Can HPV really lead to cervical cancer?

Human papilloma virus, or HPV, affects nearly all sexually active men and women at some point in their lives. Many people “clear” or fight off their infections without ever knowing that they had an infection at all. However, a percentage of people with the virus do not clear their infections and may develop genital warts, cervical cancer, or other types of cancer.

We spoke to Dr. Terez Yonan, an adolescent medicine specialist at CHOC Children’s, to get the facts on HPV and how it can indeed lead to cervical cancer.

terez-yonan-do
Dr. Terez Yonan, an adolescent medicine specialist at CHOC Children’s.

How common is HPV?

There are nearly 80 million people currently infected with HPV in the United States, according to the Centers for Disease Control, and nearly 14 million people, including teenagers, become infected with HPV each year.

How does HPV lead to cervical cancer?

The most common way to contract HPV is through sexual contact, from a direct transmission from one person’s genitals to the other. When transmitted vaginally, the HPV cells will integrate into cells of the vaginal wall and cervix. This changes the composition of the normal, healthy cells and you end up with dysplasia, also known as abnormal and pre-cancerous cells. This can worsen and turn into cervical cancer.

For people with a normal immune system, it could take years for HPV to turn into cervical cancer, but for someone who is immune-compromised, that process could take just a few months.

HPV does not always lead to cervical cancer. There are what we call high-grade infections and low-grade infections. Low-grade infections are easily cleared by the body on its own. It takes about two years for a healthy person to clear HPV. High-grade infections can last longer in the body and put you at risk for cervical cancer or genital warts. Although not considered dangerous, genital warts are unsightly and can cause irritation depending on where they are. If not treated, warts can grow into different types of cancer, including oral and anal and penile cancer.

What are the warning signs of cervical cancer?

Most of the time, people don’t know they have HPV because there are no warning signs. In some cases, genital warts may appear. Abnormal vaginal bleeding can be a sign of cervical cancer. If you notice abnormal bleeding, consult your primary care provider, gynecologist, or adolescent medicine specialist.

Can I get tested for HPV?

A Pap smear, also called a Pap test, is a pelvic exam designed to test for cervical cancer in women. An HPV test can be done using the same sample of cells collected during a Pap smear.

When should I get my first Pap smear?

A Pap smear is intended for healthy, sexually-active people. They are generally not recommended before 21 years of age. For people who are immunocompromised, Pap smears are recommended when you become sexually active regardless of age because of the increased risk for picking up infections , and for those infections to more quickly develop into cancer.

How often should I get a Pap smear?

Someone who is immunocompromised needs two Pap smears within the first year of becoming sexually active. If those are normal, the exam can be done annually. Healthy women in their 20s need a Pap smear every three years. Beginning at age 30, Pap smears can usually be done every five years.

Who can do my Pap smear?

You can get a Pap smear from your adolescent medicine specialist, family medicine provider, internal medicine provider, or gynecologist. Nurse practitioners and physician assistants  in each of these offices can perform the exam as well.

What does an abnormal Pap smear mean?

If your results are abnormal, you will undergo more frequent Pap smears for monitoring, until your results are in the normal range. The frequency of these Pap smears will be determined by your doctor, but it could range from every three months to every year. Since many people’s bodies clear HPV on their own, when the results are clear again, you will return to an every three- or five-year schedule for Pap smears, depending on your age.

Your doctor may suggest a colposcopy, another type of cervical cancer test. This gives them a better view of your cervix. If they identify cells that may be abnormal, they will perform a biopsy and remove a tiny sample of tissue from either the inside or outside of your cervix. If the biopsy confirms the presence of abnormal cells, your doctor will discuss specific treatment options.

How can I prevent cervical cancer?

Receiving the HPV vaccine is the only way to protect against cervical cancer. Each year in the U.S., 13,200 women are diagnosed with cervical cancer. This number has decreased since the introduction of the HPV vaccine.

What happens if I get cervical cancer?

If you are diagnosed with cervical cancer, you will be referred to a gynecologic oncologist—a doctor who specializes in cancers of the female reproductive system. Most cases require chemotherapy, and some require radiation as well. Surgery may be a treatment option.

Get more facts about HPV

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Does my child need the HPV vaccine?

Human papilloma virus, or HPV, affects nearly all sexually
active men and women at some point in their lives. Many people “clear” or fight
off their infections without ever knowing that they had an infection at all. However,
a percentage of people with the virus do not clear their infections and may
develop genital warts, cervical cancer, head and neck cancers, and penile
cancers.

We spoke to Dr. Marisa Turner, a CHOC Children’s pediatrician, on the most common myths she hears from parents regarding the HPV vaccine.

dr-marisa-turner-choc-childrens-pediatrician
Dr. Marisa Turner, a CHOC Children’s pediatrician, addresses the most common myths about the HPV vaccine.

Myth 1: My child is
too young. They don’t need the vaccine yet.

Some parents decline the HPV vaccine because they think
since they have years until their child is sexually active. However, many
parents don’t realize the vaccine is more effective the earlier it is given.
The immune response to the vaccine is better when given younger, therefore only
two doses are needed if the series is started prior to the 15th birthday.

