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Prevention & Treatment of oncogenic HPV and cervical cancer
Cervical Cancer
Cervical screening is the early detection, diagnosis and treatment of HPV-associated pre-cancerous lesions that have the potential to develop into cancer. The risk of developing cervical cancer is reduced by approximately 80% in women who are regularly screened (Schiller and Davies 2004). However, screening does not prevent HPV infection. It is estimated that up to 80% of people will acquire an HPV infection in their lifetime (Brown et al 2005), and up to 75% of those people will acquire an infection with an oncogenic HPV type (Peto 2004; Cushieri 2004).
Abnormal or inadequate screening results can be a source of significant anxiety for women, even though in most cases the test simply needs repeating, and the majority of abnormalities spontaneously regress or can be successfully treated (Lerman et al 1991). For many women, anxiety stems from a lack of understanding of the causes of cervical cancer, and further information around HPV and its role in cervical cancer can provide reassurance (Waller et al 2005).
Once cancer is diagnosed, accurate ‘staging’ of cervical cancer is necessary to determine the most appropriate treatment. Early in disease progression, a simple hysterectomy offers a good outcome. For more advanced cervical cancers, a number of options can be considered. These include radical hysterectomy, radiation therapy, chemotherapy and anti-cancer drugs, either alone or in combination.
Where screening programmes are not in place, protection against cervical cancer relies on education programmes that encourage abstinence to prevent the transmission of HPV. The use of condoms can also provide some protection against HPV transmission. However, condoms do not fully protect women, as HPV transmission may occur from genital skin-to-skin contact (McIntosh 2000; Schiffman and Kjaer 2003). Vaccines are currently in development that protect women from infection with the two most common oncogenic HPV types, 16 and 18 (Harper et al 2004; Muñoz et al 2004), and also from the low-risk HPV types 6 and 11 (Villa et al 2005).