What women need to know about HPV and cervical cancer: the HPV vaccination is a new weapon in the fight

As a practicing gynecologist, I know how concerned women are about cancer. Yet, fear, anxiety and lack of knowledge prevent far too many women, particularly women of color, from getting recommended preventive care and gaining awareness of their bodies.

For decades we have known that the human papillomavirus (HPV) is the primary cause of cervical cancer and of associated pre-cancerous changes of the cervix (dysplasia). Cervical cancer is a leading cause of gynecologic cancer death. According to the American Cancer Society, in this year alone, more than 11,000 women will be diagnosed with invasive cervical cancer, and about 3,500 will die from this disease.

According to the Centers for Disease Control and Prevention (CDC), genital HPV is the most common sexually transmitted infection in the U.S. If you have had sexual intercourse, you have likely been exposed to at least one of the various types of HPV. Each year, more than 6 million Americans are infected with HPV, and the infection is unlike the more commonly discussed sexual infections, such as chlamydia and gonorrhea. The majority of those infected with HPV have no obvious signs or symptoms. For a certain percentage, however, HPV infection results in benign genital warts, pre-cancerous changes, and if not treated, possibly cervical cancer.

Typically, the progression from pre-cancer to invasive cervical cancer is a long process over decades. Men carry and transmit the virus, but they have no symptoms. So it's vital that women, particularly young women, are informed and checked.

Unfortunately, condom use is not a solid defense against HPV, which still can be transmitted during "safe sex." Worse, there is no medical treatment for HPV. For most young women under 30, their body's defense mechanisms will eliminate an HPV infection within two years. For sexually active women over 30, an HPV test is recommended, in addition to a Pap. The HPV test can detect high-risk types of the virus.

In June of last year, there was new focus on the condition when the FDA approved the first licensed vaccine against HPV infection. Targeted for females who are 9 to 26 years old, Gardasil is an important advancement in the fight against cervical cancer. The vaccine, which consists of a series of three muscle injections, offers protection against four strains of HPV that cause the majority of disease in women.

The HPV vaccine is most effective when given before the onset of sexual activity. Whether or not we accept it, on average, our young people are having sex at earlier ages. Studies support and indicate that the HPV vaccine is safe and highly effective in the prevention of infection of 70 percent of the high-risk virus types that cause genital warts and cervical cancer changes.

Not surprisingly, the HPV vaccine has triggered public debate and controversy. Officials in various states are considering mandating HPV vaccination for girls entering middle school. Further, Gardasil may soon be added to the list of "must have" childhood vaccines. It protects young women against HPV infection when--and if--they become involved in sexual activity. And despite some concern among parents, studies indicate that most young women do not feel that the vaccination is a license to be promiscuous or to start having sex.

For reasons that still are not fully understood, cervical cancer is more deadly among African-American women, who have more than twice the incidence and death rate as Caucasian women. Why is there such a disparity? A major factor is due to the lack of regular Pap testing. A Pap test is highly effective in detecting pre-cancerous abnormalities, but it is not perfect; it can miss up to 40 percent of pre-cancerous changes. If an abnormality is not detected in one test, it will likely be found on the next test, before it develops into cancer. That's why routine screening is critical.

The National Cancer Institute reports that women ages 65 and older represent more than 20 percent of all cervical cancer cases, and 41 percent of cervical cancer deaths in the United States, yet this age group has much lower screening rates than younger women. Women who have never had a Pap test, or who have not had one in several years, have a higherthan-average risk of developing cervical cancer. An estimated 80 percent of cervical cancer deaths could be prevented by regular Pap tests and patient follow-up. Often, in women who die of cervical cancer, diagnosis was not made until the disease had already spread.

The American Cancer Society recommends a yearly Pap test for women who have been sexually active or who have reached age 21. (There is no upper age limit for Pap tests.) Women who have had sexual intercourse at an early age, have multiple sexual partners, or have partners who have multiple sexual partners are at higher-than-average risk of developing cervical cancer. Other risk factors include smoking and a weakened immune system, caused by HIV and other conditions.

Several medical organizations, including the CDC and the American College of Obstetricians and Gynecologists, advocate widespread screening, regardless of sexual activity. In addition, vaccination is advised for those who are already sexually active, as it protects against virus types to which individuals may not have been exposed.