Human Papillomavirus and Cervical Cancer.

Cervical cancer is the second most common form of cancer among women and one of the leading causes of early death in women worldwide. Here in the United States, 14,500 cervical cancer cases are diagnosed each year and 4,800 women die as a result of the disease. Cervical cancer deaths can be prevented with early detection and later initiation of sexual activity: the earlier the diagnosis and treatment, the higher the survival rate.

Human papillomavirus (HPV) is a virus that causes warts in cattle, rabbits, horses, and deer, as well as genital warts and abscesses in humans. There are more than 70 types of HPV viruses. In studies of women who have had cervical cancer, HPV has been found and appears to be highly associated with the cancer. The types of HPV most likely to be related to cervical cancer are HPV 16, 18, 31, 33, 45, and 56.

Interestingly, HPV infection can persist for two years or longer. It is known to cause cancers of the anus, penis, vulva, and temporal mandibular joints (jaw joints), and oral and cervical cancers. It can live in the male scrotum without an open infection for at least seven years and still be passed during sexual activity.

Two factors that increase the chance of cervical cancer are early sexual activity and multiple partners. Earlier sexual activity (before age 16) significantly increases the risk of cervical cancer. This risk rapidly decreases to nearly zero if the woman waits until she is 20 years old (see Table 1) to initiate sexual activity.

Table 1 Earlier sexual activity increases the likelihood of cervical cancer.

                                                   Relative Risk
If sexual activity occurs before her first
 menstrual cycle                                     26:1
If sexual activity is delayed until after she
 is 16                                               16:1
If sexual activity is delayed until after she
 is 20                                               1:1

The anatomy of the cervix contains an area called the transformation zone, which lies between the vagina and cervix. This zone is highly susceptible to the human papillomavirus, or HPV. The transformation zone lies lower into the vagina in a young child. The body naturally protects the transformation zone as a girl changes to a woman. As a girl matures, this zone slowly ascends higher into the cervix to a more protected region. This change takes place between the ages of 12 and 21 years of age. Other studies confirm that the transformational zone is at risk at younger ages. Studies of young women who are virgins (younger than 16 years old) who marry a sexually active male (outside of the relationship) increase their chances of cervical cancer.

Multiple partners of either the woman or her spouse increase her likelihood of cervical cancer. A woman's prison study found that women who were more sexually active and who had multiple partners were highly likely to have multiple HPV viruses and HPV infections.

Husbands whose wives were undergoing surgery for cervical cancer were asked about their sexual activity. The results showed that husbands who traveled more often in their jobs had wives who were more likely to have cervical cancer.

Other occupations associated with significantly higher cervical cancer are cleaner's employees, food preparation workers, and restaurant attendants; however, the reasons for the increased risk of women with these occupations are not entirely clear.

Another factor in cervical cancer is smoking, which may increase the probability of cancer. Smoking increases the risk twofold and is highest with older smokers and two-or-more-packs-a-day smokers. Researchers have found nicotine and cotinine in the cervical mucus of smokers. Smoking, which decreases the body's immune functions (immunosuppressive effects), may enhance the persistence of HPV infection.

At one time oral contraceptives were thought to increase the likelihood of cervical cancer from 0.9 to 2.2/1,000 with two years of use. And after 10 years of use cervical cancer rose to more than four times that of nonusers. It may be that the increase in sexual activity presented a greater threat, rather than the oral contraceptive. Those women who use oral contraceptives may be more sexually active. More studies need to be done to better determine the relationship between hormones and cancer.

Even though the American Cancer Society recommends a healthy diet with all of the food groups, studies evaluating diet changes to prevent cancer are showing no association with cervical cancer.

The following are important points to remember about HPV infection:

HPV infection:

* is more likely in women under 20

* is easily obtained through sexual intercourse

* can disappear after a number of years and declines sharply with age

* is the highest between the ages of 16 to 25 years

* can occur with contact with an infected male at any age

HPV symptoms include:

* pain during intercourse

* discharge that is white and thick

* difficulty urinating

* bleeding between periods

* fatigue

* lower abdominal pain

* decrease in sexual desire

Survival rates rise with these early detection techniques:

* PAP smear annually

* physical examination

* chest X-ray

* IVP or intravenous pyelogram

* cervical biopsy

* cystoscopy

* proctosigmoidoscopy

Other screening methods include:

* microscopic

* molecular

* magnifying eyepiece

* tissue stains

* cervicography (cervical photography after staining with acetic acid)

Prevention of HPV transmission is nearly impossible! Condoms are not safe, because they are not able to cover scrotal or perineal lesions. Sites for harboring HPV are the penis and the vaginal areas.

Vaccines are being tested, but not one is reliable at this time Immunization methods are being studied and may be available in the future.

The safest way to diagnosis HPV infection early and prevent cervical cancer is a regular PAP smear!

Table 2

The earlier the detection, the better the survival rates.

* If cervical cancer is detected at stage 1, survival rate is more than 90 percent.

* At stage 4 the survival rate is about 10 percent.

Elaine W. Trei is director of rehabilitation for the Social Action Corps Health Service in San Bernardino, California.