| What is cervical cancer? How common is it?
Cervical cancer is cancer that begins in the cervix, the part of the
uterus, or womb, that opens to the vagina. Cervical cancer was once
the leading cause of death from cancer in women. Thanks to the
Pap test, the number of women in the United States who get cervical
cancer has decreased. Now a new test is available that might improve
on the Pap test and help women to prevent cervical cancer. Cervical
cancer can be prevented in most cases by early detection.
What is HPV? How does it lead to cervical cancer?
HPV is short for human papillomavirus. An HPV infection is usually
harmless and temporary: most people with HPV will never know they
are infected because the virus usually goes away on its own. There are
many types of this common virus, and only a few “high-risk”
types
can lead to cervical cancer. These high-risk HPV types are spread
through sexual contact. There are also “low-risk” types of
HPV that
can cause genital warts but do not cause cancer. If high-risk HPV
types don’t go away on their own, they may progress to abnormal
precancer cells. If these abnormal cells are not found and treated, they
may become cancer over time. Most cell changes return to normal by
themselves or simply die without progressing to cancerous lesions. It
is very rare for an HPV infection to lead to cervical cancer.
Who can get cervical cancer?
Because almost all cervical cancers are caused by HPV, any woman
who has had sex can get (is at risk for) cervical cancer. Some things
place women at more risk than others. These include high-risk types
of HPV infection, smoking, and HIV infection. The women who are
most at risk are those women who are not getting Pap tests at all, or
who don’t get them for several years.
Who can get HPV?
Anyone who has ever had sex, both men and women, can get an HPV
infection. It is estimated that three out of every four people will get
an
HPV infection during their lifetime. HPV infection is spread by direct
skin-to-skin contact during vaginal sex. HPV infection is more common
in younger age groups, particularly in women in their late teens
and 20s. Because HPV is spread mainly through sex, your chances
of getting it increase with number of sex partners. Women who start
having sex at a young age, who have many sex partners, and whose
sex partners have or have had many other partners are at increased
risk for having an HPV infection.
Will I know if I have HPV?
In most cases, infection with the HPV virus has no symptoms.
However, a high-risk HPV infection may cause changes in the cervical
cells. These changes should show up on your Pap test. Signs of HPV
infection can appear weeks, months, or years after first infection, so
it
is possible to become infected without being aware of it. Only a small
number of women infected with HPV develop cell changes.
Can HPV infections be treated?
There is no treatment available for the virus
itself. However, there are treatments for
cervical changes that HPV can cause. Your
health care provider will discuss these treatment
options with you, if you need them.
Is there a test for HPV?
Yes, there is an HPV test that can detect
high-risk types of HPV in cervical cells. HPV
tests are already used to help doctors decide
which women with certain abnormal results
on their Pap test need further testing. Now
this test can also be used in routine testing of
women over the age of 30 at the same time
that they get their Pap test.
What is a Pap test? What is the difference between a Pap test
and an HPV test?
A Pap test is the standard way to see if there
are any cell changes that you should be concerned
about. The Pap test looks at a sample
of cells from the cervix under a microscope
to see if there are any abnormal cells. It is a
very good test for finding not only cervical
cancer cells but also cells that might become
cancer cells. Usually health care providers do
the Pap test as part of a pelvic exam.
An HPV test checks directly for high-risk
HPV viruses. For both the Pap test and HPV
test, a small soft brush is used to collect
cervical cells that are sent to a laboratory.
Whether you have both tests or the Pap test
alone, you will not notice a difference in
your exam.
Should I be tested for HPV infection?
If you are more than 30 years old, you can
get both an HPV test and a Pap test at the
same time. Getting both tests together makes
it more likely that any abnormal cervical cell
changes will be found compared with using
just one test. If both test results are negative
(normal), you should not repeat either test
more often than every three years. The choice
of whether or not to be tested for HPV is
yours, and you should discuss your decision
and possible results with your health care
provider. You also may want to ask about the
cost of the test and whether your insurance will
cover that. Remember, it will still be important to
continue having routine health exams, no matter
what the result of your Pap or HPV test is.
I am under age 30—should I get an HPV test in addition
to my Pap test?
HPV is very common in women under the age
of 30, and cervical cancer is very rare in this age
group. In most women younger than 30 who
have HPV, the virus will go away before it causes
any cell changes or symptoms. Including an
HPV test along with your Pap test provides no
real health benefit for younger women
and might lead to too many tests and
unnecessary treatment.
I am younger 30, but my doctor suggested HPV testing after my
Pap result came back as abnormal. Why?
The most common abnormal Pap result is called
atypical squamous cells of undetermined significance
(ASC-US). ASC-US cells are not precancerous,
but they are not quite normal. About
half of the women with ASC-US have these cell
changes because of the presence of HPV. Your
doctor suggested you get the HPV test to see if
your abnormal cell changes were caused by HPV.
Only women with ASC-US who test positive for
HPV need further tests. HPV testing is helpful at
any age for deciding which women with ASC-US
need follow-up. This is different from using an
HPV test with the Pap test as part of a normal
health visit for women over age 30.
How should I prepare for a Pap test or Pap and HPV test?
Try not to schedule an appointment that will
be during your menstrual period. For 48 hours
before the test, do not douche; do not have
sexual intercourse; do not use tampons, birth
control foams, jellies, or other vaginal creams or
vaginal medications.
If I tested positive for HPV, what does this mean for me?
Women with a normal Pap result who test
positive for HPV will usually be tested for HPV
again in 6–12 months. Testing positive a second
time does not mean that there is great risk of
cervical cancer, or even that cell changes may
lead to cervical cancer, but it does mean that
further tests will likely be recommended. If you
have a positive HPV test result and an abnormal
Pap result, your health care provider will explain
what further tests you might need.
If I test positive for HPV, when did I get it?
It is usually impossible to know when a person
got HPV or from whom. HPV may be found
fairly soon after contact or not until many years
later. Most men and women are not aware that
they have the virus. Condoms do not offer complete
protection from HPV. The virus is so common
that having only one lifetime partner does
not ensure protection. For all these reasons, it is
not helpful, or fair, to blame your partner.
If I have an HPV infection that goes away, can I get it again?
Most sexually active couples share the HPV
until the immune response eliminates the infection.
Partners who are sexually intimate only
with each other do not pass the virus back and
forth. In other words, when the virus is shared,
being exposed to more of the same virus by
your partner does not make it more difficult to
get rid of the infection. When HPV infection
goes away, the immune system will remember
that HPV type and keep a new infection of
the same HPV type from ever occurring again.
However, because there are many different types
of HPV, becoming immune to one HPV type
does not protect you from getting another
HPV type.
If I have HPV or a cell abnormality, is there anything I can
do?
Yes: don’t smoke. Smoking has been shown
to increase the chance that cell abnormalities
might progress to more severe changes.
Remember that almost everyone gets HPV at
some time. Be sure to keep your follow-up
doctor appointments.
Will I always have the HPV virus?
No one really knows, but probably not. HPV
usually goes away within one to two years.
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