The
number of recommended doses depends on the child’s age when they receive their
first dose.
A two-dose series is given for children starting the
series before their 15th birthday. Children who start the series on
or after their 15th birthday will receive a three-dose series.

Myth 2: You can only
get HPV if you’re sexually active.

Although sexual intercourse is the most common way to get HPV, it is
not the only way to get it. It could take just one encounter to catch the
virus, and most people who carry the virus have no symptoms and don’t realize
they even have it. Even for those that are having protected intercourse, you
can still catch HPV despite using a condom.

Myth 3: Giving my
child the HPV vaccine will make them become sexually active.

Multiple studies have shown that giving this vaccine doesn’t
increase rates of sexual activity in those patients compared to those who don’t
receive it.

It’s important for adolescents to take a part in their own health
and begin to realize that decisions they make now can affect them later in life
and their future health.

Myth 4: Getting the
vaccine will guarantee my child does not contract HPV.

Most adults are likely to get HPV at some point in their
lives. Some people clear it on their own, but others do not. If your child is
vaccinated against HPV and later contracts HPV, it’s s likely to be a strain
you can clear on your own.

The HPV vaccine prevents against the nine strains of HPV
most likely to lead to cancer. About half of all new infections are in people 15-24-year-olds,
the peak age at which one should receive the HPV vaccine.

Myth 5: HPV only affects females, so my son does not need the HPV vaccine.

The HPV vaccine has benefits for males too. It prevents oral,
anal and penile cancer, and genital warts. Getting vaccinated will also help
prevent them from passing it on to other partners, which can happen even in the
absence of visible symptoms of HPV.

Myth 6: This vaccine
is new, so it must not be safe enough to give my child.

The HPV vaccine was first administered in 2006. Prior to
coming to market, it was studied for many years. Ongoing studies have tracked
patients for years after receiving the vaccine, and they have not shown any
adverse effects. The HPV vaccine is administered and studied all over the
world.

Each year in the U.S., 13,200 women are diagnosed with
cervical cancer. This number has decreased since the introduction of the HPV
vaccine.

Myth 7: My child
doesn’t need the HPV vaccine. If they contract HPV, we’ll just treat it.

There is no good treatment for HPV. Some strains clear on
their own, but others do not. It’s better to get vaccinated and lower your risk
of getting HPV in the first place.

Myth 8: Getting the
HPV vaccine will affect my child’s fertility later in life.

Receiving the HPV vaccine will not affect fertility. However, having HPV can cause changes in the cervix which can later affect fertility.

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What Vaccines Does My Teen Need?

By Nina Nosavan and Rosie Korman, pediatric residents at CHOC Children’s

Vaccines are not just important for little ones. Your preteens and teens need to be vaccinated too! It’s important for parents to be aware of vaccines updated that will benefit their adolescents.

Meningococcus (MCV)

Meningitis is a severe, life-threatening illness that begins with fever, headache, and stiff neck and can rapidly progress to coma, multi-organ failure, and death. Approximately 10-15 percent of cases are fatal, and of the survivors, 20 percent can have severe disabilities including hearing loss, brain damage, amputations, kidney damage and other complications. Almost all disease is caused by the five serotypes A, B, C, W, and Y of bacteria Neisseria meningitidis. Protection against four of the five of these serotypes is provided by the meningococcus conjugate vaccine (MCV). The meningococcus conjugate vaccine is recommended for all adolescents after age 11, with a booster given at age 16. This vaccine schedule provides critical protection against this devastating disease during the college years, when meningitis commonly occurs as outbreaks in young adults living in close quarters in dormitories.

The B serotype of meningococcus is not included in the MCV. Protection against this form of meningococcus requires a separate immunization. This vaccine can be given to any adolescent 16 to 23 years of age to provide protection from serotype B during this high-risk period. The serotype B vaccination is recommended to be given in multiple doses; there are two different brands of licensed vaccinations, each with a different dosing schedule. Ask your provider which serotype B vaccine they have available at their clinic, and which dosing schedule they recommend.

vaccinesPhoto courtesy of The National Meningitis Association.

Additionally, children 10 years or older who are at increased risk for serogroup B meningococcal infections should receive the vaccine. This group includes:

  • People exposed to a serogroup B meningococcal disease outbreak
  • People with no spleens or damaged spleens
  • People diagnosed with persistent complement component deficiency

HPV Vaccine

The HPV (human papillomavirus) vaccine protects against HPV infections and HPV-associated diseases such as cervical, vaginal, vulvar, penile, oropharyngeal, and anal cancers and genital warts.  HPV is very common; nearly all sexually active adults (both men and women) will become infected with at least one of the human papillomaviruses in their lifetime. The majority of HPV infections are asymptomatic, however, over time the human papillomavirus causes cervical and other cancers. The HPV vaccine has been shown to be incredibly effective in preventing both HPV infection and the subsequent cancers HPV causes. It is most effective if given prior to the onset of sexual activity (and thus prior to HPV infection), though is still highly effective in sexually active individuals. The vaccine is recommended for patients between 9 and 26 years of age.

