HPV and Cervical Cancer: What’s the Connection?

In 2023 alone, more than 13,000 women were diagnosed with cervical cancer. Up to 90% of cervical cancer cases may be caused by HPV. Understanding the connection between HPV and cervical cancer can help women make informed decisions about cervical cancer screening and prevention.

What is HPV?

The human papillomavirus, or HPV, is the name for a group of more than 200 viruses. It is a very common infection — most people who are sexually active become infected with some form of HPV at some point in their lives.

How do you get HPV?

Different types of HPV spread in different ways. The types commonly associated with cervical cancer are generally sexually transmitted infections (STIs). They spread through skin-to-skin contact. A person may get HPV from a partner during vaginal, oral, or anal intercourse.

What is dysplasia?

When cells in a particular area become abnormal, health care providers use the term dysplasia to describe it.

Some types of HPV can cause dysplasia of cervical cells. The virus can get inside cells, changing how they duplicate, divide and signal to each other. As a result, cells grow differently, leading to abnormalities.

Can dysplasia caused by HPV be treated?

Doctors classify dysplasia based on severity. There are three types: low-grade, moderate-grade, and high-grade.

Low-grade or mild dysplasia caused by HPV often goes away once the HPV infection resolves. As a result, it may not require treatment.

When HPV infections continue for an extended period, moderate-grade and high-grade dysplasia can occur. In most cases, doctors will remove the abnormal cells by performing surgery. Two common procedures used to treat dysplasia are:

• Loop electrosurgical excision procedure (LEEP): A procedure where a provider uses a wire loop that has an electrical current passing through it to remove abnormal cells.
• Cold knife conization: A procedure where a provider removes a cone-shaped sample of tissue using a scalpel or laser knife.

Doctors determine which procedure to use based on several factors, including the location and severity of the dysplasia and the patient’s age and health history.

What is cervical cancer?

Cervical cancer is a form of cancer, a disease that occurs when cells grow uncontrollably. In the case of cervical cancer, these cells are on the cervix, the lower end of the uterus. Cancer develops over time, and cancer of the cervix may eventually spread to other parts of the body if not treated.

How does HPV cause cervical cancer?

When HPV persists, dysplasia can continue to develop, becoming pre-cancer. Should the virus continue to act on the cells, the cellular changes can progress, leading to cervical cancer.

What types of HPV cause cervical cancer?

Not all types of HPV cause cervical cancer. Experts divide HPV infections into two categories: high-risk and low-risk.

Sometimes called non-oncogenic or wart-causing types, low-risk HPV types don’t usually cause cancer. Some can cause other symptoms, such as genital warts or breathing problems.

High-risk HPV types, also called oncogenic or cancer-causing types, are those known to cause changes in cells. HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59 are all high-risk types for cervical cancer. However, HPV 16 and 18 are responsible for most cancers.

In addition to cervical cancer, some high-risk HPV infections can cause other types of cancer, such as cancers of the vagina, vulva, anus, penis and oropharynx (back of the throat).

How quickly does HPV cause cervical cancer?

HPV causes cells to change slowly. Studies have revealed that it usually takes 5 to 10 years for HPV to lead to pre-cancer. It may take up to 20 years for abnormal cells to become cancer due to HPV.

Are there any risk factors for cervical cancer due to HPV?

High-risk types of HPV can lead to cervical cancer in anyone who contracts them. However, studies show that some risk factors can make high-risk types of HPV more likely to persist, increasing the risk of cervical cancer. These factors include:

• Smoking and exposure to secondhand smoke
• Weakened immune system caused by a medical condition
• Uncontrolled/untreated HIV infection
• Medications that suppress the immune system

What is HPV screening for cervical cancer?

HPV screening is a test performed to detect high-risk HPV types that may lead to cervical cancer. The test involves taking a sample of cells from the cervix and then sending them away to a laboratory for study.

Health care providers typically perform HPV tests in the office. During the test, the patient lies on an examination table with foot stirrups. The provider uses a plastic or metal tool called a speculum to widen the vagina. Then, they insert a brush and gently lift cells away from the cervix.

During the test, the patient may have mild discomfort, similar to menstrual cramps. Light spotting may occur after the test. Patients can typically go back to their everyday activities immediately after the test.

The HPV test isn’t the only cervical cancer screening test. The Pap test is another option. Providers follow the same general steps when performing a Pap test. However, the lab looks for abnormal and cancerous cells when studying the sample collected.

An HPV test and a Pap test can be performed at the same time. Health care providers refer to this as co-testing. The United States Preventive Services Task Force (USPSTF) has established the following guidelines for cervical cancer screening:

• At age 21, women should get their first Pap test. If they’re sexually active, their doctors may recommend Pap testing sooner.
• From age 21 to 29, women should get a Pap test every three years.
• From age 30 to 65, women should be screened in one of three ways:
  • HPV test every 5 years
  • Pap test every 3 years
  • Co-testing every 5 years
• After age 65, women with a recent history of abnormal HPV or Pap test results should continue screening. Otherwise, screening after 65 is usually not necessary.

Women with certain risk factors may need more frequent screening.

HPV and cervical cancer prevention

Although it may not be possible to completely prevent all cases of cervical cancer, there are things that women can do to lower their risk.

HPV vaccine

The HPV vaccine protects against the highest-risk types of HPV that cause cervical cancer. The U.S. Centers for Disease Control and Prevention (CDC) recommends the vaccine for everyone under the age of 26. In some cases, doctors may also suggest that people between the ages of 27 and 45 get vaccinated for HPV. The majority of cervical cancer can be prevented by HPV vaccination and regular screening exams.

Addressing risk factors

Quitting smoking and limiting exposure to secondhand smoke may lower the likelihood of high-risk HPV developing into cancer. Reaching or maintaining a healthy weight through diet and exercise may also be beneficial.

Practicing safe sex

Using condoms during vaginal and anal sex may help reduce the risk of HPV and cervical cancer caused by the virus. In addition, condoms help prevent HIV, an STI that makes HPV more likely to persist and cause cancer.

Treating dysplasia and pre-cancer

Treating dysplasia and pre-cancer due to HPV can reduce the risk of cervical cancer. Cervical cancer screening can lead to the early detection of dysplasia and pre-cancer — the earlier it’s detected, the better the outcomes are likely to be.