HPV and Cervical Cancer Essay

HPV & Cervical Cancer – What Every Woman Should Know

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     I was eighteen years old when I had my first abnormal pap smear. I received a call from my OB/GYN’s office and was informed that I had the Human Papilloma Virus show up on my pap smear. This was the first pap smear I had ever had, and I was terrified. The news got worse. I researched this virus and learned that it was actually a sexually transmitted disease that could either cause cervical cancer, or genital warts! I didn’t understand, I had been with my boyfriend for five years and he was my first partner. How could I have contracted a sexually transmitted disease?HPV and Cervical Cancer Essay

Cervical cancer is the type of cancer that forms in the cervix tissue in women. The cervix is the organ which connects the uterus and the vagina. There are multiple causes for cervical cancer. These causes include: HPV, smoking, immunosuppression, chlamydial infection, diet, oral contraceptives, intrauterine device use, multiple full term pregnancies, young at a first full term pregnancy, poverty, diethylstilbestrol, and a family history of cervical cancer. The most important risk factor for cervical cancer is the Human Papillomavirus, also known as, HPV. HPV is a virus spread through skin-to-skin contact. It is normally sexually transmitted and usually goes away on its own but can sometimes become cancerous. It is such a major…show more content…
There are two main types of cervical cancers. They are termed squamous cell carcinoma and adenocarcinoma. Approximately eighty to ninety percent of cervical cancers are squamous cell carcinomas. This means they grow in the squamous cells that cover the surface of the outer part of the cervix. Squamous cell carcinomas usually start where the outer part of the cervix(exocervix) meets the inner part of the cervix(endocervix). Almost all other cervical cancers are adenocarcinomas. These cancers have become more frequent in the past twenty to thirty years. They develop from the mucus-producing gland cells located in the endocervix. There are also some rare types of cervical cancers that contain traits from both squamous cell carcinomas and adenocarcinomas. These types are labeled adenosquamous carcinomas which means mixed carcinomas. Even though almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer such as melanoma, sarcoma and lymphoma can also occur in the cervix. It is true that pre-cancerous changes cause cervical cancer, but only some women with pre-cancer cervix skills will develop cancer. The pre-cancer to cancer progression usually takes about several years, but can sometimes occur in less than one year. Pre- cancerous cells normally go away without treatment but some become invasive cancers. HPV and Cervical Cancer Essay

Risk factors you can possibly change
Human papillomavirus (HPV) infection
Infection by the human papillomavirus1
(HPV) is the most important risk factor for
cervical cancer. HPV is a group of more than 150 related viruses. Some of them cause
a type of growth called papillomas, which are more commonly known as warts.
HPV can infect cells on the surface of the skin, and those lining the genitals, anus,
mouth and throat, but not the blood or internal organs such as the heart or lungs.

HPV can spread from one person to another during skin-to-skin contact. One way
HPV spreads is through sexual activity, including vaginal, anal, and even oral sex.HPV and Cervical Cancer Essay

Different types of HPV cause warts on different parts of the body. Some cause
common warts on the hands and feet; others tend to cause warts on the lips or

Certain types of HPV may cause warts on or around the female and male genital organs
and in the anal area. These are called low-risk types of HPV because they are seldom
linked to cancer.
Other types of HPV are called high-risk types because they are strongly linked to
cancers, including cancer of the cervix, vulva2
, and vagina3
in women, penile cancer4
men, and cancers of the anus5
, mouth, and throat6
in both men and women.
Infection with HPV is common, and in most people the body can clear the infection by
itself. Sometimes, however, the infection does not go away and becomes chronic.
Chronic infection, especially when it is caused by certain high-risk HPV types, can
eventually cause certain cancers, such as cervical cancer.
American Cancer Society cancer.org | 1.800.227.2345  HPV and Cervical Cancer Essay
Although there is currently no cure for HPV infection, there are ways to treat the warts
and abnormal cell growth that HPV causes. Also, HPV vaccines7
are available to help
prevent infection by certain types of HPV and some of the cancers linked to those types.
For more information on this topic, see HPV8
Sexual history
Several factors related to your sexual history can increase the risk of cervical cancer.
The risk is most likely affected by increasing the chances of exposure to HPV.
● Becoming sexually active at a young age (especially younger than 18 years old)
● Having many sexual partners
Having one partner who is considered high risk (someone with HPV infection or
who has many sexual partners)

