In China, cervical cancer is still the top malignant tumor of female reproductive tract, with about 150,000 new cases and 30,000 deaths from cervical cancer every year, and there is a rising trend of younger patients. Cervical cancer is the leading cause of cervical cancer in China. It is now clear that cervical cancer is an infectious disease and its causative agent is high-risk human papillomavirus (HPV) infection, so in clinical practice, HPV testing is commonly used as a screening method for cervical cancer together with liquid-based cytology. Because of this, many patients are alarmed and psychologically burdened when they are detected with cervical HPV infection, thinking that they are almost suffering from cervical cancer or whether they have an STD. So, does having HPV infection in the cervix mean you must have cervical cancer and is it really scary? Guo Ruixia, Department of Obstetrics and Gynecology, First Affiliated Hospital of Zhengzhou University
HPV, known as human papillomavirus, is a tiny virus that can cause infection to both skin and mucous membrane epithelium. HPV is divided into high-risk and low-risk types, with low-risk types mainly causing genital warts and other lesions, such as HPV 6 and 11; high-risk HPV infection can lead to cervical precancer and cervical cancer, mainly HPV 16, 18, 31 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, 82, etc., of which HPV 16 and HPV 18 are the most common HPV subtypes.
HPV infection is mainly transmitted through “skin-to-skin” and “mucosa-to-mucosa” contact, but it can also be transmitted through general contact, and sexual transmission is one of the modes of transmission, which cannot be avoided even by using condoms. Asymptomatic HPV infection can be detected in 5%-20% of sexually active women of reproductive age, especially in women under 30 years of age who are sexually active, the infection rate is higher, but most HPV infections are only transient or intermittent, and if the body’s immune function is normal, HPV can mostly turn negative naturally without special treatment, and it takes 8-10 months for the body to clear HPV. Only long time and continuous infection with high-risk HPV can lead to cervical precancerous lesions and finally cervical cancer. In actual life, the incidence of cervical cancer is very low in sexually active women under 30 years old despite the high rate of HPV infection, while the rate of HPV infection decreases significantly in women over 30 years old, and the rate of HPV infection is even lower around 40 years old, but the incidence of cervical cancer is increasing because, only persistent HPV infection is likely to develop into cervical cancer, and, from the infection of high-risk HPV to the development of cervical cancer usually It takes a relatively long time, about 5-10 years, to develop cervical cancer from HPV infection to cervical cancer. If cervical precancer and cervical cancer screening is done regularly during this relatively long period of time, regular gynecological checkups and liquid-based cytology and high-risk HPV testing are performed on time, and cervical precancer is actively treated, it is believed that women’s chance of developing cervical cancer will be greatly reduced. Therefore, HPV infection in the cervix is not that scary, so don’t “talk about HPV”. At the same time, HPV infection is not an STD in the typical sense, and it cannot be said that you or your spouse have been “unfaithful”.
Given the relationship between HPV infection and cervical cancer, cervical cancer is expected to be a fully preventable and controllable gynecologic cancer. Vaccines for HPV are currently being developed in two categories: therapeutic and prophylactic vaccines. The vaccines currently in clinical trials are mostly prophylactic vaccines, which are type-specific in their protection against new HPV persistent infections and inhibition of CIN development. The bivalent vaccines against HPV types 16 and 18 prepared by GSK and the quadrivalent vaccine “Gardasil” against HPV types 6, 11, 16 and 18 prepared by Merck have been marketed to prevent cervical cancer, vulvar and vaginal precancer caused by the above four HPV types, as well as the low-level HPV vaccine caused by these four HPV types. The vaccine is suitable for women aged 9 to 26 years, especially for unmarried girls aged 10 to 14 years, and is most effective in preventing cervical, vaginal and vulvar pre-cancer caused by HPV 16 and HPV 18. “The estimated price of the HPV vaccine is $360. How long the protection can be maintained and how safe it is in the long term needs to be followed up. There will be a big market for HPV vaccines in China in the future,” said Professor Wei Lihui of Peking University People’s Hospital. However, at this stage, HPV vaccine is still too “sunny and snowy” for the general Chinese public, and HPV testing and early diagnosis and treatment is a more practical way to prevent the disease.”