  • Girls and boys who initiate the vaccine series before 15 years of age should receive 2 doses at least 6 months apart.
  • Teenagers and young adults who initiate the vaccine series after 15 years of age should receive 3 doses at 0, 1 or 2, and 6 months.

Learn more about the HPV vaccine from a pediatrician’s perspective, or ask your child’s healthcare provider for more information.

Tdap Vaccine

Infants and young children receive the DTap vaccine to protect against tetanus, diphtheria and pertussis. As they get older, the protection wears off. The Tdap vaccine is a booster that helps to protect your preteen or teen from these illnesses.

  • Tetanus (lockjaw) is caused by bacteria in the soil and enters the body through cuts in the skin. It can cause lockjaw, painful muscle cramps, breathing problems, and paralysis. Up to 1 out of 5 people who get tetanus die.
  •  Diptheria is spread through coughing and sneezing. It causes destruction of tissue in the upper respiratory system that impairs a person’s ability to breathe or swallow. It can also cause heart failure and paralysis. Up to 1 out of 10 people who get diphtheria die.
  • Pertussis (whooping cough) is spread through coughing and sneezing. It can cause infants to stop breathing or children to have uncontrollable coughing fits. It can make preteens and teens very sick.

The first Tdap vaccine should be given at age 11 or 12. If your teen is 13 to 18 years old and has not received the vaccine, talk to you doctor right away. This vaccine is also recommended for pregnant women during every pregnancy, and for everyone that lives in the same household as a newborn baby. A variant of this vaccine, Td, is recommended every 10 years for adults.

Catch-up Immunizations

Is your adolescent up-to-date on all their immunizations? Did you know that if your adolescent missed some of his immunizations as a child, it is not too late to immunize? Vaccinations for many common illnesses, including polio, hepatitis A, hepatitis B, varicella (chickenpox), measles, mumps and rubella, all can be caught-up during the adolescent years. Be sure to ask your physician if your child has received all the necessary immunizations, and whether any catch-up immunizations are necessary.

PPSV23 Vaccine

Pneumococcal disease causes infections of the blood, infections of the lining of the brain and spinal cord, ear infections, and pneumonia. Infants and young children should receive the pneumococcal conjugate vaccine (PCV13) to protect against these infections.

The pneumococcal polysaccharide vaccine (PPSV23) protects against 23 types of pneumococcal bacteria and is recommended for children older than 2 years of age with certain medical conditions such as sickle cell disease, HIV infection, chronic heart or lung conditions, or cochlear implants. Teenagers and young adults who have asthma or who smoke cigarettes should also receive this vaccine.

Download your immunization guide

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The HPV Vaccine: A Doctor’s Perspective

By Dr. Shruti Vora, pediatric resident at CHOC Children’s

What is HPV?

Human papilloma virus affects nearly all sexually active men and women at some point in their lives according to the Centers for Disease Control and Prevention (CDC). Many people “clear” or fight off their infections within one to two years, never knowing that they ever had an infection at all. A percentage of people with the virus do not clear their infections and may develop genital warts, cervical cancer, head and neck cancers, and penile cancers.

What is the vaccine made of?

Scientists use a “virus-like particle” to make the HPV vaccine. It cannot cause HPV because it is not a portion of the actual virus. The serotypes (specific strains) responsible for the majority of cancers are HPV 16 and 18.  Ninety percent of genital warts are caused by HPV 6 and 11. All four serotypes are contained in the quadrivalent (four type) Gardasil vaccine. Gardasil 9, which covers nine additional strains, will soon be replacing the quadrivalent Gardasil, offering even better protection.

If HPV is transmitted sexually, and my child is not having sex, why do they need to get the vaccine?

The HPV vaccine is a preventative vaccine. Studies have shown that in patients who never had HPV, the effectiveness of preventing pre-cancerous changes to the cervix was 97-100 percent . This is why the vaccine is recommended in all girls before they begin to be sexually active. The vaccine is also known to be more effective when given at a younger age. It is recommended in girls 9-26 years of age.

My son is not at risk for cervical cancer, why should he get the vaccine?

The vaccine is recommended in all boys ages 9-21 years due to the fact that many head and neck, penile and anal cancers are directly linked to HPV serotypes 16 and 18. Vaccinating males can also help prevent cervical cancer in their female partners by reducing the rate of transmission.

I am concerned that my child will become sexually active at an earlier age because they received the HPV vaccine.

This is a common concern and actually has been studied multiple times. In the journal Pediatrics in 2012, doctors looked at the medical records of 493 girls who received the HPV vaccine and 905 who did not. There was no difference between the number of pregnancies, rates of sexually transmitted disease testing, or discussions regarding birth control between the two groups.

How do we know that giving the vaccine will not have any side effects?

The most common side effect has been pain and redness at the site of the shot. Fainting has also been reported as the second most common side effect, but the CDC has recommended some years ago for all patients to stay seated or lying flat for 15 minutes after the injection is given. This has greatly reduced the number of fainting spells and subsequent falls.

The HPV vaccine is a rare opportunity for you to make an investment in your child’s future and potentially prevent cancer in our young ones.  Ask your pediatrician about it.

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