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Cervical Cancer Screening, HPV, and Diagnosis

HPV and Risk Factors

Human papillomavirus (HPV) can cause several types of cancer, including cervical cancer. It is important to understand how this common sexually transmitted infection (STI) may lead to a cancer diagnosis.

There are over 200 types, or strains, of HPV, some of which are spread through direct sexual contact. The strains can be divided into two categories of HPV:

  • Low-risk - rarely associated with cancer, but some can cause issues like genital warts.
  • High-risk - can cause certain types of cancer such as cervical, head and neck, and anal cancers. Out of the 14 high-risk strains of HPV, two types (HPV16 and HPV18) are responsible for most HPV-related cancers.

Nearly all sexually active people are infected with HPV at some point during their lifetime. This is normal. Although about half of these infections are with a high-risk HPV type, most infections do not lead to cancer because the immune system is usually able to fight them off.

How does HPV cause cancer?

Sometimes the immune system is unable to fight off an HPV infection. When a high-risk HPV infection is persistent (does not go away over time), it can lead to cell changes (dysplasia) that, if left untreated, may develop into cancer. It takes about 10-20 years (or longer) for HPV-infected cervical cells to develop into cancer.

There are risk factors for HPV persistence and the development of cervical cancer, which include:

  • HPV-type (having a high-risk type, like HPV16 or HPV18)
  • Weakened immune system (e.g., those living with HIV or taking medicines to suppress the immune system)
  • Co-infection with other STIs
  • Smoking tobacco

Aside from cervical cancer, HPV can also lead to other types of cancer such as vaginal, vulvar, penile, anal, and oropharyngeal.

While HPV is the most common cause of cervical cancer, it is important to note that another cause of cervical cancer (though much more rare) is exposure to diethylstilbestrol (DES) in utero. DES is a synthetic form of the female hormone estrogen. There are some other rare types of cervical cancer that are not due to HPV.

Several risk factors can increase the likelihood of developing cervical cancer. At the same time, many women with these risk factors do not develop the disease.

While HPV is the greatest risk factor for developing cervical cancer, other risk factors include:

  • Smoking cigarettes
  • Taking oral contraceptives (birth control)
  • Having a weakened immune system
  • Giving birth multiple times
  • Being unvaccinated against HPV
  • Having a history of abnormal Pap tests
  • Not having regular Pap tests
Just because some of these risk factors may apply to you, does not mean you will get cervical cancer. It simply means you may be at a higher risk. The most important thing is to remain diligent with adhering to screening guidelines and to follow-up with your healthcare provider regarding any abnormal results or other concerns.

Screening and Prevention

When it comes to cervical cancer, the good news is that there are a few steps you can take to prevent the onset of HPV or catch any abnormal cells before they have the chance to progress.

HPV Vaccine

There is only one HPV vaccine used in the United States. The HPV vaccine protects against infection from nine HPV types, including the high-risk types that cause most HPV-related cancers, as well as those that cause the majority of genital warts. The vaccine is most effective when given between the ages of 9-12 (for both males and females), with eligibility up until 45 years of age. However, individuals between the ages of 27-45 should discuss with their doctor whether or not it is beneficial for them to get the vaccine. It is estimated that HPV vaccination prevents up to 90% of HPV-related cancers.

Since the HPV vaccine was approved in 2006, cervical cancer cases have steadily declined in the United States. However, the rate of other HPV-related cancers without standardized screening guidelines have increased during the same time period. As a result, research has shown that vaccination must be accompanied by routine screening in order to catch cancers early enough.

Pap Test

The Pap test (or Pap smear) is most commonly used to screen for cervical cancer. The Pap test consists of collecting cells from the cervix by using a cotton swab or soft brush. These cells are then viewed under a microscope to determine whether they are normal or abnormal.

HPV Test

The HPV test is used to detect the presence of cervical infection with high-risk HPV types that can cause abnormal cells. Like the Pap test, it involves the collection of cells from the cervix. The results will come back as either positive or negative for HPV.

What are the screening guidelines for cervical cancer?

  • 21 - 29 years old - it is generally recommended that Pap testing begins at age 21 with routine testing every three years (if results are normal)
  • 30 - 65 years old - talk to your doctor about what test(s) are right for you:
  • A Pap test every three years
  • An HPV test every five years
  • An HPV test and Pap test together every five years
  • 65+ - you may not need to be screened anymore if your results have come back normal for 20 years or you had your cervix removed.