HPV infection and cervical cancer in women

  HPV is a general term for a group of viruses, which can be clinically classified into many subtypes, and different subtypes can cause different diseases. Based on the risk of HPV and tumor, HPV can be divided into low risk and high risk types. Low-risk HPV types include HPV 6, 11, 42, 43, 44, etc., which often cause benign lesions such as external genital warts including cervical intraepithelial lesions (CIN I), while high-risk HPV types include HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, etc., which are associated with cervical cancer and cervical intraepithelial lesions (CIN II/III). (CIN II/III), especially HPV types 16 and 18, are associated with the development of cervical cancer and cervical intraepithelial lesions of high severity (CIN II/III).  The ability of HPV-positive women to progress to high cervical intraepithelial lesions and cancer is strongly associated with the HPV type. Studies have shown that among women with low-grade cervical lesions, the risk of cervical lesion progression is greater in women with positive HPV infection of high-risk types than in women with low-risk HPV infection or HPV negativity. In addition, HPV DNA dose levels and the timing of the first HPV infection are also important. The most common types of HPV infections in the genital tract are 16,18,6,11. HPV types 6 and 11 frequently infect the vulva, anus, and vagina and are low-risk types. They are more common in women with condyloma acuminata or low-grade cervical intraepithelial lesions and are not significantly associated with cervical invasive cancer. Types 16 and 18, on the other hand, are high-risk. Studies of cervical cancer specimens from around the world have shown that HPV types 16 and 18 have the highest infection rates, with HPV16 accounting for 50% of all types detected, HPV18 for 14%, HPV45 for 8%, HPV31 for 5%, and other types of HPV for 23%. HPV16 predominates in squamous epithelial cell carcinoma (51% of squamous epithelial cell carcinoma specimens), while HPV18 predominates in adenoidal epithelial cell carcinoma (56% of adenoidal epithelial cell carcinoma specimens) and adenosquamous cell carcinoma (39% of adenosquamous cell carcinoma specimens) of the uterine cervix.  HPV infection of the genital tract is a long-term process that can remain latent in cells for several years, and the latent virus can resume activity once the body’s immunity decreases. the process of HPV infection is usually divided into the latent infection phase, the subclinical infection phase, the clinical symptom phase, and the HPV-associated tumor phase. Cervical cancer also has a series of precursor lesions, namely cervical epithelial atypical hyperplasia, pathologically known as cervical intraepithelial neoplasia (CIN), which is usually divided into three levels according to the severity: cervical intraepithelial mild neoplasia (CIN I), cervical intraepithelial moderate neoplasia (CIN II) and cervical intraepithelial high neoplasia (CIN III), all of which may develop into cervical invasive cancer.  According to the long-term observation of medical experts, HPV can be detected in 99.8% of cervical cancer patients, while HPV-negative patients almost never develop cervical cancer. In addition, HPV is also present in more than 98% of patients with cervical disease, and during the long latent period, any gynecological checkup cancer screening can detect precancerous lesions of the cervix. In other words, through HPV screening, we can accurately know the possibility of our disease and relax our mind, or detect and treat it early. There is a period of about 10 years between the onset of HPV lesions and the development of cervical cancer, which is enough time for us to prepare carefully and save ourselves. Early detection and treatment during this period can effectively prevent the occurrence of cervical cancer.