What is an abnormal pap smear?
When pap smears are reported, there is a wide range from normal to cancer, with variations of slightly abnormal, moderately and severely abnormal along this spectrum. When a pap smear is reported as abnormal, the first thing we want to know is whether or not HPV (Human papillomavirus) is present. We now know that HPV is required to cause cervical cancer. If HPV is not present, then the abnormality is mild and the pap is considered normal. If HPV is present, then the abnormal pap has the potential to progress to a more severe abnormality or even cancer. I stress potential, because most of these will not progress even if we do nothing. However, this potential requires that we do some additional testing and more frequent monitoring in this patient. You should never get cervical cancer if you have your annual pap smear, because early pre-cancerous changes can be detected and treated.
What is the Human Papilomavirus (HPV)?
HPV is a member of the wart virus family. There are over a hundred strains of this virus and about 40 of them can infect the genital area and can be sexually transmitted. Some strains cause visible warts. Others cause cellular changes with no visible warts. The first group is unsightly and unwanted, but the second group is really more worrisome, because this second group can cause progressive abnormalities in the skin, which can become cancer. 50% of all sexually active adults have HPV, 80% by the age of 50.
How can I prevent HPV?
HPV is a sexually transmitted disease, so you prevent it by limiting your number of sexual partners and practicing safe-sex. Using condoms helps but is not 100%, because the virus can live on skin outside of the area covered by the condom. Be selective and be careful.
Is there a vaccine against HPV?
Yes, there are now two vaccinations to protect against HPV infection. Gardasil (Merck) was approved in 2006 and it protects against 4 strains of the HPV virus; strains 6 & 11, which cause 90% of genital warts, and strains 16 & 18, which cause two-thirds of all cervical cancers. Cervarix, (GlaxoSmithKline) was approved for use in the US in 2009. It protects against strains 16 & 18. The vaccines have many similarities, but some differences. You should have a conversation with your doctor if you are considering vaccination against HPV.
Who should receive the HPV vaccine?
Both vaccines are FDA approved for use in women between the ages of 9 and 26. The CDC recommends vaccination of all young women around the ages of 11 – 12, with the goal being to vaccinate these girls before they ever become sexually active. Women who have been sexually active may still benefit from the vaccine if they were not previously infected with the HPV strains contained in the vaccine.