The Relationship Between HPV and Cervical Cancer
Most of us are focused on the Coronavirus these days but it's important to pay attention to another virus out there that has been around a lot longer: the Human papillomavirus or HPV, and undetected, it may lead to cervical cancer. Dr. Ioannis Alagkiozidis discusses the Human papillomavirus, how it may be contracted, and how women can protect themselves against this disease.
Featured Speaker:
Ioannis Alagkiozidis, MD
Dr. Ioannis Alagkiozidis is the Director of Gynecologic Oncology at Maimonides Medical Center. Dr. Alagkiozidis completed his residency training in Obstetrics and Gynecology at the University of Texas in Houston and fellowship training in Gynecologic Oncology in SUNY-Downstate/Kings County Hospital. He is board-certified in Gynecologic Oncology and Obstetrics and Gynecology. Transcription:
The Relationship Between HPV and Cervical Cancer
Alyne Ellis (Host): Most of us are focused on the Coronavirus these days, but it's important to pay attention to another virus out there that has been around a lot longer, the human papilloma virus commonly called HPV. Undetected, it may lead to cervical cancer. Here to tell us women how to protect ourselves is Dr. Ioannis Alagkiozidis,
the director of the gynecologic oncology department at my monities medical center. This is Maimo Med Talk. I'm your host Alyne Ellis. Welcome Doctor.
Ioannis Alagkiozidis, MD (Guest): Well, thank you. Thank you for inviting me.
Host: Let's start with an understanding of what is HPV and how do you get it?
Dr. Alagakiozidis: HPV is a sexually transmitted virus. It can be transmitted in various stages of life through sexual activity. Actually, at this time, more than 50% of the people, men and women carry HPV. And it has been associated with a risk for cervical cancer.
Host: Does it have any symptoms when you first get it?
Dr. Alagakiozidis: Not really, HPV, it tends to cause an assymptomatic infection in the cervix predominantly, that can, stay in that assymptomatic condition for many years before evolving to precancerous or cancerous conditions with the cervix.
Host: And so how do you detect it?
Dr. Alagakiozidis: The goal here is to detect precancerous changes in the cervix. And this can be accomplished through screening strategies for cervix cancer. We have specific screening protocols that have been implemented through various associations. And those screening guidelines include screening through cytology, which is the PAP smear, or testing for the HP virus itself or the combination of the two. Following those screening guidelines, will increase the possibility of diagnosing precancerous conditions of the cervix.
Host: So, would it be your advice, for example, that not only would a woman have a pap smear, but also have a test specifically for HPV?
Dr. Alagakiozidis: There is different strategies for screening for precancerous conditions of the cervix. One strategy involves screening through cytology only. Through PAP smear only. An alternative to that is screening with both cytology and HPV testing. The time interval for each strategy is different, but both are very effective strategies in preventing cervix cancer. Either of them is a great option for women in order to prevent cervix cancer.
Host: And what about when a woman is older? Does the risk for cancer increase or some people can just ride it out and not get anything.
Dr. Alagakiozidis: It's typically acquired at any phase of a patient's life and all patients are at risk for HPV infection and the consequences of an HPV infection that can be precancerous conditions of the cervix or even invasive cervical cancer. Screening guidelines recommend continuation of screening up to the age of 65, based on certain criteria. For specific groups of patients that are at higher risk for cervical cancer, this age of 65 is not absolute and can be modified depending on the patient specific characteristics.
Host: So, how do you know if you're at a higher risk for cervical cancer?
Dr. Alagakiozidis: There is several risk factors that have been established. Most of them are associated with HPV infection. For instance, sexual activity, age that sexual activity was initiated, number of sexual partners, or, sexual activity of the partner; all have been associated with the increases for cervix cancer. Also, immunosuppression, illnesses that could does suppress the immune system. And the most commonly seen is HIV is another risk factor for cervix cancer. So, all these factors would increase the patient's risk of developing cervix cancer. And, they are being taken into consideration where a screening strategy is followed.
