The Human Papilloma virus is responsible for almost all cervical cancers and some cancers of the vagina, vulva, penis, anus, and oropharynx. Averaging 34,800 cases per year in the United States, these cancers are not as common as colon, prostate, breast, and lung, all running almost ten-fold over HPV. It is significant to know that this cancer is both readily screened as well as commonly immunized. This provides a double opportunity for surveillance and treatment not known to any other cancer.
As a sexually transmitted disease, most cases of HPV have no symptoms. Upon contracting the infection, the body can clear many of this family of viruses within a year or two spontaneously. There are different strains of virus that may lead to precancers as well as cancer outright. Those strains of HPV include types 16, 18, 31 33, 45, 52 and 58. There are also strains 6 and 11, not leading to cancer but responsible for venereal warts. All nine viruses are responsive to the 9vHPV immunization. The most common cancers listed are oropharyngeal and cervical.
HPV vaccines are the most common way to impact cancer prevention, usually administered during early adolescence, ages 11 or 12. Unfortunately, only about half of these eligible individuals have received their vaccines. There is a process of catch-up vaccines provided to those at risk up to age 26 not previously vaccinated. Although there is controversial benefit to vaccinate those into their mid-40s, the benefit if immunization diminishes into the older age groups.
Cervical cancer is the only HPV cancer that routine screening is recommended. The age group for screening is suggested for women ages 21 to 65 in three different subgroups. Women 21-29 should be screened with Papanicolaou (Pap) smears every three years. Those 30 to 65 are recommended to have either a Pap every three years, an HPV test every five years or both a Pap and HPV every five years. The progression of persisting infection to precancers and eventually cancer is a slow, years duration process. Even if there is no evidence of early infection, the insidious process of infection dictates the need for ongoing screening later in life. For more information about HPV, contact your primary care provider.
Bradford Croft, DO
East Flagstaff Family Medicine