Cervical cancer develops in a woman’s cervix (the entrance to the uterus from the vagina). Almost all cervical cancer cases (99%) are linked to infection with high-risk human papilloma viruses (HPV), an extremely common virus transmitted through sexual contact. Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women.Cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570 000 women were diagnosed with cervical cancer worldwide and about 311 000 women died from the disease.Effective primary (HPV vaccination) and secondary prevention approaches (screening for, and treating precancerous lesions) will prevent most cervical cancer cases.
When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care. With a comprehensive approach to prevent, screen and treat, cervical cancer can be eliminated as a public health problem within a generation.
WHAT IS THE CAUSE OF CERVICAL CANCER?
Persistent infection with the Human Papillomavirus (HPV) is the main cause of cervical cancer. HPV is a common infection, transmitted through skin to skin sexual contact. The majority of people will have an HPV infection during their lifetime, even though they do not know they have it, and many may not have any signs or symptoms of infection. HPV infection usually clears on its own, with the body’s immune system response. However, in some people, especially in women older than 30 years of age, HPV infection may persist over time, and lead to changes in the cervix that can develop into cervical cancer. Pre-cancerous lesions in the cervix are the first stage of changes, before cervical cancer develops. These lesions can be detected with screening tests, and treated effectively to prevent cancer from developing. Cervical cancer can be treated and cured if it is detected in its early stages. If treatment is not provided, cervical cancer can be fatal.
WHO DEVELOPS CERVICAL CANCER?
Women, generally over 30 years of age who have a persistent infection with HPV, the cause of the disease, may develop cervical cancer. In addition, women more at risk for developing cervical cancer are those who:
- have had multiple sexual partners
- have given birth to three or more children
- have given birth to their first child at an early age (before 17 years of age)
- smoke cigarettes
- have a disease that affects the immune system
- are not regularly screened for cervical cancer
CAN CERVICAL CANCER BE PREVENTED?
Human Papillomavirus (HPV) infection is the main cause of cervical cancer. HPV infection can be prevented by HPV vaccines, administered prior to onset of sexual life, generally to girls between 9 and 14 years old. Cervical cancer can be prevented, by screening women for cervical pre-cancerous lesions, generally women over 30 years of age, and then treating the lesions.
HOW DO I KNOW IF I HAVE CERVICAL CANCER?
Women should seek medical care to be screened for cervical cancer, especially if they are over 30 years of age. This will involve a gynecological examination, with an early detection test to determine if a precancerous lesion exists, or if cancer exists, or if there is a high risk for developing cancer because of an HPV infection. If you are over 30 years of age, regardless of whether you are now sexually active or not, or whether you have had the HPV vaccine or not, get screened regularly. Cervical cancer can be prevented, with HPV vaccines in young girls 9-14 years of age, and regular screening tests in women 30 years.
WHAT IS THE HUMAN PAPILLOMAVIRUS?
Human Papillomavirus (HPV) is a common virus, transmitted through skin to skin sexual contact. Most people will have an HPV infection during their lifetime, even though they do not know they have it and many may not have any signs or symptoms of infection. HPV can infect both women and men. HPV infection usually clears on its own with the body’s immune system. However, in some people, HPV infection may persist over time. There are more than 100 HPV types, and each type is identified by a number. Some HPV types can cause genital or anal warts. Other HPV types can cause cancer, most commonly cervical cancer. HPV infection is also a risk factor for vaginal, penile, anal, mouth and throat cancers. For cervical cancer, persistent infection from HPV can cause changes in the cells of the cervix, known as pre-cancer lesions. Pre-cancer lesions are the pre-stage for cervical cancer. These lesions can lead to cervical cancer if they are not detected or treated. Genital warts caused by the HPV virus can disappear on their own or may require treatment, but do not cause cancer. Cervical cancer can be treated and cured, if detected early. If not treated, cervical cancer is almost always fatal.
WHAT ARE THE HPV TYPES AND WHAT DO THEY CAUSE?
There are high and low-risk HPV types:
- Low-risk HPV types cause genital warts in men and women. Among the most common of these HPV types are HPV 6 and 11 and some of the available HPV vaccines offer protection against these types.
- High-risk HPV types can cause cancer. The main cause of cervical cancer is persistent infection with one or more high risk HPV types that cause abnormal changes in the cervical cells. Among the most common of these HPV types are HPV 16 and 18, and HPV vaccines offer protection against these types. This health education material provides information on the human papillomavirus and how it causes cervical cancer.
