What’s the connection between the human papillomavirus (HPV) and cervical cancer? Can regular pap smears detect precancerous lesions? Gynecological oncologist Katina Robison talks about the HPV vaccine and explains cervical cancer treatment, risks and prevention. Plus, test your cervical cancer IQ with our quiz...
While cervical cancer remains a major threat to women’s health worldwide – it’s the second-leading cause of cancer death in women – tremendous progress has been made in the U.S. According to the American Cancer Society, only about 11,000 women a year are diagnosed with cervical cancer and 3,800 a year die from it.
That success in reducing cervical cancer cases comes down to two words: early detection.
“If we catch cervical cancer early, we’re usually able to cure it,” says Katina Robison, M.D., a Women’s Reproductive Health Scholar and Gynecological Oncologist at the Women and Infants Hospital at Brown University. “When women have regular Pap smears, the disease is often found through pre-cancerous lesions.”
But, confusion and misinformation abound when it comes to cervical cancer and the human papillomavirus (HPV) that causes it.
The disease still carries a stigma. “While it’s true certain sexual behaviors like having multiple partners does increase the risk of exposure, almost anyone can become infected with HPV," Robison says. "The infection sometimes lingers in the body, so even a woman who has been married and monogamous for 20 years can have HPV.”
Cervical cancer can wreck havoc with a woman’s sexuality and fertility. We asked Robison to clear up misconceptions about HPV infection, cervical cancer and how both can affect your health.
Who is most likely to get cervical cancer? What genetic or lifestyle factors put a woman at risk?
Cervical cancer is most often seen in middle-aged women, and the risk climbs as you get older. Smoking dramatically increases your risk, but when you quit smoking, your risk factors go back to normal.
There appears to be a slight genetic component, in that women who have two first-degree relatives with cervical cancer seem to have an elevated risk, but we haven’t isolated a specific gene that shows a direct correlation like we’ve found with breast cancer.
The cause of the vast majority of cervical cancer cases is HPV infection, which is sexually transmitted.
How does sex affect your risk of getting an HPV infection?
The virus is most prevalent among people who have multiple partners and began having intercourse at an early age. But you can’t protect against HPV as you can with other sexually transmitted diseases. Condoms provide some protection, but not total.
And the virus is not just spread by intercourse, but also by oral sex or any genital touching. It’s also related to vulva, penile and anal cancer and can appear anywhere on genitalia.
HPV can linger undiagnosed in the body for years, and if the woman isn’t tested for it, she probably has no idea she has it. Sometimes when doctors inform a woman she has HPV, she reacts with shock and says, “My husband must be cheating on me.”
But she may just now be finding out about a condition she’s had since before she was married.
Does HPV always lead to cervical cancer?
No. In fact, in most cases it doesn’t. There are about 30 kinds of HPV that can cause genital infections, and most of these infections disappear on their own over time or show up as a low-risk form like genital warts.
Two strains, types 16 and 18, cause more than 70% of cervical cancer and are considered to be high-risk strains.
So how can a woman make sure she’s not walking around with a high-risk strain of HPV?
Regular Pap smears are the gold standard for early detection. Young women can get the HPV vaccine. (One of the most popular is brand name Gardasil.)
It protects against only two out of the 15 strains of HPV that could cause cervical cancer, but those are types 16 and 18, the most likely ones. It also protects against types 6 and 11, which cause vaginal warts.
Who should get the HPV vaccine?
The two drugs currently on the market are aimed toward females ages 9-26, although it’s often appropriate for males to get the vaccine as well. It’s a series of three shots.
Starting as early as 9 sounds so young. Do kids who aren’t sexually active still need the vaccine?
The vaccine is most effective if it’s started before the person becomes sexually active. While the highest chance of HPV infection is between ages 15-25, the vaccine is most effective on patients between ages 9-11.
Is there anyone who shouldn’t be vaccinated?
In my mind, no. I think in time we may see older women getting the vaccine.
