| Question | Answer |
| 1. What is HPV? | HPV is the abbreviation for human papillomavirus, which lives on the skin or in the mucous membranes and causes a very common infection in women and men. There are two types of HPV: low-risk and oncogenic. Infection with oncogenic HPV has been shown to be the necessary cause of cervical cancer (Bosch et al 2002). The prevalence of HPV in cervical cancers is 99.7% (Walboomers et al 1999) Of the roughly 100 types of HPV that have been identified (Burd 2003; Burns and Maitland 2005), approximately 15 types have been classified as oncogenic.(Burd 2003) Up to 80% of sexually active adults will harbour HPV at some point in their lives. (Brown et al 2005)Typically, an HPV infection will be transient, disappearing spontaneously within a few months to a year, and without symptoms or permanent effects. However, persistent infection with oncogenic HPV types may lead to cervical cancer. (Giuliano et al 2002; Ho et al 1998) |
| 2. How common is cervical cancer? | Worldwide, cervical cancer is currently the second most common cancer diagnosed in women (after breast cancer) and the third leading cause of cancer deaths among women after breast and lung cancer. (Ferlay et al 2004)There are nearly 500,000 new cases each year and 273,000 deaths (Ferlay et al 2004). In less developed regions of the world, cervical cancer is the leading cause of cancer deaths in women (234,000) (Ferlay et al 2004). |
| 3. Do condoms protect against HPV infection? | Barrier devices do not protect against infection completely, as HPV infection does not depend on penetrative sex: it occurs from skin-to-skin contact of the genital area. Reducing this skin-to-skin contact will reduce the risk of infection. Hence, condoms can provide some protection, but they do not fully protect against HPV infection (McIntosh 2000). |
| 4. If a woman is in a long-term monogamous relationship, is she still at risk of HPV infection? | Every sexually-active woman is at risk of contracting the human papillomavirus (HPV) (Gravitt and Jamshidi 2005). HPV is a common infection and is easily transmitted through sexual activity (Baseman and Koutsky 2005; Schiffman and Kjaer 2003). The risk of HPV infection is dependent on the total lifetime relationships that the woman and her partner (male or female) have had prior to their current relationship (Burd 2003). Therefore, current monogamy does not necessarily remove the risk of HPV infection. |
| 5. What causes cervical cancer? | Only persistent infection with oncogenic HPV types may lead to cancer (ie, infection which continues over time). The progress from initial neoplasia (intraepithelial dysplasia) to cervical cancer may take many years (in some cases up to 10-20 years), although in a small number of cases CIN III can be seen within 2 years (Burd 2003). |
| 6. Does every woman infected by an oncogenic HPV type develop cancer? | No. HPV is very common, but cervical cancer is not. It is estimated that up to 50-80 per cent of women will acquire an HPV infection in their lifetime (Baseman and Koutsky 2005; Brown et al 2005; Ho et al 1998), and up to 75% of those infections will be an oncogenic type HPV infection (Peto 2004; Cushieri 2004). However, in the US, for example, only around 13,000 women (or 7.7 per 100,000) develop cervical cancer. (Ferlay et al 2004) The body’s defence mechanisms clear most HPV infections without any risk of the infection progressing to cancer. But some women infected with oncogenic HPV types develop long-term persistent infections. These women are likely to develop progressive, high-grade, pre-cancerous lesions. If these are not detected by screening and treated, cervical cancer may develop. Currently, it is not possible to predict which lesions will progress to cancer, but lesions are investigated further by repeat cytology, HPV testing or by colposcopy, and all but the early precursor lesions are treated. |
| 7. At what age are women most likely to develop cervical cancer? | The highest burden of a diagnosis of cervical cancer is among women aged over 45 years, although 30% of cases occur in women under the age of 45, meaning that every year 145,000 women aged 45 years and under are diagnosed with cervical cancer (Ferlay et al 2004). However, cervical cancer is extremely rare in women under the age of 20; there were no cases of cervical cancer diagnosed in women aged 20 and under in the US between 1998 and 2002 (SEER Cancer Statistics Review 2005). |
| 8. What is the lifetime risk of dying from cervical cancer? | The cumulative lifetime risk for dying from cervical cancer ranges from around 0.27% (1 in 370) in the USA (American Cancer Society 2005) to approximately 0.8% in developing countries (1 in 125) (Ferlay et al 2004) (this figure is cumulative risk for ages 0-64 years). In most European countries cumulative lifetime risk for dying from cervical cancer is 0.34% (1 in 294) (Boyle and Ferlay 2005). |
| 9. If screening shows that a woman has CIN changes, does that mean she will develop cervical cancer? | The answer is probably not, but the risk depends on the CIN category. Cervical intraepithelial neoplasia (CIN) is a diagnosis that may be made when a Pap smear test reveals abnormal findings. The risk of developing invasive cervical cancer rises with increasing severity of the CIN lesion (graded I to III) with CIN I being less likely to progress to invasive cervical cancer (1%) than CIN III (>12%) (Östör 1993). Currently there are no tests to determine which women will clear their CIN and which will progress to invasive cervical cancer. |
| 10. What is the impact of a diagnosis of cervical cancer? | A diagnosis of cervical cancer and the need for treatment can have a major impact on a woman’s quality of life, resulting in emotional, sexual and relationship problems, as well as stress and anxiety (Basen-Engquist et al 2003);(Greimel et al 2002) (Pearman 2003). Even being told that a Pap smear test is positive for abnormal cells (Bell et al 1995), or that an HPV test is positive, can result in raised anxiety and stress (McCaffery et al 2004). |
