HPV and Cervical Cancer

Text Size: Normal / Medium / Large
Printer-friendly versionPrinter-friendly version

HPV and Cervical Cancer

Why is it important to talk about cervical cancer?

The estimate for 2013 was that 1,450 Canadian women would be diagnosed with cervical cancer and 380 women would die from it. Cancer of the cervix (the opening to the uterus) is a serious health concern, although it is not the most common cancer for women. Of the 36,000 cancer female deaths in Canada in 2013, 26.3% were due to lung cancer, 13.9% of breast cancer and 1.0% of cervical cancer (For more information see the Canadian Cancer Society: Canadian Cancer Statistics Publications).

The numbers are still unacceptably high. What is encouraging is that the number of cases has dropped dramatically since regular Pap testing was first introduced (See our FAQ on Pap Tests). However, those most at risk for cervical cancer include low-income, Aboriginal and marginalized women as well as women with compromised immune systems. Some women may be more at risk because they do not have access to regular Pap testing and/or follow-up treatment. Anyone with a cervix needs clear information about how to prevent cervical cancer.

What is Human Papillomavirus (HPV)?

HPV is the most common sexually transmitted infection (STI) in the world. (For more information on STIs, see our FAQ on STIs). There are over 100 strains that infect different parts of the body. Of these, about 40 strains infect and affect the genitals and reproductive tract.

We can divide these 40 strains into low-risk and high-risk types. The low-risk types (like types 6 and 11) can cause warts on the genitals, inside the vagina, anus and anywhere in the area covered by a pair of boxer shorts. These warts are not dangerous. However, it can be stressful to have warts, especially if they are visible to a partner. You may need more than one treatment to deal with them.

High-risk HPV types (like types 16 and 18), can eventually cause cancer. The good news is that most people’s immune systems will get rid of HPV on their own (about 90% within two years). However, for those people who continue to have an HPV infection, it could eventually lead to cancer of the cervix, anus, penis, vulva, as well as head and neck cancers, like throat cancer.

Cancer of the penis is rare. But men can carry high-risk types and infect their partners without experiencing any symptoms or harm to themselves.

How do you know if you have HPV?

The overwhelming majority of people who have had any sexual partners in their lifetime will probably have been exposed to the virus through skin-to-skin contact in the “boxer shorts” area. The infection may come and then go without any signs or symptoms. 

However, if someone has a bump in the genital area, a health care provider can diagnose an HPV wart by just looking at it.

There is no screening test for the virus itself as there is for other STIs like chlamydia. An abnormal Pap test result may indicate that a woman has HPV (see below). As of this writing, there is no HPV test for men.

Does HPV cause cervical cancer?

High-risk HPV is found in all cervical cancers; but having high-risk HPV on the cervix does not automatically mean you will get cervical cancer.

For women under 30, their immune system usually clears up the infection as well as any resulting abnormal cells. Women over 30 who smoke or who have problems with their immune system (like women living with HIV?AIDS) may develop abnormal cells which require treatment. Without treatment, these cells may eventually become invasive cancer.

What is the role of the Pap test?

The Pap test is the first step in checking for problems on the cervix. (For a detailed explanation of the Pap test, see our FAQ on Pap Tests)

During an internal exam, the health care practitioner takes a sample of cells from the cervix. These cells are sent to the laboratory.

If the test result is normal, your next test is due in three years. If the test result is abnormal, follow-up will depend on your age and the specific results.

Anyone with a cervix needs to have their first Pap test at age 25. If you have had unprotected sexual activity before 25 (oral, vaginal or anal sex), you will need STI testing before your first Pap test (See our FAQ on STIs).

What do Pap test results mean?

Cancer of the cervix can take 10 – 20 years to develop. At every step, your health care provider decides whether or not treatment is necessary. Below are Pap test results from “normal” to “cancer”.

  • Most results are “normal”.
  • Atypical Squamous Cells of Undetermined Significance (ASCUS) is common. ASCUS usually clears up on its own.
  •  A Low-grade Squamous Intraepithelial Lesion (LSIL) may also clear on its own:
    • if the woman is under 30
    • if she does not smoke
    • A High-Grade Squamous Intraepithelial Lesion (HSIL) requires treatment.
    • Carcinoma in situ, is not cancer, but requires treatment.
      • Without treatment, these abnormal cells may progress to invasive cervical cancer.
      • Squamous cell carcinoma – cancer.

(For more information see Canadian Cancer Society: Ontario Cervical Screening Cytology Guidelines Summary PDF)

For more information on guidelines and results, see the Cancer Care website for your province or territory. Also see our FAQ on Abnormal Pap tests.

What if the cervix is infected with a high-risk type of HPV?

A sample of abnormal cervical cells taken during a Pap test from someone over 30 should be sent for HPV DNA testing. If the HPV test indicates that you have a high-risk type (see above in “What is HPV?”), you need a second test called colposcopy. An instrument visually magnifies the cervix looking for an area of abnormal cells. During this examination, they may do a small biopsy.

Sometimes treatment is recommended, like laser or freezing, to kill the abnormal cells. Early detection and treatment makes this one of the most preventable cancers. 

How can you avoid getting HPV in the first place?

Any skin-to-skin contact in the genital area can spread HPV. Condoms are good protection for the sexual parts that are covered. A male condom protects the penis, but not the base of the penis. It protects the vagina and cervix, but not the vulva. Female condoms offer some additional protection to the vulva.

How can you prevent cervical cancer?

  • Postponing unprotected vaginal sexual activity until age 18 allows the cervix to fully mature. (See our FAQ: Keeping Your Cervix Healthy)
  • Using condoms as described above
  • Not smoking
    • Nicotine plays a role in the development of cervical cancer.
    • Nicotine inhaled from tobacco smoke, including second-hand smoke, is absorbed by the cervix.
    • Maintaining a strong immune system
    • Getting regular Pap tests
    • Getting follow-up testing and treatment as advised by your health care provider

What about HPV vaccines?

There are two vaccines available in Canada. Government programs offer Gardasil free to young girls (and in some provinces, to boys). Gardasil protects against infection from four HPV types – two of which are responsible for the majority of genital warts (6 and 11) and two of which are found in the majority of cervical cancers (16 and 18). Cervarix protects against the latter two. Most adult women will already have been exposed to one or several types of HPV.

HPV vaccination for adults is costly. As of this writing, research has shown protection following vaccination that lasts for six years. Getting vaccinated is a very individual choice (See Network Article HPV Vaccine: Why Aren’t Canadians Buying in? and the CWHN’s publication HPV, Vaccines, and Gender: Policy Considerations (2007)).

Do partners have to get treated for HPV?

If someone has warts, they can be treated. However, treating HPV warts does not guarantee a person is no longer infectious. Warts may also clear without treatment.

If there is a diagnosis of a cervical lesion caused by a high-risk type of HPV, there is no treatment for partners. However, there is evidence that these lesions clear up more quickly with condom use.

Where can I get More Information?

This FAQ may provide medical information, but is not meant to be a substitute for medical advice. When you have questions about your health, it is always advisable to ask a health care practitioner.

Created January 2014.