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The HPV and cervical cancer link

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There are "seven dirty words" that can't be said on radio. But there are three more that women never want to hear anywhere: sexually transmitted disease (STD). That's because STDs carry a dirty stigma; only promiscuous women get them. But that's just not true. Human papillomavirus (HPV) is challenging this mindset.

A woman who has had only one sexual partner can have it. So can a woman whose partner used a condom. Even a woman well into her 80s can have it. Now it's time to learn what you can do about it.

FACT: By age 50, eight out of 10 sexually active women will have a genital HPV infection.
According to the Centers for Disease Control, genital HPV is the most common sexually transmitted infection in the US, with roughly 5.5 million people newly infected each year. "Genital HPV is spread through sexual intercourse or through skin-to-skin contact, so you don't have to have intercourse to get it," says Virtua Health obstetrician/gynecologist Bruce Levine, MD. "Latex condoms offer some protection but don't guard completely against transmission through skin-to-skin contact."

Even though HPV is an extremely common virus with 70 known types, only around 30 strains cause genital infections. Genital HPV types are broken up into low-risk and high-risk groups.

"Some low-risk HPV types don't cause any problems, while others cause minor changes in cervical cells that often go away on their own," says Dr. Levine. "In addition, low-risk HPV can cause genital warts. These appear as soft bumps that can form in clusters in the genital area or on the cervix. They may go away on their own, but if they don't, they can be treated with medicated cream, cryosurgery (freezing), electrocautery (burning) or laser surgery. The good news is that an infection with low-risk HPV won't lead to cervical cancer," says Dr. Levine.

High-risk HPV is the more worrisome of the two groups of genital HPV, and it causes no visible symptoms. "There are more than a dozen strains of high-risk HPV that can cause an abnormal change in cervical cells called dysplasia. Dysplasia is a highly treatable precancerous condition. However, if left untreated, these abnormal cells may eventually develop into cervical cancer," explains Dr. Levine.

FACT: HPV is the major cause of all cervical cancers according to the National Cancer Institute.
If a woman tests positive for high-risk HPV and her Pap test shows dysplasia, her gynecologist likely will perform a colposcopy. During this procedure, the doctor inspects the cervix with a special scope through the vagina. The doctor then takes a biopsy, or tissue sample, which will be sent to a pathologist to check for cancer cells.

If the biopsy shows cervical cell dysplasia, treatment options include a loop electrosurgical excision procedure (LEEP), which uses an electrically charged wire to cut out abnormal cells; surgical excision, which removes a cone-shaped section of the cervix; cryosurgery, which freezes abnormal cells; or, laser surgery, which uses laser beams to destroy the cells.

"When cervical cancer is found, prognosis and treatment options will depend on many factors including the stage of the cancer, tumor size, the woman's age and her desire to have children," states Virtua Health gynecologic oncologist Randolph Deger, MD. Treatment usually involves hysterectomy (surgical removal of the uterus and cervix) and/or radiation combined with chemotherapy.

FACT: An annual gyn exam and Pap test are key to early detection.
The American Cancer Society (ACS) credits the Pap test for a 75% decrease in cervical cancer in American women in the last 50 years. Even still, the ACS estimates that more than 10,000 American women will be diagnosed with cervical cancer in 2005, and nearly 3,700 will die from it. "Though recommendations for cervical cancer screening changed slightly in 2002, there should be no confusion over how important Pap tests are in protecting women against cervical cancer," says Dr. Deger.

According to the American College of Obstetricians and Gynecologists (ACOG), a woman should start having Pap tests within three years of becoming sexually active or at least by age 21. Then, she should have an annual Pap test until she turns 30. If she continues to have normal Pap tests, her physician may recommend increasing the screening intervals to every two or three years. "Even with normal Pap tests, a woman should continue to have an annual gyn exam to monitor overall breast and gyn health, as well as lower gastrointestinal and urinary issues," advises Dr. Deger.

In addition to a Pap test, women over age 30 can ask their gynecologist for an HPV test as well. The HPV test uses advanced, molecular technology to determine if high-risk HPV types are present in cervical cells. Used together with a Pap test, HPV testing can increase a woman's chances of detecting dysplasia long before the cells develop into cervical cancer.

Although recent studies have reported on a highly effective HPV vaccine, this technology is still undergoing clinical trials. At least one third of cervical cancer-associated HPV strains are not included in the current vaccine. Nonetheless, one day in the not so distant future, cervical cancer may be considered a "preventable" disease.

If it's been more than a year since you've had a gyn exam, don't wait. Call 1-888-VIRTUA-3 (1-888-847-8823) today for an appointment with a Virtua ob/gyn.

Physician Profiles
Randolph Deger, MD, is board certified in gynecologic oncology, obstetrics and gynecology, and hospice and palliative medicine. He earned his medical degree from Mt. Sinai School of Medicine in New York. Dr. Deger completed a residency in obstetrics and gynecology and a fellowship in gynecologic oncology at the Hospital of the University of Pennsylvania. His research has been published in several medical journals.

Bruce Levine, MD, received his medical degree from the University of Pennsylvania School of Medicine. He completed a residency in obstetrics and gynecology at Lankenau Hospital. Dr. Levine is a board-certified obstetrician and gynecologist. He has served as principal investigator on several national clinical trials for women's health issues including STDs, uterine fibroids and menopause.