FACT SHEET
HUMAN PAPILOMAVIRUS (HPV) CAN HPV INFECTION BE PREVENTED? HPV infection is very common and most people become infected after beginning their sexual life. HPV infection can be prevented by HPV vaccines, recommended for girls aged 9-14 years prior to the age of beginning sexual life. Some country guidelines also recommend HPV vaccination for boys. It is very important to educate girls and boys about sexual health and HPV infection, with age appropriate and culturally relevant messages. In adolescents who have initiated sexual activity, sexual health messages should include information about HPV infection and cervical cancer screening, as well as condom use. The use of condoms does not provide full protection against HPV, but it protects against other sexual transmitted infections and unwanted pregnancies. HPV infection is not prevented with personal hygiene measures.
HOW IS AN HPV INFECTION DETECTED?
Infection by HPV can be detected with the HPV test, given to women during a gynecological exam. The HPV test is a relatively new test, that is not available in all countries. An HPV test is generally given to women over 30 years of age to detect HPV infection. In younger women, HPV infection is very common, and in most cases the infection clears by itself. If an HPV infection is detected, there is a greater risk for the woman to develop precancerous lesions in her cervix. For this reason, it is very important that women detected with an HPV infection receive follow up medical care and treatment for precancerous lesions, as needed. If precancerous lesions are left untreated, it will likely develop into cervical cancer.
CAN HPV INFECTION BE TREATED?
There is no treatment for the virus, but there is treatment for the health problems caused by HPV infection. 1. Genital warts Genital warts are visible, soft, moist, and skin-colored bumps. In women, warts are found around the vagina, cervix or anus. In men, genital warts may appear on the tip of the penis. Warts caused by HPV may disappear on their own or may require treatment. It is possible for warts to go away spontaneously, and re-appear again. Medical care should be sought for wart removal.
2. Precancerous cervical lesions If a screening test detects changes in the cervical cells, a woman will usually need another test by a medical doctor during a gynecological exam. This is called colposcopy, and may be performed with or without a biopsy. If a precancerous lesion is diagnosed, treatment is given to prevent the development of cervical cancer. Treatment involves removing the lesions. Detection of HPV infection, and screening for precancerous lesions followed by timely treatment are essential for the prevention of cervical cancer
HUMAN PAPILLOMAVIRUS (HPV) VACCINES
WHAT IS THE HPV VACCINE?
The HPV vaccine protects against HPV infection and can prevent cervical cancer. The HPV vaccine is recommended for girls aged 9-14 years. Some countries also recommend HPV vaccines for boys. It is not necessary to ask whether sexual activity has been initiated before administering the vaccine. If an HPV infection already exists, the HPV vaccine will not eliminate the infection, which is why it is not typically used in adult women. The HPV vaccine is given in 2 or 3 separate doses (depending on the country guideline) over six months. The HPV vaccine is effective and safe and does not have any known long –term side effects. At time of vaccination, pain in the injection site may occur, but it usually resolves shortly after the vaccine is given. There are reported cases of girls fainting right after receiving the vaccine. This, however, can occur regardless of the type of vaccine given in an adolescent population. HPV vaccines are usually offered through school immunization programs and/or at health clinics. For girls 9-14 years of age, vaccinate against HPV to prevent cervical cancer.
IF THE HPV VACCINE WAS GIVEN, IS THERE A NEED FOR AN EARLY DETECTION TEST?
Yes, it is important for women, regardless of whether or not they received the HPV vaccine, to continue to have the early detection tests to prevent cervical cancer, especially if they are over 30 years of age. This can detect precancerous lesions and, with appropriate treatment, prevent cervical cancer. Protect children´s health by providing HPV vaccines to prevent cervical cancer.
CAN CERVICAL CANCER BE PREVENTED?
Yes, HPV vaccines can prevent HPV infection, the cause of cervical cancer. HPV vaccines are recommended for girls aged 9 to 14 years, prior to onset of sexual life. Some country guidelines recommend HPV vaccines also for boys. Cervical cancer can be prevented in adult women with early detection tests, such as the HPV test or PAP test, followed by treatment. Early detection tests can identify pre-cancerous lesions in the cervix, which can then be treated before the lesion develops into cervical cancer. These tests are recommended for women aged 30 years and older, although the recommended age group may vary by country, according to national guidelines.
EARLY DETECTION TESTS TO PREVENT CERVICAL CANCER
All women, especially those aged 30-49 years, should undergo a gynecological exam and a test to determine if a precancerous lesion exists in the cervix, or if there is a high risk for developing one because of an HPV infection. Three different early detection tests are currently available: HPV test, PAP (Papanicolaou) test; and visual inspection with acetic acid (VIA). The type of test used may vary by country, according to national guidelines.
