Why does a preventable cancer affect thousands each year?
When it comes to cancer prevention, a few actions probably come to mind. Quitting smoking lowers the risk of lung cancer and wearing sunscreen can help prevent skin cancer. However, many people are not aware that prevention is possible when it comes to cervical cancer.
To understand how cervical cancer can be prevented and treated, we must understand HPV, the human papillomavirus. Nearly all cervical cancers are linked to this virus.
HPV is a group of more than 150 related viruses and the most commonly sexually transmitted infection in the world. It is transmitted through intimate skin-to-skin contact. The Centers for Disease Control and Prevention (CDC) estimates that 79 million Americans — one out of every four people — are infected with HPV. Because it is so common, nearly every person who is sexually active will get HPV at some time in their life if they don't get the HPV vaccine. Most people with the virus do not develop symptoms and may never know they are infected. For others, the virus can lead to cervical and other gynecologic cancers or oropharyngeal (middle throat) cancers. Despite these staggering figures, HPV vaccination rates remain low in the United States.
"HPV is very common. We assume that everyone who is sexually active has been exposed because it affects such a massive portion of the population. It's the reason that we do testing and screening," said John Wallbillich, M.D., member of the Gynecologic Oncology Multidisciplinary Team at the Barbara Ann Karmanos Cancer Institute.
Prevention — The HPV vaccine
A vaccine is available to aid in the prevention of HPV. It is recommended for everyone through 26 years of age, if not previously vaccinated. The CDC estimates that vaccination can reduce more than 90% of the cancers caused by HPV every year. Therefore, HPV vaccination is recommended for females and males at age 11 or 12 years (or can be started as early as age 9).
While HPV vaccination is not routinely recommended for adults older than 26, some adults ages 27-45 may consider getting vaccinated based on advice from their health care provider regarding future risk of HPV infections and the possible benefits of HPV vaccination.
Although HPV vaccines can prevent the majority of cervical, anal, oropharyngeal and other genital cancers, vaccination rates remain significantly lower than other recommended adolescent vaccines in the U.S. Just 49.5% of girls and 37.5% of boys have completed the HPV vaccine series. As a National Cancer Institute-designated cancer center, Karmanos is among a group of elite, specialized centers from across the nation that share the goal of sending a powerful message to parents, adolescents and health care providers about the importance of HPV vaccination for the elimination of HPV-related cancers.
Screening and testing
Because vaccination rates are low, HPV and pap testing are crucial in providing favorable outcomes for patients and cervical cancer prevention. HPV testing is commonly done alongside a pap test, which examines cells for irregularities that may indicate cancer or pre-cancer. Both tests require that a medical professional collect and analyze cells from the cervix. A health care provider can determine when and how often a woman should be tested based on age and health history.
"HPV gets into the DNA of the cell and causes an infection," explained Dr. Wallbillich. “Many times, the body can clear the infection on its own. However, in some cases, the virus can stay in the cells. This causes irregularities which can turn into pre-cancer and even cancer.”
"It would be impossible to prevent absolutely every single case of cervical cancer, but with routine testing, we can look for pre-cancerous or cancerous cells and test for the cancer-causing strains of HPV," said Dr. Wallbillich.
Karmanos Cancer Institute recommends that women talk to their gynecologist or primary care provider about HPV and pap testing. Those who do not have a gynecologist or primary care provider and would like to be screened may be seen by a specialist though Karmanos’ Cancer Screening and Prevention Program. Women diagnosed with cervical cancer should also visit Karmanos to speak with a dedicated oncologist and design a treatment plan.
Other cancers linked to HPV
While the majority of cervical cancer cases are linked to HPV, the virus can cause many other forms of cancer too. In women, most vaginal and many vulvar cancers are also linked to HPV. In men, HPV can cause penile cancer. It can also cause head and neck, anal and oral cancers in both men and women. Studies have begun to show that around 70% of oropharyngeal (back of the throat) cancers can be linked to HPV, according to the CDC. Until recently, these cancers were largely attributed to tobacco and alcohol use. Overall, the CDC estimates that HPV causes about 34,800 cancers in the United States each year.
"It's sad that we see these cases when we know so many of them could be prevented," said Dr. Wallbillich.
HPV and pap testing, along with vaccination, are key when it comes to decreasing cases of HPV-related cancers, such as cervical cancers. For those who are diagnosed, Karmanos offers expertise from a multidisciplinary team of specialists. Each of these team members works specifically with patients who are affected by gynecological cancers, ensuring that patients receive care that is fully dedicated to their form of cancer. In the fight against cancer, prevention, early detection and expert treatment are the best weapons.
To request a screening appointment, visit karmanos.org/paptest or call 1-800-KARMANOS.