Human
papillomavirus (HPV) is the most common viral infection of the reproductive
tract. Most sexually active women and men will be infected at some point in
their lives and some may be repeatedly infected.
The peak time for acquiring infection for both women and men is shortly
after becoming sexually active. HPV is sexually transmitted, but penetrative
sex is not required for transmission. Skin-to-skin genital contact is a
well-recognized mode of transmission.
There are many types of HPV, and many do not cause problems. HPV infections
usually clear up without any intervention within a few months after
acquisition, and about 90% clear within 2 years. A small proportion of
infections with certain types of HPV can persist and progress to cancer.
Cervical
cancer is by far the most common HPV-related disease. Nearly all cases of
cervical cancer can be attributable to HPV infection.
Though data on anogenital cancers other than cancer of the cervix are
limited, there is an increasing body of evidence linking HPV with cancers of
the anus, vulva, vagina, and penis. Although these cancers are less frequent
than cancer of the cervix, their association with HPV make them potentially
preventable using similar primary prevention strategies as those for cervical
cancer.
Non-cancer causing types of HPV (especially types 6 and 11) can cause
genital warts and respiratory papillomatosis (a disease in which tumours grow
in the air passages leading from the nose and mouth into the lungs). Although
these conditions very rarely result in death, they may cause significant
occurrence of disease. Genital warts are very common and highly infectious.
Signs and symptoms
The majority of HPV infections do not cause symptoms or disease and
resolve spontaneously. However, persistent infection with specific types of HPV
(most frequently types 16 and 18) may lead to precancerous lesions. If
untreated, these lesions may progress to cervical cancer, but this progression
usually takes many years.
Symptoms of cervical cancer tend to appear only after the cancer has
reached an advanced stage and may include:
- irregular, intermenstrual (between periods) or abnormal vaginal bleeding after sexual intercourse;
- back, leg or pelvic pain;
- fatigue, weight loss, loss of appetite;
- vaginal discomfort or odourous discharge; and
- a single swollen leg.
More severe symptoms may arise at advanced stages.
How HPV infection leads to cervical cancer
Although most HPV infections clear up on their own and most
pre-cancerous lesions resolve spontaneously, there is a risk for all women that
HPV infection may become chronic and pre-cancerous lesions progress to invasive
cervical cancer.
It takes 15 to 20 years for cervical cancer to develop in women with
normal immune systems. It can take only 5 to 10 years in women with weakened
immune systems, such as those with untreated HIV infection.
Risk factors for HPV persistence and
development of cervical cancer
- Early first sexual intercourse
- Multiple sexual partners
- Tobacco use
- Immune suppression (for example, HIV-infected individuals are at higher risk of HPV infection and are infected by a broader range of HPV types)
Scope of the problem
Worldwide, cervical cancer is the fourth most frequent cancer in women
with an estimated 530 000 new cases in 2012 representing 7.5% of all female cancer
deaths. Of the estimated more than 270 000 deaths from cervical
cancer every year, more than 85% of these occur in less developed regions.
In developed countries, programmes are in place which enable women to
get screened, making most pre-cancerous lesions identifiable at stages when
they can easily be treated. Early treatment prevents up to 80% of cervical
cancers in these countries.
In developing countries, limited access to effective screening means
that the disease is often not identified until it is further advanced and
symptoms develop. In addition, prospects for treatment of such late-stage
disease may be poor, resulting in a higher rate of death from cervical cancer
in these countries.
The high mortality rate from cervical cancer globally (52%) could be
reduced by effective screening
and treatment programmes.
Screening for cervical cancer
Cervical
cancer screening is testing for pre-cancer and cancer among women who have
no symptoms and may feel perfectly healthy. When screening detects
pre-cancerous lesions, these can easily be treated and cancer avoided.
Screening can also detect cancer at an early stage and treatment has a high
potential for cure.
Because pre-cancerous lesions take many years to develop, screening is
recommended for every woman from aged 30 to 49 at least once in a lifetime and
ideally more frequently. Screening is only effective on cervical cancer
mortality, if a high proportion of women participate.
There are 3 different types of screening tests are currently available:
- conventional (Pap) test and liquid-based cytology (LBC)
- visual inspection with Acetic Acid (VIA)
- HPV testing for high-risk HPV types.
HPV vaccination
There are currently 2 vaccines
which protect against both HPV 16 and 18, which are known to cause at least 70%
of cervical cancers. The vaccines may also have some cross-protection against
other less common HPV types which cause cervical cancer. One of the vaccines
also protects against HPV types 6 and 11 which cause anogenital warts.
Clinical trial results show that both vaccines are safe and very
effective in preventing infection with HPV 16 and 18.
Both vaccines work best if administered prior to exposure to HPV.
Therefore, it is preferable to administer them before first sexual activity.
The vaccines
cannot treat HPV infection or HPV-associated disease such as cancer.
Some countries have started to vaccinate boys as the vaccination
prevents genital cancers in males as well as females, and one of the two
available vaccines also prevents genital warts in males and females. WHO
recommends vaccination for girls aged 9-13 years as this is the most
cost-effective public health measure against cervical cancer.
HPV vaccination does not replace cervical cancer screening. In countries
where HPV vaccine is introduced, screening programmes may still need to be
developed or strengthened.
Cervical cancer prevention and control: A comprehensive approach
WHO recommends a comprehensive approach to cervical cancer prevention
and control. The recommended set of actions includes interventions across the
life course. It should be multidisciplinary, including components from
community education, social mobilization, vaccination, screening, treatment and
palliative care.
Primary prevention begins with HPV
vaccination of girls aged 9-13 years, before they become sexually active.
Other recommended preventive interventions for boys and girls as
appropriate are:
- education about safe sexual practices, including delayed start of sexual activity;
- promotion and provision of condoms for those already engaged in sexual activity;
- warnings about tobacco use, which often starts during adolescence, and which is an important risk factor for cervical and other cancers; and
- male circumcision.
Women who are sexually active should be screened for abnormal cervical
cells and pre-cancerous lesions, starting from 30 years of age.
Source: http://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer
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