Dr Fong Kah Leng, obstetrician and gynaecologist at Mount Elizabeth Hospital, talks about the relationship between HPV and cervical cancer, and why the HPV vaccine can help protect you.
Virtually all cervical cancers are associated with the human papillomavirus (HPV). Specifically, HPV types 16 & 18 account for about 70% of cervical cancer cases. These HPV types can cause cancers of the penis in men as well. HPV can also cause cancers of the mouth, throat and anus in both men and women.
How is the HPV infection spread?
HPV infection is spread through sexual contact or skin-to-skin contact. HPV infection is very common, and most people with HPV infection do not develop cancer.
However, in some women, the HPV infection persists and causes changes in the cells of the cervix. This abnormality on the cervix is detectable by a Pap smear as well as specific HPV tests. With further investigation via colposcopy and appropriate surgical treatment, the abnormal cells can be prevented from developing into cervical cancer.
What are the symptoms of cervical cancer?
Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body.
Women with early cervical cancers usually have no symptoms. Symptoms often do not begin until the cancer becomes invasive and grows into nearby tissue. When this happens, the most common symptoms are abnormal vaginal bleeding, unusual discharge from the vagina, pelvic pain, or pain during sex. While bleeding after sex may not be due to a serious condition, it may also indicate the presence of cervical cancer.
How is cervical cancer treated?
The treatment of cervical cancer varies worldwide, depending on the access to surgeons skilled in radical pelvic surgery, and the availability of ‘fertility-sparing therapy’.
Radiation therapy may be used in all stages where surgical options do not exist. Surgical intervention may have better treatment success than radiological approaches. An effective surgery would mean that the entire cancer must be removed with no cancer found at the margins of the removed tissue on examination under a microscope.
What does the HPV vaccine do?
Widespread immunisation with the HPV vaccine could reduce the impact of cervical cancer worldwide. The Centres for Disease Control and Prevention (CDC) recommends routine HPV vaccine for girls and boys ages 11 – 12, although some organisations recommend starting the vaccine as early as age 9 or 10. Two vaccines, Gardasil and Cervarix, are available. Cervarix is for girls only, while Gardasil can be used for both girls and boys.
These 2 vaccines can prevent most cases of cervical cancer, if given before the individual is exposed to the virus. In addition, these vaccines can prevent vaginal and vulvar cancer in women, while Gardasil can prevent genital warts and anal cancer in women and men.
In theory, vaccinating boys against the types of HPV associated with cervical cancer might also help protect girls from the virus by possibly decreasing the spread of the virus. Certain types of HPV have also been linked to cancers in the mouth and throat, so the HPV vaccine likely offers some protection against these cancers, too.
Research has shown that receiving the vaccine at a young age isn't linked to an earlier start of sexual activity. Also, response to the vaccine is better at younger ages than it is at older ages.
Does the HPV vaccine help if you're already sexually active?
You could still benefit from the vaccine because it can protect you from other strains of the virus that you don't yet have.
However, the vaccines can’t protect you from the strains of HPV that you have already been exposed to.
How can I protect myself from cervical cancer?
Go for a vaccination and regular Pap smears. All women aged 21 and above who have ever had sex or are sexually active should have regular Pap smears. Even if you are already vaccinated, you should still go for regular Pap smears.
In women 30 years and older, screening with both the Pap test and the HPV test (co-testing) lowers the number of cases of cervical cancer.
Consider getting a gynaecologist to assist you in maintaining your gynaecologic health, provide early cancer detection, as well as provide individualised management and treatment of your specific conditions.
HPV vaccination reduces the chances of getting cervical cancer. It works by preventing the infection of specific types of HPV. Vaccinated women should still go for regular Pap smears so that they can detect and prevent or treat cervical cancer early.
While preventing specific types of HPV, the vaccines do not protect you against all cancer-causing HPV sub-types. About 30% cervical cancer cases are caused by HPV sub-types which the vaccines do not protect you from.