When someone smokes, they and those around them are exposed to many cancercausing chemicals that affect organs other than the lungs. These harmful substances
are absorbed through the lungs and carried in the bloodstream throughout the body.
Women who smoke are about twice as likely as non-smokers to get cervical cancer.
Tobacco by-products have been found in the cervical mucus of women who smoke.
Researchers believe that these substances damage the DNA of cervix cells and may
contribute to the development of cervical cancer. Smoking also makes the immune
system less effective in fighting HPV infections.
Having a weakened immune system
Human immunodeficiency virus (HIV)9
, the virus that causes AIDS, weakens the
immune system and puts people at higher risk for HPV infections.
The immune system is important in destroying cancer cells and slowing their growth and
spread. In women with HIV, a cervical pre-cancer might develop into an invasive cancer
faster than it normally would.HPV and Cervical Cancer Essay
Another group of women at risk for cervical cancer are those taking drugs to suppress
their immune response, such as those being treated for an autoimmune disease (in
which the immune system sees the body’s own tissues as foreign and attacks them, as
American Cancer Society cancer.org | 1.800.227.2345 ____________________________________________________________________________________
it would a germ) or those who have had an organ transplant.
Chlamydia infection
Chlamydia is a relatively common kind of bacteria that can infect the reproductive
system. It is spread by sexual contact. Women who are infected with chlamydia often
have no symptoms and they may not know that they are infected at all unless they are
tested during a pelvic exam. Chlamydia infection can cause pelvic inflammation, leading
to infertility.
Some studies have seen a higher risk of cervical cancer in women whose blood tests
and cervical mucus showed evidence of past or current chlamydia infection. Certain
studies show that the Chlamydia bacteria may help HPV grow and live on in the cervix
which may increase the risk of cervical cancer.
Long-term use of oral contraceptives (birth control pills)
There is evidence that taking oral contraceptives (OCs) for a long time increases the
risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up
the longer a woman takes OCs, but the risk goes back down again after the OCs are
stopped, and returns to normal many years after stopping.
A woman and her doctor should discuss whether the benefits of using OCs outweigh
the potential risks.
Having multiple full-term pregnancies
Women who have had 3 or more full-term pregnancies have an increased risk of
developing cervical cancer. It is thought this is probably due to the increased exposure
to HPV infection with sexual activity. Also, studies have pointed to hormonal changes
during pregnancy as possibly making women more susceptible to HPV infection or
cancer growth. Another thought is that pregnant women might have weaker immune
systems, allowing for HPV infection and cancer growth.
Young age at first full-term pregnancy
Women who were younger than 20 years when they had their first full-term pregnancy
are more likely to get cervical cancer later in life than women who waited to get
pregnant until they were 25 years or older.
Economic status
American Cancer Society cancer.org | 1.800.227.2345 ____________________________________________________________________________________
Many low-income women do not have easy access to adequate health care services,
including cervical cancer screening with Pap tests and HPV tests. This means they may
not get screened or treated for cervical pre-cancers.HPV and Cervical Cancer Essay
A diet low in fruits and vegetables
Women whose diets don’t include enough fruits and vegetables may be at increased
risk for cervical cancer.
Risk factors that cannot be changed
Diethylstilbestrol (DES)
DES is a hormonal drug that was given to some women between 1938 and 1971 to
prevent miscarriage. Women whose mothers took DES (when pregnant with them)
develop clear-cell adenocarcinoma of the vagina or cervix more often than would
normally be expected. These types of cancer are extremely rare in women who haven’t
been exposed to DES. There is about 1 case of vaginal or cervical clear-cell
adenocarcinoma in every 1,000 women whose mothers took DES during pregnancy.
This means that about 99.9% of “DES daughters” do not develop these cancers.
DES-related clear cell adenocarcinoma is more common in the vagina than the cervix.
The risk appears to be greatest in women whose mothers took the drug during their first
16 weeks of pregnancy. The average age of women diagnosed with DES-related clearcell adenocarcinoma is 19 years. Since the use of DES during pregnancy was stopped
by the FDA in 1971, even the youngest DES daughters are older than 40 past the age
of highest risk. Still, there is no age cut-off when these women are felt to be safe from
DES-related cancer. Doctors do not know exactly how long these women will remain at
DES daughters may also be at increased risk of developing squamous cell cancers and
pre-cancers of the cervix linked to HPV.
You can learn more in DES Exposure: Questions and Answers10. Read it on our
website, or call (1-800-227-2345) to have a free copy sent to you.
Having a family history of cervical cancer
Cervical cancer may run in some families. If your mother or sister had cervical cancer,
your chances of developing the disease are higher than if no one in the family had it.HPV and Cervical Cancer Essay
American Cancer Society cancer.org | 1.800.227.2345 ____________________________________________________________________________________
Some researchers suspect that some rare instances of this familial tendency are
caused by an inherited condition that makes some women less able to fight off HPV
infection than others. In other instances, women in the same family as a patient already
diagnosed could be more likely to have one or more of the other non-genetic risk factors
previously described in this section.
Factors that may lower your risk
Intrauterine device ( IUD) use
Some research suggests that women who had ever used an intrauterine device (IUD)
had a lower risk of cervical cancer. The effect on risk was seen even in women who had
an IUD for less than a year, and the protective effect remained after the IUDs were
IUDs do have some risks. A woman interested in using an IUD should first discuss the
possible risks and benefits with her doctor. Also, a woman with multiple sexual partners
should use condoms to lower her risk of sexually transmitted illnesses no matter what
other form of contraception she uses.HPV and Cervical Cancer Essay

