It is responsible for virtually all cervical cancers in women (99%) and for some cancers of the anus, vulva, vagina, penis and throat. We are talking about the human papillomavirus, or Hpv, with which almost everyone comes into contact (90% of the population) in the course of life, through sexual intercourse. There are over 100 strains, but only 12 can cause cancer if the infection persists: usually, the lesion appears more than 10 years after infection.
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Hpv and cervical cancer
When we talk about Hpv we are talking above all about cancer of the cervix (or cervix) and there is a reason. It ranks fourth among the most common cancers in women, and according to the report “Global Cancer Statistics 2020 represents 6.5% of all cancers diagnosed in women in the world. In our country this pathology represents 1.3% of all cancers affecting women, with 2,400 new cases registered every year and about 500 deaths. But across the Western world, the number of cervical cancer cases and deaths are steadily declining, thanks to the spread of screening for early detection and vaccination to prevent infection. Thanks to this combined action, in Italy in recent years – before the pandemic, it should be emphasized – the incidence of cervical cancer has decreased by almost 25%.
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What is cervical cancer screening?
With us, cervical cancer screening is offered free of charge to women in different ways depending on the region (in some cases you receive an invitation to participate with the appointment already set, in others you have to book it independently, you can inform your family doctor). The Pap-test is offered free of charge in Italy every 3 years to women between 25 and 30 years old, while the HPV-Dna-Test is performed every 5 years at 30-64 years old. The Italian health system, through the regions, is completing the transition towards the screening model based on the HPV-Test, which is becoming the first level diagnostic test for cervical cancer (on the website of the Ministry of Health it is possible to find all information; it is possible that not all regions have adapted to the new screening based on Hpv-Dna Test).
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What is the difference between a Pap test and an HPV DNA test?
The Pap-Test identifies in the cervix the cells possibly modified by the presence of the HPV virus, it is therefore a cytological test. The HPV-DNA-test (or HPV-test) is instead a molecular test and does not detect the presence of cells altered by the virus, but directly the viral DNA. It is therefore a very sensitive examination. The HPV-test must be carried out no earlier than 30 years of age and must be repeated at intervals of not less than 5 years. From 25 to 30 years the reference exam remains the Pap-Test to be performed every three years. This choice is due to the fact that when you are young the probability of having an HPV infection is very high, but very rarely takes on clinical importance, i.e. it leads to a tumor or another pathology.
What happens if I am positive for the HPV test?
An HPV-positive woman will have to undergo a Pap test which, therefore, becomes a completion test (also called a triage test). If the Pap test does not detect alterations, just repeat the HPV test after one year. Instead, in cases where microscopic analysis shows the presence of cells with pre-tumor or tumor characteristics, the screening protocol provides for further in-depth examinations: colposcopy and biopsy.
What is colposcopy and what is it for?
Colposcopy allows the specialist to see the uterine cervix, which is the anatomical part that separates the vaginal canal from the uterus, enlarged. In this way, the doctor can confirm the presence of pre-tumor or tumor lesions and evaluate their extent. The colposcopy can also be followed by a biopsy, that is the removal of a small portion of abnormal tissue, which is subjected to an analysis that definitively confirms the exact characteristics of the tumor. Adhering to screening programs, respecting the correct intervals, greatly increases the chances of detecting the disease at a very early stage of development. Which often allows the case to be resolved with surgery.
What does HPV have to do with genital warts?
Only 12 HPV strains are oncogenes. The others remain silent or give rise to genital warts (condylomas), that is, benign skin tumors, which are lesions that can be removed surgically or with cryotherapy techniques.
Is a condom useful for avoiding HPV?
HPV is almost exclusively transmitted sexually, so the use of a condom is very helpful in avoiding this type of cancer. However, it should be remembered that the condom is not 100% effective, since the papillomavirus can also be transmitted through contact with areas of the skin or mucous membranes that are not covered by the condom. Since we are talking about a sexually transmitted infection, an early onset of sexual activity and multiple partners – in the absence of protection and / or vaccination – increase the risk of getting sick.
Even if you have a permanent partner, do you get the infection?
Over 80% of sexually active women contract HPV in their lifetime, but men are also exposed to the infection. There is also a risk for women in a stable relationship: in fact, HPV can remain latent for a long time and manifest itself clinically after many years from the moment of contact. So finding out you have an infection means that at some point in your life you have contracted the virus, and not that your partner has had relationships with other people.
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Who can get vaccinated against HPV?
In our country, HPV vaccination is recommended for girls and boys during their 12th year of life, that is, before they become sexually active, and in this age group it is offered free of charge throughout the country. In some regions the offer is free even for those over 12 years old.
Does the vaccine only protect against cervical cancer?
Vaccination against papillomavirus is very useful because it protects against the virus responsible for cervical cancer, but not only: other types of cancer caused by the “bad” strains of this virus can also be avoided by vaccinating, for example tumors of the cord oral, and anus. The vaccine can prevent about 90% of HPV-induced malignancies.
Why do men also benefit from the vaccine?
Males also benefit from anti-HPV, because they are protected from anogenital warts and some infection-related cancers, such as that of the penis, anus and base of the tongue. Furthermore, vaccinating both boys and girls restricts the circulation of the virus for everyone. According to the WHO, which has supported HPV vaccination since the beginning, 5% of all cancer cases in the world are associated with HPV infection, 3% are women, 2% of men.
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Do vaccinated women also have to continue screening?
Yes. As reported by the Italian Cervicocarcinoma Screening Group, “it is important that vaccinated women are informed that they too will have to participate in screening when they are invited because the vaccine currently available does not protect against all 12 types of viruses that cause lesions. pre-invasive and invasive of the uterus, but only towards two oncogenic types ”. These two strains are responsible for the majority of cases, but in each case there remains a percentage of risk.
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