HPV and Cervical Cancer
HPV & Cervical Cancer: The Facts
Cervical cancer is one of the most prevalent cancers in women worldwide and one of the highest causes of women's cancer-related deaths1—604,127 new cases of cervical cancer were diagnosed in 2020.2 Furthermore, cervical cancer disproportionately affects women who face significant barriers to screening; 84% of all cases and 88% of deaths caused by cervical cancer occurred in low- and middle-income countries.3 Yet, the elimination of cervical cancer is within reach with proper vaccination, screening, and treatment.
The link between cervical cancer and human papillomavirus (HPV) has become clear over the past few decades. It is well-known that persistent infection with specific types of HPV account for nearly all cases of cervical cancer.4 Because cervical cancer rarely causes overt symptoms in its early stages—when treatment is most effective—it is important to screen for high-risk HPV infections that are at the greatest risk of progressing to cervical precancer and cancer. Identifying women at risk, before disease develops, is an important part of cervical cancer prevention. With today's technologies, no woman should die from cervical cancer.
HPV: A Link to Cervical Cancer
HPV is a common sexually transmitted infection, and most women will not know that they or their partners have it. HPV is most often spread through sexual intercourse. It can also be transmitted via non penetrative sexual activity through skin-to-skin contact.6
HPV is a small, double-stranded DNA virus that affects epithelial cells such as skin and mucous membranes. There are more than 200 HPV genotypes,7 about 30 of which are sexually transmitted.8 Most HPV strains are harmless; however, a handful of high-risk types cause infections that can develop into cervical cancer.
High-risk HPV causes over 99% of cervical cancers.4 There are 14 high-risk HPV types that are found in most cases.9 Two HPV types, HPV 16 and HPV 18, are associated with 70% of all cervical cancers.10 Globally, genotypes HPV 16 and HPV 18 are more oncogenic and likely to progress to high grade cervical disease than all other high-risk HPV genotypes combined.11
The Progression to Cervical Cancer
While most HPV infections resolve on their own, some infections with high-risk HPV types can progress to cervical intraepithelial neoplasia (CIN), and these precursor lesions can be identified as low- or high-grade. It is possible for lesions to resolve and the infection to clear, but generally higher grade cases are less likely to regress.12 An HPV infection can progress to cervical precancer - or invasive cancer - years or even decades after the initial HPV exposure.13
Early treatment at the precancer stage is critical because in this stage, high-grade lesions and cervical cancers confined to the cervix can be completely excised. If cervical cancer is detected and treated before it has spread, the 5-year survival rate is approximately 92%.14
- Human papillomavirus (HPV) and cervical cancer 24 January 2019. https://www.who.int/en/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer (accessed 29 April 2020)
- Cancer Today, International Agency for Research in Cancer (IARC) GLOBOCAN 2020 Registry: https://gco.iarc.fr/today/data/factsheets/cancers/23-Cervix-uteri-fact-sheet.pdf (accessed 11 January 2021)
- Arbyn M, Weiderpass E, Bruni L, Sanjosé S de, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Global Heal. 2019;8(2):e191–203.)
- Walboomers JMM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathology. 1999;189(1):12–9.
- Chesson HW, et al. The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis. 2014;41(11):660-4
- Centers for Disease Control and Prevention. Human papillomavirus: Epidemiology and prevention of vaccine-preventable diseases. Available at: https://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html (accessed 19 May 2020)
- Bioinformatics and Computational Biosciences Branch at the NIAID Office of Cyber Infrastructure and Computational Biology (2016). Papillomavirus Episteme. Available at: https://pave.niaid.nih.gov (accessed 17 December 2020)
- Burd EM. Human Papillomavirus and Cervical Cancer. Clin Microbiol Rev. 2003;16(1):1–17
- Sanjose S de, Quint WG, Alemany L, Geraets DT, Klaustermeier JE, Lloveras B, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010;11(11):1048–56.
- Khan MJ, Castle PE, Lorincz AT, et al. The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst. 2005;97(14):1072-1079.
- Motamedi M, Böhmer G, Neumann HH, Wasielewski R von. CIN III lesions and regression: retrospective analysis of 635 cases. Bmc Infect Dis. 2015;15(1):541. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654894/pdf/12879_2015_Article_1277.pdf
- Vink MA, Bogaards JA, Kemenade FJ van, Melker HE de, Meijer CJLM, Berkhof J. Clinical Progression of High-Grade Cervical Intraepithelial Neoplasia: Estimating the Time to Preclinical Cervical Cancer From Doubly Censored National Registry Data. Am J Epidemiol. 2013;178(7):1161–9.
- National Cancer Institute. SEER stat fact sheets: cervix uteri. Available at: http://seer.cancer.gov/statfacts/html/cervix.html (accessed 19 May 2020)