Human Papillomavirus (HPV) poses a serious health threat to women. It has been shown to have a direct link to cervical cancer and other cancers of the reproductive and urinary tract (CDC, 2014). Most of the time, the immune system fights off the disease. It is a concern when the immune system is unable to fight it off completely and the virus remains in their system. If a person has HPV for two years or more they have an increased chance of developing these types of cancers (CDC, 2014).

Many people who have HPV develop no symptoms. It can cause genital warts or warts in the throat. There are several different species of HPV, only one type produces genital warts. The type of HPV that produces genital warts is not the same as the type that produces cancer. Cervical cancer typically does not have symptoms until it is advanced into the later stages (CDC, 2014). Every detection is the hallmark of successful treatment of cervical cancer.HPV and Cervical Cancer Essay

There is no known treatment for HPV once someone has contracted it. However there are several ways that people can lower their risk of getting HPV. One of them is through an HPV vaccine that that can protect both males and females. The vaccine is given three times over six month period (CDC, 2014). Gardasil and Cevarix are recommended for girls between the ages of 11 and 12 years old in girls. In boys and men Gardasil is recommended between the ages of 11 and 12 (CDC, 2014). Condoms may help to reduce the risk of HPV, but they are not entirely effective. The virus can still infect areas that are not covered by the condom (CDC, 2014).