Host: And I'm assuming that also means that if you have that kind of cancer in your family, that might place you also at a higher risk or not?
Dr. Alagakiozidis: Family history is not a significant factor specifically for cervix cancer. Most strongly associated risk factor is HPV infection. Okay. And all other risk factors have been associated with HPV itself.
Host: And how often does HPV lead to cervical cancer? Is that rare? Or does that happen a lot?
Dr. Alagakiozidis: For HPV to lead to invasive cervix cancer, there is a process that it may last for years or decades. There is a process of tradition for persistent HPV infection to pre-invasive cervical dysplasia, then eventually cervical cancer. A possibility that this sequence of events will eventually lead to cervical cancer. It depends on several factors. The patient's immune system is an important factor. And this is an area that we don't have a lot of information at this point. So, it's not clear. You know, what are the factors that will affect this process from persistent HPV infection to preinvasive cervical neoplasia to invasive cervical cancer.
Host: Now, how often do you recommend then that somebody is at high risk be tested with a PAP test or whatever other tests you'd recommend?
Dr. Alagakiozidis: Based on the existing guidelines, testing with cytology should be or should be performed every three years. While testing with a combination of cytology and HPV should be done every five years. These refers to the average risk population and the testing should be extended up to the age of 65.
For high risk patients, such as patients with HIV, screening protocol differs. And the age that the screening should be continued is over the age of 65. For those patients, the screening strategies will be formed in an individualized based, after discussion with the patient.
Host: Now is HPV also dangerous for men?
Dr. Alagakiozidis: Yes, HPV as a sexually transmitted virus can affect both men and women. It has been shown that, HPV can increase the risk for penile cancer for men. The incidence of this cancer is far less than the incidence of cervical cancer in women. Okay. But indeed, a HPV can affect men and can also increase, their risk for genital cancer.
Host: And how do you test men for this?
Dr. Alagakiozidis: This falls into the area of urology and I think the urologists and the pediatricians are the ones that will screen for and diagnose these malignancies. To my knowledge, there is no screening test for, these type of cancers in men. This may have to do with the number of factors. For instance, the low incidence of this cancer is the most relevant factor that comes into my mind. But more details on this could be given by the urology colleagues.
Host: So, HPV can cause other types of cancer too, such as cancer of your tonsils and maybe the back of your throat?
Dr. Alagakiozidis: Indeed. HPV can also affect those areas and can lead to a process of carcinogenesis in these areas and the upper respiratory tract.
Host: So, let's say you do have HPV. How is it treated? Can you get rid of it?
Dr. Alagakiozidis: There is no antiviral treatment that will eliminate the HPV infection. The management strategy that we follow is to try to prevent the most significant sequel of HPV infection, which is cancer.
Host: And what is the best way finally, to prevent a transmission of HPV?
Dr. Alagakiozidis: As stated, HPV is a sexually transmitted disease and therefore, prevention comes through lifestyle changes that decrease the risk for sexual transmission. So, this can be the use of safe sex practices and all factors that would decrease the possibility of sexual transmission.
Host: But what I'm really thinking then is if a woman has this, for example, not to transmit it to her partner, it'd be important to use a condom or vice versa if a man has it.
Dr. Alagakiozidis: Of course. Yeah, this falls into the safe sex practices modifications.
Ioannis Alagkiozidis, MD (Guest): modifications.
Host: Is there anything else you'd like to tell us, sir?
Dr. Alagakiozidis: , just, try to relay the point that cervix cancer is a preventable cancer and the combination of effective screening strategy through cytology and HPV testing, with the vaccination for HPV, has decreased the incidence and the mortality of cervix cancer dramatically. Over the past 50 years there have been a decrease, of about 75% in the incidence and the mortality of cervix cancer, through these two interventions; effective screening and HPV vaccination. So, it's very important message to relate to the community that screening for cervix cancer is of paramount importance and also HPV vaccination for the young adults and the children is critical in order to prevent this disease and hopefully eliminate this disease in the future.
