with cervical cancer. HPV is so common that about three out of four people have HPV at some point in their lives. But most people who have it don't know it.

Although most HPV infections go away within eight to 13 months, some will not. HPV infections that do not go away can "hide" in the body for years and not be detected. That's why it is impossible to determine exactly when people became infected, how long they've been infected, or who passed the infection to them.

If you have HPV, you should not be ashamed or afraid. Most people who have ever had sex have HPV at some point in their lives.

Does HPV cause cervical cancer?
Yes, high-risk types of genital HPV are linked to cervical cancer. Most HPV infections go away by themselves and don't cause cancer. But high-risk HPV that does not go away over many years increases the risk of cervical cancer. Abnormal cells can develop when high-risk types of HPV don't go away. If these cell changes are not detected and treated and persist for many years, they can lead to cervical cancer.

Most women recover from HPV infections with no health problems at all, and many women develop immunity — a natural protection — against different types of HPV that they have been exposed to.

It is not fully known why some women develop long term HPV infection, precancerous abnormal cell changes, or cervical cancer. But we do know that women who have damaged immune systems are at higher risk, although most who get cervical cancer have normal immunity.

It is also known that cigarette smoking increases the risk of cervical cancer.

How do genital HPV infections spread?
Vaginal and anal intercourse spread genital HPV infections. In some cases, other kinds of skin-to-skin contact, including sex play, such as body rubbing and oral sex, may also transmit HPV.

How can I reduce my risk of genital HPV infections, including those that cause cervical cancer?
You can reduce your risk if you

• Practice abstinence

• Have only one partner who has no other intimate partners

• Have sex play that does not include vaginal or anal intercourse

• Use condoms every time

Condoms are not as effective in preventing HPV as they are in preventing some other infections, such as HIV, gonorrhea, chlamydia, and trichomoniasis, because HPV may be present in skin that is beyond the area covered or protected by a condom.

Are there any symptoms of high-risk HPV infection?
High-risk types of HPV do not cause any symptoms. Most women feel fine even when they have cell changes in their cervix and during the early stages of cervical cancer.

Once cervical cancer has developed, abnormal vaginal bleeding, especially during intercourse, increased discharge, and lower abdominal pain may be warning signs. Of course, most women with these signs do not have cervical cancer, but if you have any of them, you should see your clinician.

How can I protect myself against cervical cancer?
You can protect yourself by having regular Pap tests. HPV testing, in certain situations, is also a way to protect yourself. Read below to find out more about when HPV testing is a good plan.

Regular Pap tests can help find very early precancerous conditions, which are easily treated to prevent cancer from developing. Most sexually active women should have a Pap test every year. Some may need them more frequently. Women over 30 who have had three or more normal Pap test results in a row, or one normal Pap test and a negative HPV test may not need to be tested as frequently. Talk with your clinician about how often you should have Pap tests.

What happens if I have abnormal Pap test results?
A number of different tests and/or treatment may be prescribed.
You may be advised to

• Repeat the pap test

• Have other tests

• Take medication

• Have a colposcopy and biopsy

Be sure to complete the prescribed treatment(s) and test(s).
If early precancerous cell changes or suspicious growths are found, you will need more testing.

Moderate to severe precancerous changes require colposcopy and biopsy to make a diagnosis. If confirmed, these cell changes usually need to be removed by one of the following treatments:

• Cryotherapy — abnormal tissue is frozen off

• Laser surgery — abnormal tissue is destroyed with a laser beam

• LEEP — abnormal tissue is removed using a thin wire loop that carries an electrical current

Discuss your options with your clinician. Also consult a cancer specialist (gynecological oncologist) if cancer is found.

Interpreting pap tests

Detecting abnormalities in a pap test may be difficult because

• Abnormalities may not be picked up by the sampler.

• Abnormalities may be difficult to see on the pap slide.

Lab technicians trained to evaluate pap tests (cytologists) and other clinicians are very careful about interpreting pap tests and recommending follow-up care. They don't want to overlook any abnormality.

They are also aware that failure to detect early cancers can lead to serious and even deadly consequences. Their caution may lead them to request redoing the Pap test, or doing other tests. In some cases, the cytologist may be unsure about whether or not there are precancerous changes. In such a case, your clinician will recommend repeat testing or other tests to be more sure.

Fewer cancers are overlooked with these precautions. But having more tests done can lead to more anxiety, as well as expense. However, these precautions can be reassuring because they improve the chance of finding abnormal cells as early as possible, when they can generally be treated more effectively.

Are there other tests I can take to protect myself against cervical cancer?
Clinicians may use HPV testing to find out a woman's risk of cervical cancer

• As a follow-up to abnormal or unclear pap test results

• At the same time as a pap test for women over 30

Who should have the HPV test?
Routine HPV testing is not recommended for women under the age of 30 unless they have an abnormal or unclear Pap result. This is because HPV is very common and cervical cancer is rare at this age, and most HPV infections go away by themselves without causing any health problems.

For women age 30 or older, a test for HPV can be done at the same time as a Pap test. If both test results are normal, a woman has a very low risk of developing cervical cancer. She will not need a Pap and HPV test for three years. Some women age 30 or older see this choice as more appealing than having a Pap test each year.

Doesn't a Pap detect HPV?
A Pap test does not detect HPV itself. A laboratory technician uses a microscope to look at a sample of cervical cells for signs of abnormal changes that may be caused by HPV.

Understanding your Pap and HPV test results
*If you are under 30, current guidelines say you do not need to be tested for HPV, unless your Pap result is unclear or abnormal.

**A colposcopy is a procedure that enables your clinician to look more closely at your cervix. In some cases, a sample of cervical tissue will be taken (biopsy) for examination. Depending on what your clinician finds, treatment may start immediately.

How are samples taken?
The clinician inserts a metal or plastic speculum into the vagina. The speculum is opened to separate the walls of the vagina so that the cervix can be seen. The clinician then uses a small sampler — a spatula or tiny brush — to gently collect cells from the cervix. The cells are sent to the laboratory to be tested for abnormalities.

Remember . . .

• Most abnormalities that are detected are not yet cancer.

• Early treatment of precancerous growths can prevent cancer from developing.

• Follow-up examinations are necessary if an abnormal condition is found.

What is the treatment for HPV infection?
There is currently no treatment to cure HPV itself. Most types of HPV infection are harmless, do not require treatment, and go away by themselves. Treatment is available for the abnormal cell changes caused by HPV. Scientists are working on vaccines to prevent certain high-risk HPV infections.

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