According to the Kaiser Family Foundation (2014), the effectiveness of the vaccine is high in the prevention of HPV and the cancers associated with it. In the beginning, the vaccine was recommended for girls between the ages of 11 and 12, but this recommendation has not been extended to boys of the same age. This recommendation is for two reasons. The first is that giving the vaccine at that age is more likely to occur before girls begin sexual activity. The second is that the vaccine tends to initiate a higher immune response at that age (Kaiser Family Foundation, 2014).HPV and Cervical Cancer Essay

Awareness of the vaccine has grown, but adoption of the vaccine has been slow. Only about one third of the girls eligible for it received the vaccine in 2013 (Kaiser Family Foundation, 2014). Twenty one states require the HPV vaccine in order to enter school. Some states provide funding to cover the vaccine, while others produce educational literature on HPV and the vaccine. These approaches have only been marginally effective in increasing use of the HPV vaccine. It was found that one of the contributing factors in the low adoption rate is that physicians are not recommending the vaccine to their patients (Kaiser Family Foundation, 2014).

Nearly 29 states have no laws or legislation pertaining to HPV and the vaccination program. The most common reasons for not receiving the vaccine was a lack of personal funds and a lack of knowledge about the vaccine. Every year, nearly 10,000 women are diagnosed with cervical cancer and 3,700 women die (NCSL, 2009). The vaccine is nearly 90% effective in preventing these cancers, yet many young women are not receiving it (NCSl, 20096). This is the issue that will be addressed in his letter.HPV and Cervical Cancer Essay

Most of us will be infected with human papillomavirus at some point in our lives. There are more than 100 different types of the virus, most of which cause no symptoms and go away by themselves without treatment. Other types cause harmless growths such as verrucas and warts.

But the virus also has a more sinister side. It causes nearly all cases of cervical cancer, and HPV infections also increase the risk of developing cancers of the genitals, anus, mouth and throat.

Together, these add up to more than 5,000 new cases of cancer every year in the UK.

Yet there’s an important question: if most people get infected with HPV at some point, why do just a few of them develop cancer?

And how exactly can a viral infection cause the disease?HPV and Cervical Cancer Essay

To answer this, we need to go on a journey back in time to see how scientists first discovered this link. Along the way we’ll find out how research has made a huge impact in reducing the number of women losing their lives to cervical cancer, and see what the future holds for preventing and treating HPV-linked cancers.

Tales from the boudoir
The potential link between a viral infection and cervical cancer was first noticed in the 50s and 60s by scientists searching for clues to things that might trigger cervical cancer. To do this, they compared the lifestyles of women with cervical cancer to those without the disease.

They came up with a surprising observation: cervical cancer seemed to be more common among women who started having sex at a younger age or who had multiple sexual partners.

This seemed odd. Cancer itself isn’t contagious, but the pattern the scientists observed was similar to that of a sexually transmitted infection.

This piqued the interest of German virologist Harold zur Hausen, who’d worked on a cancer-causing virus called EBV. Zur Hausen had read reports from doctors about women with genital warts also developing cervical cancer, and had also heard about the work of US researcher Richard Shope from the 1930s, showing that infection with a type of papillomavirus could cause warts and cancers in rabbits. He figured that a similar virus might be responsible for human cancers, and set out to find it.HPV and Cervical Cancer Essay

The human papillomavirus
The human papillomavirus

Zur Hausen began his quest by looking for viruses in human genital warts, leading to the discovery of a new type of papillomavirus, which he called HPV-6 (versions one to five had already been discovered). Much to his disappointment, his team couldn’t find HPV-6 in any cervical cancer samples, but it did lead him to a closely related papillomavirus, ultimately named HPV-11. In 1983 zur Hausen published evidence that HPV-11 was present in three out of 24 cervical cancer samples he tested.

And now he and his team were on a roll. It became apparent that there were many different types of HPV. They continued their search and discovered HPV-16, which was detected in about half of cervical cancers, then HPV-18, present in around one in five cervical cancer samples.HPV and Cervical Cancer Essay

It was becoming clear that infection with these two types was closely linked to cervical cancer – a discovery that eventually won zur Hausen a Nobel Prize.

Over the next decade more evidence began to pour in, linking more types of the virus to cervical cancer. To join all the dots together, in 1995 the International Biological Study on Cervical Cancer group was set up to look at the bigger picture. Using samples from 22 countries, they found HPV in more than nine out of every ten cervical cancer samples (93 per cent), and this figure was consistent across the globe.