How often should you have boosters?
The vaccine hasn’t been out long enough to know if boosters will be necessary.
Do any early symptoms indicate a woman should be checked for possible cervical cancer?
There aren’t a lot of symptoms in the early stages, which is why a routine Pap smear is important. You should have Pap smears every 1-3 years depending on your age. As for early symptoms, some women report bleeding between periods or after intercourse or have an abnormal amount of vaginal discharge. If the disease is advanced, you may find pelvic pain or constipation.
What exactly does a Pap smear look for?
It looks for abnormal cells, but a Pap smear in itself is rarely enough to diagnose cervical cancer.
So if the doctor calls to tell you there’s a problem with your Pap smear, you shouldn’t panic.
Absolutely not. Most abnormal cells are not cancerous, and even if you have precancerous lesions, most go away on their own. Your doctor may opt to just monitor the situation – it takes between 10-15 years for most abnormal cells to develop into cervical cancer, if they ever do. Especially with younger women, the immune system usually fights off the disease and most abnormalities clear up on their own.
What if the abnormal cells stick around?
The next step is usually a cone biopsy in which the doctor cuts out a piece of the cervix. It’s an outpatient procedure and low-risk. The biopsy will determine what stage of cervical cancer, if any, you’re dealing with.
What are the stages of cervical cancer?
Cervical cancer usually grows locally and rarely metastasizes, so the stages are defined by where the cancerous cells are located. Most diagnosed cancers in the U.S. are stage 1. Stage 1 is confined to the cervix. Stage 2 involves some adjacent areas and may affect the vagina. Stage 3 has grown into the vagina or pelvic wall.
In stage 4, the cancer has spread to the bladder or rectum. Stage 4B, where the cancer has moved into a distant part of the body, is very rare.
What are your options for cervical cancer treatment?
Stage 1 treatment usually involves a radical hysterectomy, which means the doctor will remove tissue around the cervix too, although they don’t always remove the ovaries. In stage 2, the addition of radiation has proven very effective. Stages 3 and 4 require chemotherapy.
Afterwards, will your sex life be normal?
It depends on the stage of cancer and the type of cervical cancer treatment. Most women choose to take a break from sex after surgery or while being radiated. After treatment is completed, you might notice changes in the vaginal area that make sex uncomfortable.
The vagina sometimes shortens or shrinks during radiation so you might need to use vaginal dilators, and you have to be a little more creative and give it time to heal. Some couples seek sexual counseling after cervical cancer treatment. Most women end up with a satisfying sex life. And of course you can be sexually active in other ways while you’re waiting to heal – what I call outercourse.
Can cervical cancer spread to your partner?
HPV infection can be passed from one person to another, but cervical cancer cannot.
Can a woman who’s had cervical cancer still have children?
If you’ve had radiation, the ovaries lose their ability to make eggs. If you’ve had a hysterectomy, obviously you can’t carry a child. So couples facing this situation need to consider fertility counseling and consider all their options.
Some women have had their ovaries removed prior to radiation so they could harvest their eggs and later have a child by surrogate.
But if cervical cancer is caught in the earliest stages – before a radical hysterectomy is necessary – a woman who still has her ovaries and uterus can certainly conceive and carry children. If her cervix was removed, it’s considered a high-risk pregnancy, but many former cervical cancer patients have been successful.
How do you know if cervical cancer treatment has worked?
You have to finish treatment, and then you have to wait. Former patients are monitored closely for five years. They will receive Pap smears every three months for the first two years and every six months afterwards. They may also receive diagnostic imaging as a precaution.
If you’ve had cervical cancer once is it likely to come back?
Most of the time, no.
What are some of the new clinical trials looking for? What’s on the horizon for cervical cancer treatment and prevention?
Trials are looking to expand the types of HPV the vaccine covers and they’re also looking at vaccinating people who already have the disease in the early stages. For women in the later stages, there are trials on different, targeted types of cervical cancer treatment with fewer side effects.
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