Host: Yes. That's the one thing I guess we didn't talk about is that particularly young girls now, and maybe boys too, can be vaccinated for HPV.
Dr. Alagakiozidis: Yes. There is HPV vaccine that is available to children and young adults from the age of nine after the age of 26. And it has been demonstrated that it decreases the risk for preinvasive disease of the cervix and also other conditions that are associated with HPV virus, such as condylomas. It's a very effective way to prevent cervical dysplasia and cervical cancer and it should be recommended to all children and young adults up to the age of 26.
Host: And that's both male and female?
Dr. Alagakiozidis: Exactly. That's a both for male and female. The incidence of genital malignancy in male is less than compared to female, but since it is a sexually transmitted, by targeting the HPV infection in male eventually decrease the incidence of cervical cancer in women by decreasing the possibility of transmission of t HPV virus.
Host: One more question on this vaccination, if you just happen to be an adult walking around later in life, and trying to avoid this and you've been tested and you don't have it, would it be a good idea for someone who's older to get this vaccination?
Dr. Alagakiozidis: There is a window of opportunity to vaccinate older adults over the age of 26. Currently, there is a recommendation to vaccinate up to the age of 45. This will be relevant for some patients that may not have been exposed to the virus previously. So, in many cases, it will be reasonable to consider this option. Sometimes it's difficult to get approval through the patient's insurance to cover for the vaccine in older adults. But, definitely specific patients that have not had an HPV infection, HPV vaccine can be recommended in older ages.
Host: Well, that sounds very hopeful. Thank you so very much for talking with us.
Dr. Alagakiozidis: Thank you. Thank you. It was my pleasure.
Host: Dr. Ioannis Alagkiozidis is
the director of the gynecologic oncology department
Alyne Ellis (Host): at my Montes medical center,
Host: you can learn more about HPV and cancer at this link. Maimo.org/gynecologiconcology That's maimo.org/gynecologic oncology. is Maimo Med Talk. I'm your host Alyne Ellis. Thank you for listening.
The Relationship Between HPV and Cervical Cancer
Alyne Ellis (Host): Most of us are focused on the Coronavirus these days, but it's important to pay attention to another virus out there that has been around a lot longer, the human papilloma virus commonly called HPV. Undetected, it may lead to cervical cancer. Here to tell us women how to protect ourselves is Dr. Ioannis Alagkiozidis,
the director of the gynecologic oncology department at my monities medical center. This is Maimo Med Talk. I'm your host Alyne Ellis. Welcome Doctor.
Ioannis Alagkiozidis, MD (Guest): Well, thank you. Thank you for inviting me.
Host: Let's start with an understanding of what is HPV and how do you get it?
Dr. Alagakiozidis: HPV is a sexually transmitted virus. It can be transmitted in various stages of life through sexual activity. Actually, at this time, more than 50% of the people, men and women carry HPV. And it has been associated with a risk for cervical cancer.
Host: Does it have any symptoms when you first get it?
Dr. Alagakiozidis: Not really, HPV, it tends to cause an assymptomatic infection in the cervix predominantly, that can, stay in that assymptomatic condition for many years before evolving to precancerous or cancerous conditions with the cervix.
Host: And so how do you detect it?
Dr. Alagakiozidis: The goal here is to detect precancerous changes in the cervix. And this can be accomplished through screening strategies for cervix cancer. We have specific screening protocols that have been implemented through various associations. And those screening guidelines include screening through cytology, which is the PAP smear, or testing for the HP virus itself or the combination of the two. Following those screening guidelines, will increase the possibility of diagnosing precancerous conditions of the cervix.
Host: So, would it be your advice, for example, that not only would a woman have a pap smear, but also have a test specifically for HPV?
Dr. Alagakiozidis: There is different strategies for screening for precancerous conditions of the cervix. One strategy involves screening through cytology only. Through PAP smear only. An alternative to that is screening with both cytology and HPV testing. The time interval for each strategy is different, but both are very effective strategies in preventing cervix cancer. Either of them is a great option for women in order to prevent cervix cancer.
