HPV and cervical cancer across the lifespan: Gynecologic oncologist discusses recent studies

The human papillomavirus (HPV) is the most common sexually transmitted infection, but HPV can also be spread through other forms of human to human contact. Some strains don’t cause any visible symptoms, while others cause warts and a few high-risk strains of HPV are responsible for cancer of the cervix, anus, penis, head, neck and throat. 

The HPV vaccine is highly effective against the cancer-causing types of human papillomavirus, yet only half of teenagers and young adults have gotten all of the doses recommended by the Centers for Disease Control and Prevention. Additionally older women, many of whom never had the opportunity to get vaccinated before being exposed to the virus, often go unscreened for HPV-related cancers after menopause. 

Mitchell Clark, MD, gynecological oncologist at the Smilow Cancer Hospital Care Centers in Waterford and at Lawrence + Memorial (L+M) Hospital,  discusses the importance of this vaccine and what his latest research tells us about preventing cervical and other HPV-related cancers. 

Human Papillomavirus (HPV)

“Most people will be exposed to a variant of HPV in their lifetime,” said Dr. Clark who researches cervical cancer prevention. “The majority of people will clear the infection on their own. Tests to determine which subtype of HPV a person has allow us to tailor screening intervals to a person’s specific risk profile.”

Rarely, people contract a high-risk strain of HPV that the body does not clear. These strains are associated with an estimated 36,000 cases of cancer annually.

The link between cervical cancer and HPV might sound more familiar than the other forms of cancer because a landmark study announced human papillomavirus is a necessary cause of invasive cervical cancer.

How a virus causes cancer

HPV enters the body through micro tears in the skin. It then replicates and stimulates human cells to divide faster than usual. In many types of HPV this manifests as warts.

Certain high-risk HPV strains can disrupt normal cell functioning and contain proteins that inhibit the body’s tumor suppressing genes, creating a pathway for cancer.  

Screening works 

Screening, Pap smears and direct HPV testing have been effective measures to detect and treat abnormal activity before it becomes cancer. 

“Cervical cancer is not just a disease of young women,” said Dr. Clark. “However, we noticed women after 50 tend to stop regular cervical cancer screenings. We wanted to know how this drop-off could impact their survival should they develop cancer down the line.”

Dr. Clark’s study in the Journal of Lower Genital Tract Diseases looked at women over 50 who were diagnosed with cervical cancer to see if their history of cervical cancer screening played a role in their overall survival. 

Dr. Clark’s team found that women who had regular screenings had better survival rates compared to women who were not regularly screened. Additionally, unscreened women were much more likely to present with advanced cervical cancer. 

“Women often ignore their gynecological health after menopause because they aren’t aware of gynecological diseases that can occur later in life and resources often aren’t brought to their attention,” said Dr. Clark. “It is important for patients and colleagues in primary care to emphasize screening as an essential part of care for older women.” 

Preventing HPV 

Dr. Clark in collaboration with senior author, Dr. Rachel Kupets wanted to better understand how HPV vaccination rates could impact morbidity and demand on the health system. The study, which began in Toronto, was funded by Ontario Health, a government agency responsible for ensuring quality healthcare. The study demonstrated that a universal school-based HPV vaccination program was associated with decreased rates of cervical abnormalities, ones that can lead to cancer.

“For cancer, we typically don’t have a way to eliminate the risk of someone getting the disease,” said Dr. Clark. “However, cervical cancer is unique because we have a vaccine that can prevent the cervix from becoming cancerous.” 

“What is troubling here is that in 2018 rates for HPV vaccination in Connecticut were approximately 50 percent in boys and girls aged 13-17. There are other vaccines offered at the same interval that exceed 90 percent. Our goal as a healthcare community is to make sure we don’t miss opportunities to provide protection from cervical and head and neck cancers. This starts by reframing the vaccine as a cancer-prevention tool above all else.”

In the US, the recommendation is for all adolescence to get the HPV vaccine. It is most effective in younger populations (ages 11-26) before they are exposed to HPV. However, people as old as 45 are eligible and should discuss this with their clinician.