HPV infections are serious and cause many cancers including cervical, anal, vulvar, penile, and cancers of the oral cavity.
HPV probably can cause cancer of the cervix by itself, for other cancers co-factors probably have to be present. We don't understand all the sequence, or which co-factors are most important. Lifetime numbers of partners seems to be a consistent risk factor in most studies.
The long held belief about cervical cancer is that first there is HPV infection, then the infection begins to induce cellular changes from mild, to moderate, to severe, and then the infection unleashes the control of the cervical cell life cycle that makes it 'immortal' or in medical terms: cancerous. At any point the HPV infection can either be latent or completely resolved. Thus testing could either be for the cell changes, the HPV infection itself, or some sort of combination testing, which is what eventually has been adopted. Since the process is fairly slow in most cases, the thought is that screening can be performed less frequently in many women.
We have a strategy to protect women from the first infection ever, but no strategy for infection resolution per se. Women who end up with procedures (biopsies, cones, LEEPs) are a bit more likely to begin testing negative for the HPV infection, so perhaps these procedures do help us eradicate HPV infection. New HPV therapeutic vaccines and T-cell therapies are being studied to try to develop HPV treatment, but they are not available. So the question remains: if HPV infection is persistent, even with a normal pap smear, is this a significant risk or not?
Knowing which virus you have been infected with can help predict risk: those with HPV 16 or HPV 18 have the greatest risk of developing advanced, or severe, precancerous changes. It seems clear that most infections won't resolve in weeks or even a few months. But many HPV infections can take years to develop. In one study conducted by Elfgren it was shown that everyone who's infection persisted for 7 years developed advanced pre-ccancerous or cervical cancer. And NONE of the women who cleared their HPV infection during this time actually developed these changes!
Cigarette smoking, and exposure to second hand smoke are associated both with acquiring HPV infection and having that HPV infection persist in your system.
Strategies to avoid risk, plans for individualized care, contraceptive management, and screening in context of your risk factors for other pelvic cancers are what we want to discuss with our patients at Women's Health Practice. 217-356-3736.