HPV (Human Papillomavirus) Test The HPV test detects infections caused by HPV, and identifies those women at high risk of developing precancerous lesions in the cervix, which if left untreated, can develop into cervical cancer. This health education material provides information on detecting cervical cancer before any signs or symptoms appear. It is intended for use by health providers and by women to be informed about early detection tests that can prevent cervical. This test involves taking a sample of cells from the cervix, during a gynecological examination performed by a medical provider. This sample is then sent to a laboratory for analysis. In some countries, HPV test is administered by the woman herself and the sample is mailed to the laboratory for analysis. HPV test results are usually provided to women, as an HPV positive or HPV negative result.
PAPANICOLAU (PAP) TEST The PAP test is the more commonly available cervical cancer early detection test. The test involves a gynecological examination by a medical provider, who takes a sample of cells from the cervix. The sample is then sent to a laboratory for analysis. The PAP test detects changes in the cervical cells and can identify precancerous or cancerous lesions. PAP test results are usually provided to women, as a normal or abnormal PAP test result.
VISUAL INSPECTION WITH ACETIC ACID (VIA) Visual inspection with acetic acid is a test to detect precancerous cervical lesions. The test involves a gynecological examination by a medical provider, who applies acetic acid (diluted vinegar) to the cervix to observe whether there are any changes in the cells. The VIA test results are provided to women immediately. Results are provided to women as VIA positive, which indicates a precancerous lesion, or VIA negative which indicates no lesion.
WHAT IF THE SCREENING TEST RESULTS ARE NORMAL? In the majority of cases, test results will be normal, indicating a healthy cervix. Women with normal results are recommended to have a test again in 3-5 years’ time, which may vary according to country guidelines. It is important for all women, even if their test result is normal, to take another test in the future, since changes in the cervical cells can develop at any point in time. With HPV tests, if the HPV test result is negative (that is, no HPV infection is detected) and the woman is over 30 years of age, there is a lower chance for cervical cancer to develop. In this case, women are recommended to have an HPV test again in 5-10 years’ time.
WHAT IF THE SCREENING TEST SHOWS ABNORMAL RESULTS? If the test results are abnormal, it may mean there are changes in the cells of the cervix, or that pre-cancerous cells are present. The recommended course of action for women with abnormal results will vary by country guideline. Generally, the health provider may give treatment at the time of providing the test result to the woman; or the health provider may refer the woman to a gynecologist for additional evaluation and treatment. For women referred for further evaluation, this will involve colposcopy, with or without biopsy. Colposcopy: Colposcopy is a visual examination of the cervix using an instrument called a colposcope. The medical provider will perform a gynecological exam, using a colposcope to examine the cervix more closely. The colposcopy examination may also be used to take a tissue sample from the cervix, called a biopsy. The exam does not cause anymore discomfort or side effects, than any other gynecological exam. Colposcopy is used to verify whether, or not, pre-cancerous cells or cancer may have developed in the cervix. During the examination, if mild abnormal changes in the cervix are observed, the woman will be recommended to return in 6-12 months for a repeat colposcopy evaluation. If precancerous lesions are observed, a biopsy will be taken. The medical provider may provide treatment at the time of the colposcopy exam, or may wait for the results of the biopsy, before providing treatment. The recommended course of action will vary by country guideline. Biopsy: A biopsy is a tissue sample, which is examined by a doctor under a microscope to diagnose precancerous cells or cancer. The biopsy results show the degree of the abnormality and inform the recommendation for treatment. The result may be mild cervical changes, which may need monitoring; or a precancerous lesion which must be treated; or cervical cancer, which requires immediate treatment. The biopsy can cause some discomfort, pain or cramps in some women.
HOW ARE PRE-CANCEROUS CERVICAL LESIONS TREATED? The treatment for cervical precancerous cells involves destroying the abnormal cells in the cervix. This is typically done by freezing the cells (cryotherapy) or by removing the cells (LEEP or other methods). Treatment is done by a trained medical provider, as an outpatient procedure. Cryotherapy is the process of freezing and destroying the abnormal cells of the cervix. It involves applying cooled gas through a metal probe directly onto the cervix. This procedure takes only a few minutes to perform. It does not typically cause pain to women, although it may produce some discomfort, cause cramping and lead to vaginal discharge, following the procedure. The health provider will indicate the care steps required for women to follow after cryotherapy treatment. A follow up visit is usually recommended 6-12 months’ post treatment. LEEP is a procedure to remove the abnormal cells of the cervix, using a thin wire heated with electricity. The procedure is performed by a medical provider, under local anesthesia. It takes only a few minutes to perform. It can cause cramping, or mild to moderate bleeding. The medical provider will recommend the care needed, following this treatment. It is important for all women, especially those aged 30-49 years of age to be screened for cervical cancer, and if precancerous lesions are detected to get treatment. Cervical cancer can be prevented.
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