Cervical cancer and HPV: how a virus is helping early detection and prevention

Great strides have been made in the detection and treatment of cervical cancer since the national Cervical Screening Programme in 1988, with an estimated 100,000 lives having been saved by 2012. Now, our understanding of the connection with a sexually acquired virus is helping to make cervical cancer an almost entirely preventable disease.

Jullien Brady – Clinical Advisor for GynaeCheck and Check4Cancer – is also a Consultant Obstetrician and Gynaecologist at Bedford Hospital, with extensive experience in the UK cervical screening programme. He explains: “Cervical cancer is effectively a sexually transmitted disease. We now know that almost all cases are caused by exposure to certain strains of human papillomavirus, or HPV.

“People are sometimes alarmed to learn that this is due to a sexually transmitted virus, but the important thing to understand about HPV is that it is endemic in the population. Everybody who is sexually active is exposed to it – it is not a sign of promiscuity – and condoms do not protect entirely against it. So, we need to put that stigma aside.”

During the past few years recognition of the potential of this approach has led to a nationwide vaccination programme for young girls. “The vaccine is called Gardasil, which has been given to school-age girls nationally, and protects them against high-risk strains of HPV. We are just beginning to see the first women who were vaccinated coming for smear tests, and we’re very hopeful that there will be a significant drop-off in the number of cases of cancer as a result of those vaccinations.”

When the UK cervical screening programme was first set up, the causal link between HPV and abnormal changes on the cells of the cervix was not understood, and detection was reliant on the traditional smear or pap test. At present, in the NHS, the smear test remains the main screening method, although women can be tested for HPV at the same appointment. “Early detection is the key to successful treatment of all forms of cancer, and by testing for high-risk strains of HPV we can, in effect, pre-empt the cancer. The processes we use now – with a combination of testing for HPV and the smear tests themselves – mean that if a woman attends the regular screening when she’s invited, her chances of dying from cervical cancer are almost zero.”

The key issues with cervical cancer screening is not the tests themselves, but getting women to attend their appointments. Recent figures suggest that around 900,000 eligible women do not attend smear tests. “We believe GynaeCheck and Check4Cancer can help with this. Our checks are a two stage process, with GynaeCheck or Check4Cancer providing the initial part of the test, to establish first whether the woman has the presence of the high-risk HPV virus.”

The advantage of the test used is that it can be administered by the woman herself in the privacy her own home, and it is less invasive and uncomfortable than the traditional smear test. “She doesn’t need to make an appointment, the instrument is no bigger than a super-size tampon, and feedback on early use of it has been very positive. The sample is sent away, and the individual is then told whether or not they are high-risk HPV positive. If they are, only then will they need a smear test, which they can still get under the NHS. And if it’s negative, great – the woman is happy and just needs to repeat the test in 1-4 years’ time, depending on where she is in terms of her personal risk.”

Early stage cervical cancer may have no symptoms at all, which is why screening is important, but if you do experience bleeding between periods, after sex or after menopause, or have other vaginal discharge or pelvic pain, you should see your GP immediately.