But even this turned out to be an underestimate. In 1999, a group of scientists, including Cancer Research UK scientist Professor Julian Peto, diligently re-tested the samples and found that virtually all cervical cancer samples (99.7 per cent) contained the virus. They showed HPV infection is the trigger for cervical cancer – this was, and remains to this day, the strongest link between a single ’cause’ and a specific cancer.HPV and Cervical Cancer Essay

Researchers have now identified more than a hundred different types of HPV. Luckily, only around a dozen – known as ‘high risk’ types – are linked to cancer,

But even among women infected with high risk HPV, it’s unlikely they will develop cancer – most will not. Instead, they’ll either carry it without noticing any symptoms, or their immune system will get rid of the virus.

But for some women, a persistent, long-lasting HPV infection causes problems. During this period HPV makes proteins that target cervical cells’ machinery to allow the virus to reproduce. This can lead to the cells growing out of control and gradually picking up more genetic faults along the way, eventually developing into a cancer.

And this delay between becoming infected with HPV and developing cancer offered a promising opportunity. Could doctors spot women with early changes that could lead to cervical cancer during this period, and pre-emptively strike to get rid of the danger?HPV and Cervical Cancer Essay

An ounce of prevention is worth a pound of cure
The answer is yes, thanks to Dr Georgios Papanicolaou’s discovery that these early changes could be spotted by collecting cells from the cervix, smearing them on a glass slide then examining them under a microscope, to see whether any of the cells look unusual or abnormal.

Smear tests can spot abnormal cells
Smear tests can spot abnormal cells

Doctors started offering this simple test, also known as the smear test (Pap test in the US) to women in the UK during routine appointments in the 1960s. But offering the test to people already going to their doctor meant women at greatest risk from cervical cancer were often missed out, and there were no follow up procedures to ensure women were screened regularly or called back if there were concerns.

To overcome these issues, in 1988 the UK government decided to make the cervical screening test a national screening programme, something our researchers played a big role in. It meant organising the programme centrally, systematically inviting women for screening every few years, and contacting them if further tests are needed.HPV and Cervical Cancer Essay

The organised programme has played a huge role in substantially reducing rates of cervical cancer over the last 30 years and our researchers have provided the proof of just how effective it is: calculating the number of lives saved (around 5,000 every year) and the proportion of cancers prevented (about three-quarters).

But even when cells in the cervix show up as abnormal, it doesn’t necessarily mean they’ll lead to cancer – sometimes, abnormal cells can disappear of their own accord and don’t need treating. So researchers wondered whether there was a way to predict which abnormal cells were at higher risk of developing into cancer, and which were more likely to vanish.

Again, our researchers were involved. Professors Jack Cuzick and Anne Szarewski discovered they could re-test some abnormal cervical samples for the HPV virus to help answer this question. Women with borderline or mildly abnormal cells in their cervix who are also infected with high risk HPV types are at higher risk of cancer, and should be referred for further testing and possible treatment, while women not infected are less likely to develop cancer, so can safely go back to having normal screening every 3 years. This ‘HPV triage’ is now a routine part of cervical screening.HPV and Cervical Cancer Essay

So can the programme be improved further? The next big step is to swap around the order of the tests, so cells collected from women are tested for HPV first, and then examined under a microscope as a follow up. This seemingly small change could have a large impact: research has shown that it could save even more lives than the current test. And it would also mean that women would only need screening every five or six years (instead of three years as in the current programme). This approach is being piloted at the moment, and we’re campaigning to make this a reality for the future.

But while the national screening programme has dramatically reduced the number of women with cervical cancer in the UK, the bigger picture tells us there’s still a lot more to be done.HPV and Cervical Cancer Essay

Worldwide, cervical cancer is the fourth most common cancer in women, and disproportionally affects lower and middle income countries – around 85 per cent of women diagnosed live in regions such as Africa and Latin America where there is little (if any) cervical screening available and poor access to healthcare in general.

