January is Cervical Health Awareness Month. The National Cervical Cancer Coalition (NCCC) and other groups focus on issues and awareness relating to cervical cancer, HPV disease, early detection and prevention, and overall cervical health. Screening and prevention methods nowadays have reduced the impact of cervical cancer. However, The American Cancer Society estimates that for 2021:
- About 14,480 new cases of invasive cervical cancer will be diagnosed.
- About 4,290 women will die from cervical cancer.
As for HPV, it is still one of the most common STIs in the US and the cause of almost all cervical cancers in women. According to the National Foundation for Infectious Diseases, about 80 million individuals in the US are infected with HPV.
That is why in this blog post, we seek to bring awareness toward Cervical Health and HPV awareness- as well as actions that you can take to protect your health.
What is Cervical Cancer?
Cervical Cancer occurs in the cell lining of the cervix (which connects the uterus to the vagina). It develops when the cells in the body grow out of control. Usually, it develops slowly over time, and HPV is almost always the cause of most cervical cancers.
Types of Cervical Cancer
The main types of cervical cancers are:
- Squamous cell carcinoma: This type of cancer forms in the cells lining of the outer part of the cervix. Most cervical cancers are squamous cell carcinomas.
- Adenocarcinoma: Most of the rest of the cancers are adenocarcinomas. It develops in these column-shaped glandular cells that line the cervical canal.
- Although less common, some cervical cancers have features attributed both to squamous cell carcinomas and adenocarcinomas. These are known as adenosquamous carcinomas or mixed carcinomas.
- Although very rare, cancer can occur in other cells in the cervix.
During the early stage, some individuals may feel no signs or symptoms. However, as cervical cancer advances- here are some of the symptoms individuals may experience:
- Vaginal bleeding after intercourse, between periods, or after menopause
- Menstrual bleeding that is longer and/or heavier than usual
- Watery, bloody, vaginal discharge that may be heavy and have a foul odor
- Unexplained, persistent pelvic pain and/or back pain
- Pain during sexual intercourse
- Almost all cervical cancers are caused by HPV. That is why having many sexual partners, early sexual activity, and participating in unprotected sex can increase your chance of contracting HPV and possibly developing cervical cancer later in time. Some types of HPV are low-risk types because they are hardly linked to cancer. Other types of HPV are considered high-risk types and are strongly linked to developing certain cancers. Chronic infection, especially when tied to high-risk HPV types, can eventually cause certain cancers, such as cervical cancer.
- Having a weakened immune system can also increase your chances of developing cervical cancer. The immune systems play an important role in destroying center calls and slowing their growth and spread. It not only includes women who have a weakened immune system due to HIV or HPV infections- but also those taking drugs that suppress their immune response.
- Studies show that smoking is associated with squamous cell cervical cancer. It is due to cigarettes containing cancer-causing chemicals that can be carried in the bloodstream throughout the body.
Those with a family history of cervical cancer have a higher chance of developing the disease later in their life.
How are HPV and Cervical Cancer Intertwined?
What is HPV?
HPV is sexually transmitted and can spread through penetrative sex and skin-to-skin genital contact. It is a viral infection that commonly causes skin or mucous membrane growths. There are more than 100 varieties of HPV. Some may cause warts (genital, common, plantar, or flat warts). Others can cause various types of cancer within the cervix, anus, penis, vagina, vulva, and back of the throat. You can get by having oral, vaginal, and anal sex with some who have the virus, even if they don’t have signs or symptoms. According to the CDC, HPV infections are very common, and it is estimated that nearly everyone will get HPV at some point in their lives.
There are many types of HPV, and many may not cause problems for individuals. Most HPV infections usually clear up without intervention within a few months from initial infection. According to WHO, about 90% clear within 2 years. However, others can persist and progress into various forms of cancer- including cervical cancer. Cervical cancer is the most common HPV-related disease, and nearly all cases can be attributed to HPV infection.
When high-risk HPV infects cells, it interferes with how the cells communicate with one another. Therefore, infected cells begin to multiply in an uncontrolled manner. It leads to the development of precancerous lesions. Some precancerous lesions may resolve on their own or with minimal intervention. However, women with HPV may become chronic and precancerous lesions may progress to invasive cervical cancer. A woman with a healthy immune system develops cervical cancer within 15-20 years. However, women with weakened immune systems may develop cervical cancer within 5-10 years.
A woman may also have a higher chance of developing cervical cancer if they have an aggressive HPV type (such as HPV 16 or HPV 18). They also have a higher chance if they already have a weakened immune system. It may be due to already having HIV, other STI’s, having a chronic illness, or by taking immunosuppressing medication.
How Can You Take Care of Yourself?
All three vaccines protect against HPV 16 and 18 (which cause the majority of 70% of cervical cancers). The third vaccine also protects against five oncogenic HPV types that account for 20% of cervical cancers. Two of the three vaccines also protect against HPV types 6 and 11, which cause anogenital warts.
HPV vaccines work when administered before the exposure of HPV. Vaccines cannot treat HPV infection or HPV-associated diseases.
The HPV vaccine series is recommended for girls and boys ages 11 and 12 and can be started as early as age 9. The second dose is administered 6 months after the initial dose. For teens who start the series on or after their 15th birthday- they need three doses given over the course of 6 months.
The CDC highly recommends everyone up to the age of 26 get their HPV vaccine if they have not already been fully vaccinated. Individuals between the ages of 27-45 can still be vaccinated. However, they should discuss with their doctor the benefits and risks. While the vaccine provides protection (better than no protection), it still does not provide complete protection. Therefore, a routine cervical cancer screening is still highly recommended.
Testing and Screening
A Pap test is a procedure that collects cells from the cervix and is looked closely in the lab to find cell changes in the cervix caused by HPV- or to find cancer or pre-cancer.
Meanwhile, an HPV test looks for infection by high-risk types of HPV that can cause pre-cancers or lead to cancers of the cervix. Pap and HPV tests are recommended for women over 30 years. Both tests can help determine your risk of developing cancer. If a test is positive, it can lead to follow-up appointments and procedures to treat any pre-cancers that may be found. It may also allow an individual to seek out their healthcare provider for further information, monitoring, and/or intervention. One can also keep others safe by knowing and taking the necessary precautions.
Because HPV can also cause other forms of cancer in the body, it is recommended that people get other screenings done to look for pre-cancer or cancer.
Anal cancer screening can help detect early cell changes or precancerous cells. As of now, there are no standard screening tests for oral cancer. But the American Dental Association (ADA) recommends dentists to look for signs of oral and oropharyngeal cancer.
Practicing Safe Sex
Due to HPV being one of the most common causes of cervical cancer developing in Women, individuals need to take action in limiting their exposure to HPV. As we have already discussed, HPV can be passed from one person to another during skin-to-skin contact with an infected area of the body. Sex does not have to occur for the infection to spread. It is even possible for genital infection to spread through hand-to-genital contact.
While there is no way for everyone to always avoid possible exposure to HPV or to be sexually abstinent for the rest of their lives, there are some precautions one can take. This includes limiting the number of partners you have sex with and being cautious with those who have had many sex partners (and have possibly not practiced safe sex). However, it is also important to note that having sexual activity with only one person can still put you at risk. Some people can have HPV for years and never experience any symptoms. Thus, they can pass it on without knowing.
It is also necessary for people to practice safe and protected sex. Wearing condoms and/or dental dams provides some protection against HPV (as well as from HIV and other STIs) but not complete protection.