Controlling HPV is the best prevention of cervical cancer

This Sunday, March 26 is World Cervical Cancer Day, a date to inform about the prevention of this pathology. We spoke with Dr. Gabriel Fiol Ruiz, Coordinator of the Andalusian Group for the Study and Prevention of Human Papilloma Virus Infection (Gaepi-HPV) and member of Top Doctors, about the early detection of Human Papilloma Virus (HPV) to avoid cervical cancer.

The cervix or cervix is the organ located at the bottom of the vagina and communicates with the uterine cavity. Its surface is smooth, made up of several layers of flattened cells, while the canal that communicates with the interior of the uterus has a single layer of cylindrical glandular cells. This distinction is important in the diagnosis and treatment of cervical cancer.

According to cancer statistics published by the Globocan study, cervical cancer is the fourth most common cancer in women, with an estimated 528,000 new cases and 266,000 deaths per year worldwide. This accounts for 7.5% of all cancer deaths in women. In less developed countries this disease is more prevalent, reaching 12% of all female cancers.

In Spain, cervical cancer is the fourth most common cancer in women after breast, colorectal and lung cancer. It is estimated that in our country there are about 2511 new cases with 848 deaths annually. This rate can be considered low since it would constitute 3.3% of cancers in women with 7.6 new cases/100,000 inhabitants/year.

Human Papilloma Virus as a cause of cervical cancer

This cancer is known to be caused by infection with a virus known as human papillomavirus (HPV). More than 200 types of this virus have been described, although not all are at risk of causing cancer. HPV is considered a necessary cause for cancer to develop. Transmission occurs mainly through sexual contact, with most infections occurring in the first few years of intercourse. It is a very prevalent disease, with one in three people under the age of 30 being infected. However, the virus can be eliminated thanks to one’s own immunity, and it is known that 90% of these infections are eliminated in the first year after infection. A number of cofactors are necessary for the persistence of the virus, including tobacco, hormonal treatments, nutritional defects and especially defects in immunity.

Persistent HPV infection causes cellular alterations in the cervix favoring precursor lesions that can evolve and lead to cancer. This is a slow process, which takes several years to evolve. This fact makes it possible to detect precursor lesions that can be treated before cancer develops.

Early diagnosis by cytology

To date, periodic cytology has been used as a screening method to detect the presence of these evolutionary cellular alterations prior to cancer. This procedure studies the desquamated cells of the cervix, both of the external epithelium and of the endocervical canal. It should be specified that cervical cytology is only intended to evaluate the presence of altered cells of the cervix, not of the uterine body or the ovary. Once this positive cytology appears, the neck should be assessed and the lesion confirmed, if necessary, by biopsy, since cytology is never a diagnostic tool, only a screening tool.

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According to European recommendation, screening by viral typing should be considered. The presence of high-risk HPV is a marker of interest in the secondary prevention of cervical cancer. However, the mere presence of the virus does not imply progression to cancer. Only 8-10% of the population over 30 years of age will have persistence of the virus. Thus, out of almost 2 million infected women in Spain, only 2511 will develop cancer. This means that follow-up and prevention are fundamental pillars in the fight against cervical cancer.

Primary prevention: the HPV vaccine

Primary prevention to avoid viral infection can be achieved by administering the vaccine against the HPV types most implicated in cervical cancer.

Two vaccines have been marketed:

  • Tetravalent: against types 6, 11, 16 and 18. The first two involved in the production of genital warts, which are highly contagious, and types 16 and 18 directly involved in cervical cancer.
  • Bivalent: against oncogenic types 16 and 18.

The nonavalent vaccine, which incorporates 5 other types of virus implicated in the production of this cancer, is pending commercialization.

In Spain it has been introduced in the vaccination calendar for girls at the age of 12. It is considered that at that age most of the population has not started sexual relations and therefore has not been able to become infected. Many countries have also incorporated vaccination in children, both to reduce the risk of transmission and because of the involvement of the virus in the development of other cancers affecting both sexes, such as vagina, vulva, anus, penis and oropharynx, although this last location is not considered in the preventive indications of the vaccine.

Although the vaccine does not prevent the present infection, given the possibility of elimination of HPV by the immunity itself, vaccination is recommended at other ages. It is known that natural immunity does not reach antibody levels that prevent reinfection or reactivation of the virus. For this reason, administration of the vaccine is indicated up to 45 years of age in women and up to 26 years of age in men. It is not necessary to determine the presence of the virus before vaccination.

There has been much debate about the dangers and side effects of HPV vaccination. To date, more than 200 million doses have been administered worldwide with good tolerance. This vaccine is not considered to present greater adverse effects than other vaccines. The Spanish Medicines Agency concludes that there are no data available to support that the HPV vaccine presents serious effects, establishing that the benefit-risk balance is still considered positive. For this reason, the recommendations of international agencies continue to recommend systematic vaccination.

No virus, no cancer, it can be prevented!

We are dealing with a cancer caused by an infection that provokes precursor lesions that progressively evolve, but which can also stabilize or even disappear. There are means of detecting these pre-cancer lesions and a vaccine is available to prevent infection with the virus.