HPV is also linked to cancers of the mouth and throat, anus, vagina, vulva and penis. Despite the fact that only a small percentage of people infected with HPV go on to develop cancer, because the virus is so widespread it still accounts for a large number of cancer cases, causing around five in every 100 cases of cancer globally.HPV and Cervical Cancer Essay

But because these cancers are caused by a virus, this brings hope for prevention – through vaccination.

Protecting the next generation
The HPV vaccine had unusual, and agricultural, beginnings. In the 1950s, vets were looking for a vaccine for cattle to protect them from bovine papilloma virus, which can cause tumours in cows.

This research turned out to be relevant to human disease too – our researchers in the Beatson Institute in Glasgow proved that a vaccine containing a molecule very similar to one made by HPV-16 (the commonest cancer causing type) protected calves from infection, providing a robust rationale for developing a human version.HPV and Cervical Cancer Essay

HPV vaccines are now being rolled out across the world

The two scientists widely credited with developing the HPV vaccine are Professor Ian Frazer and Dr Jian Zhou (although there is some dispute over this). The pair came up with the basis of the vaccine in Queensland, Australia, but they met and began their studies on an HPV vaccine in Cambridge while they were working in Professor Lionel Crawford’s lab – Crawford was a Cancer Research UK scientist and an expert on cancer and virology (most famous for his partnership with Professor David Lane and their discovery of p53, the “guardian of the genome”).

Companies bought the rights to produce vaccines commercially and, after trials proved they were effective in preventing the disease. In 2008 the HPV vaccination programme was rolled out across the UK in schools. Now, all girls aged 12-13 are offered a vaccine to protect them against the types of HPV that cause most cases of cervical cancer.HPV and Cervical Cancer Essay

HPV vaccines are now being rolled out across the world. Although it’s too early to show that vaccination has cut cancer rates, promising early results from Scotland, Australia and Denmark show that fewer vaccinated women have abnormal cervical cells (which can turn into cancer) detected during cervical screening compared to unvaccinated women.

Not the end of the story
So vaccination could significantly reduce the number of HPV-related cancers in the future. But not everyone receives the vaccine, so there are still plenty of people who aren’t protected. Furthermore, the vaccine doesn’t offer protection against all the types of HPV that cause cancer. So we urgently need to carry on work to make sure treatments for people who develop HPV-linked cancers are the best they can be.

In fact, it’s possible that vaccines – but not the ones we use at the moment to prevent infection – could help treat people with HPV-linked cancer. A vaccine could help boost an immune response against cancer by targeting molecules made by the virus – similar to an approach being tested for cancers linked to another virus, EBV. We’re supporting researchers in Southampton to work out which HPV molecules are the most potent activators of the immune system – these could form the basis of future treatments.HPV and Cervical Cancer Essay

Another observation that could lead to new treatments is the fact that patients with mouth and throat cancers caused by HPV tend to respond better to therapy than those with similar cancers which aren’t caused by the virus. The increasing numbers of people being diagnosed with mouth and throat cancers raises two questions – firstly, is there a way of testing people for oral HPV infection? And, because people with HPV-linked oral cancer respond well to treatment, could they receive less intensive therapy to spare them some of the side effects, while still keeping the treatment as effective as possible? Trials are underway at the moment to test whether this could be an option.

We’ve come a long way since HPV and its links to cancer were discovered. Thanks to the NHS Screening Programme, thousands fewer women in the UK every year are losing their lives to cervical cancer – something that urgently needs to be addressed in lower and middle income countries. And the introduction of the vaccine will save many more lives in future, protecting people against many types of cancer.HPV and Cervical Cancer Essay

All of these life-saving advances were brought about by years of dedicated work around the world.

And although there’s still a lot to be done before we can say we’ve truly beaten HPV-linked cancers, there’s no doubting how far we’ve come. HPV and Cervical Cancer Essay

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