HPV disease including cancer
What is HPV?
HPV stands for human papillomavirus, which is a group of more than 100 viruses. Most people will get a HPV infection during their lifetime, usually from sexual activity. Most of these infections do not need treatment, but they can cause genital warts. In some people, however, HPV infection causes changes in the cervix that can develop into cervical cancer. HPV infection causes almost all cervical cancers. It is now known that HPV infection can also cause cancers of the vagina and vulva, cancers of the penis and cancers of the throat (oropharynx) and back passage (rectum) in both men and women. Cancers of the throat caused by HPV are much commoner in men than women. The number of throat cancers caused by HPV is increasing.
HPV infection is most common in people in their late teens and early 20s.
HPV infection rates are now known to be rising rapidly among women and men in high income countries like Ireland.
How is HPV transmitted?
You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms.
Anyone who is sexually active can get HPV, even if you have had sex with only one person. You also can develop symptoms years after you have sex with someone who is infected. This makes it hard to know when you first became infected.
Always use condoms the right way every time you have sex. This can lower your chances of getting HPV. HPV can infect areas not covered by a condom – so condoms may not fully protect against getting HPV.
Transmission from mother to baby can also occur immediately before or after birth.
Cancers caused by HPV in Ireland
HPV infection may cause cancers
- cancers of the cervix, vagina, and vulva in women;
- cancers of the penis in men; and
- cancers of the back passage (anus) and of the throat (oropharyngeal) in both women and men.
In Ireland, an average of 406 cancers caused by HPV infection are diagnosed annually. Cervical cancer is the most frequent cancer caused by HPV. Each year about 300 women are diagnosed with cervical cancer and 86 women die because of this cancer
Each year 57 people are diagnosed with throat (oropharyngeal) cancer caused by HPV. Throat cancer caused by HPV is much commoner in men than in women. Each year 25 people die secondary to oropharyngeal cancer in Ireland.
Each year 28 people are diagnosed with cancer of the back passage (anus/rectum) caused by HPV and 6 people die.
Cancer of the penis caused by HPV is diagnosed in 10 men each year and three die because of this cancer.
What is cervical cancer?
Cervical cancer is a cancer of a woman's cervix, the entrance to the womb.
How common is cervical cancer?
Every year in Ireland about 300 women get cervical cancer and 90 women die from it. Cervical cancer is the second most common cause of death due to cancer in women aged 25 to 39 years. Worldwide cervical cancer is the fourth most common cancer in women with over 500,000 new cases and over 250,000 deaths in 2012. The HPV vaccine protects women from 7 out of 10 cervical cancers which are caused by HPV. Therefore most cervical cancers can be prevented by the vaccine.
How does HPV infection cause cervical cancer?
HPVs associated with cancer are called oncogenic or 'high risk' types. HPVs that do not cause cancer are termed 'low risk' types.
Two types (16 and 18) cause 7 out of 10 cervical cancers. These are the HPV types that the Gardasil 4 vaccine protects against.
Seven types (16 and 18, 31, 33, 45, 52, and 58) cause 9 out of 10 cervical cancers. These are the HPV types that the new Gardasil 9 vaccine protects against.
HPV can infect the cells on the surface of the cervix and damage them, causing their appearance to change and lead to abnormalities in these cells over a number of years. These abnormalities are known as Cervical Intraepithelial Neoplasia (CIN). These changes are classified according to their severity. A mild change is known as CIN 1 and a severe change is called CIN 2 or 3.
In some cases these more severe changes can develop into cervical cancer. The progression of mild and severe changes to cancer takes many years so these abnormalities are known as pre-cancerous. These changes are diagnosed when women attend for their regular smear tests with CervicalCheck, the national cervical screening programme.
Every year over 6,500 women are diagnosed with CIN and need hospital treatment to prevent cervical cancer caused by the HPV virus. This treatment can lead to infertility problems, miscarriage and premature delivery.
Can cervical cancer be prevented?
Ireland has had a cervical cancer screening programme since 2008.
However even in countries with well-established screening programmes many young women still die from cervical cancer.
Cervical screening looks for pre-cancer changes of the cervix before they become cancer. The HPV vaccine prevents these precancer changes to the cervix. The HPV vaccine will greatly reduce the number of women dying from cancer and also the need for hospital treatment of cervical precancers (CIN).
HPV4 vaccine protects against HPV types 16 and 18 which cause 7 out of 10 cervical cancers.
HPV9 vaccine protects against HPV types 16, 18, 31, 33, 45, 52, and 58 which cause 9 out of 10 cervical cancers.
It is still very important for girls to have regular smear tests when they are adults to detect cancers caused by HPV types not in the vaccine.
Where can I find out more about the National Cervical Screening Programme?
More information on the cervical screening programme is available at: http://www.cervicalcheck.ie/ The HPV vaccine will protect girls from developing cervical cancer when they are adults and is available free of charge from the HSE.
Cancers of throat (oropharyngeal), back passage (anus/rectum) and penis caused by HPV
There is no screening programme for these cancers. Cases of cancers of the throat (oropharyngeal) are increasing in high income countries.
HPV9 vaccine protects against HPV types 16, 18, 31, 33, 45, 52, and 58 which cause 9 out of 10 throat (oropharyngeal) cancers and cancers of the back passage and penis caused by HPV.
Genital warts are ‘warts’ in the genital area caused by the Human Papilloma Virus (HPV). Over 90% of genital warts are associated with Type 6 and 11 HPV. The HPV vaccine offers protection against HPV types 6 and 11.
Since the introduction of HPV vaccine in Ireland in 2010 the reports of ano-genital warts have continued to decrease as shown in figure 1 below. (data from HPSC) Additional information is available from the HPSC website
Additional information about genital warts is available from sexualwellbeing.ie