From the Guidelines
Human Papillomavirus (HPV) is a significant cause of several cancers, most notably cervical cancer, and its infection is managed through prevention with vaccination and regular screening. The relationship between HPV and cancer is well-established, with HPV detected in 99% of cervical tumors, particularly the oncogenic subtypes such as HPV 16 and 18 1. The management of HPV infection involves prevention with vaccination, and the HPV vaccine (Gardasil 9) is recommended for all children starting at age 11-12, though it can be given as early as age 9 and up to age 45, with the standard regimen being two doses six months apart for those under 15, and three doses for those 15 and older.
For cervical cancer screening, individuals with a cervix should undergo regular Pap tests starting at age 21, with HPV co-testing beginning at age 30, as recommended by the American Cancer Society guidelines 1. Those with abnormal results may require colposcopy, biopsy, or procedures like LEEP to remove precancerous cells. The use of HPV testing as a screening tool has been shown to provide 60%–70% greater protection against invasive cervical cancer compared to conventional cytology 1.
The evidence from recent studies, such as the 2019 NCCN Clinical Practice Guidelines in Oncology, supports the use of HPV vaccination and screening for the prevention and early detection of cervical cancer 1. Additionally, the 2017 ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of cervical cancer highlight the importance of HPV vaccination and screening in reducing the incidence and mortality of cervical cancer 1.
Key points to consider in the management of HPV infection and cervical cancer include:
- The use of HPV vaccine (Gardasil 9) for prevention of HPV-related cancers
- Regular Pap tests starting at age 21, with HPV co-testing beginning at age 30
- The use of HPV testing as a screening tool for cervical cancer
- The importance of early detection and treatment of precancerous lesions to prevent the development of invasive cervical cancer
- The role of standard cancer therapies, including surgery, radiation, and chemotherapy, in the treatment of established HPV-related cancers.
Overall, the management of HPV infection and cervical cancer requires a comprehensive approach that includes prevention with vaccination, regular screening, and early detection and treatment of precancerous lesions.
From the Research
Relationship Between Human Papillomavirus (HPV) and Cancer
- Human Papillomavirus (HPV) is a small oncogenic DNA virus with over 200 identified types, some of which are etiologically linked to the development of anogenital malignancies, such as cervical cancer 2.
- HPV is also linked to tonsillar and oropharyngeal cancer, with high-risk HPV types causing a subset of these cancers 2, 3.
- The relationship between HPV and cancer is well-established, with persistent infection with high-risk HPV types being a necessary cause of cervical cancer 3, 4.
Clinical Management of HPV-Related Cancers
- Clinical management of cervical cancer and head and neck squamous cell carcinomas (HNSCCs) involves surgical removal of the tumor tissue and adjuvant chemoradiation therapy 2.
- HPV-positive HNSCCs have been found to respond better to therapeutic intervention compared to HPV-negative tumors 2.
- Treatment of HPV-induced nonmelanoma skin cancer is based on local excision, with topically applied immune-modulating substances representing non-surgical alternatives for smaller cutaneous tumors 2.
Prevention and Screening
- Vaccination is the primary method of prevention for HPV-related cancers, with the nonavalent HPV vaccine being effective in preventing high-grade precancerous cervical lesions in noninfected patients 4.
- Screening for HPV infection is effective in identifying precancerous lesions and allows for interventions that can prevent the development of cancer 4, 5.
- Use of condoms and dental dams may decrease the spread of the virus, and a history of multiple sex partners, early initiation of sexual activity, and other factors increase the risk of persistent HPV infections 4.