Host: And what about when a woman is older? Does the risk for cancer increase or some people can just ride it out and not get anything.
Dr. Alagakiozidis: It's typically acquired at any phase of a patient's life and all patients are at risk for HPV infection and the consequences of an HPV infection that can be precancerous conditions of the cervix or even invasive cervical cancer. Screening guidelines recommend continuation of screening up to the age of 65, based on certain criteria. For specific groups of patients that are at higher risk for cervical cancer, this age of 65 is not absolute and can be modified depending on the patient specific characteristics.
Host: So, how do you know if you're at a higher risk for cervical cancer?
Dr. Alagakiozidis: There is several risk factors that have been established. Most of them are associated with HPV infection. For instance, sexual activity, age that sexual activity was initiated, number of sexual partners, or, sexual activity of the partner; all have been associated with the increases for cervix cancer. Also, immunosuppression, illnesses that could does suppress the immune system. And the most commonly seen is HIV is another risk factor for cervix cancer. So, all these factors would increase the patient's risk of developing cervix cancer. And, they are being taken into consideration where a screening strategy is followed.
Host: And I'm assuming that also means that if you have that kind of cancer in your family, that might place you also at a higher risk or not?
Dr. Alagakiozidis: Family history is not a significant factor specifically for cervix cancer. Most strongly associated risk factor is HPV infection. Okay. And all other risk factors have been associated with HPV itself.
Host: And how often does HPV lead to cervical cancer? Is that rare? Or does that happen a lot?
Dr. Alagakiozidis: For HPV to lead to invasive cervix cancer, there is a process that it may last for years or decades. There is a process of tradition for persistent HPV infection to pre-invasive cervical dysplasia, then eventually cervical cancer. A possibility that this sequence of events will eventually lead to cervical cancer. It depends on several factors. The patient's immune system is an important factor. And this is an area that we don't have a lot of information at this point. So, it's not clear. You know, what are the factors that will affect this process from persistent HPV infection to preinvasive cervical neoplasia to invasive cervical cancer.
Host: Now, how often do you recommend then that somebody is at high risk be tested with a PAP test or whatever other tests you'd recommend?
Dr. Alagakiozidis: Based on the existing guidelines, testing with cytology should be or should be performed every three years. While testing with a combination of cytology and HPV should be done every five years. These refers to the average risk population and the testing should be extended up to the age of 65.
For high risk patients, such as patients with HIV, screening protocol differs. And the age that the screening should be continued is over the age of 65. For those patients, the screening strategies will be formed in an individualized based, after discussion with the patient.
Host: Now is HPV also dangerous for men?
Dr. Alagakiozidis: Yes, HPV as a sexually transmitted virus can affect both men and women. It has been shown that, HPV can increase the risk for penile cancer for men. The incidence of this cancer is far less than the incidence of cervical cancer in women. Okay. But indeed, a HPV can affect men and can also increase, their risk for genital cancer.
Host: And how do you test men for this?
Dr. Alagakiozidis: This falls into the area of urology and I think the urologists and the pediatricians are the ones that will screen for and diagnose these malignancies. To my knowledge, there is no screening test for, these type of cancers in men. This may have to do with the number of factors. For instance, the low incidence of this cancer is the most relevant factor that comes into my mind. But more details on this could be given by the urology colleagues.
Host: So, HPV can cause other types of cancer too, such as cancer of your tonsils and maybe the back of your throat?
Dr. Alagakiozidis: Indeed. HPV can also affect those areas and can lead to a process of carcinogenesis in these areas and the upper respiratory tract.
Host: So, let's say you do have HPV. How is it treated? Can you get rid of it?
Dr. Alagakiozidis: There is no antiviral treatment that will eliminate the HPV infection. The management strategy that we follow is to try to prevent the most significant sequel of HPV infection, which is cancer.
Host: And what is the best way finally, to prevent a transmission of HPV?
Dr. Alagakiozidis: As stated, HPV is a sexually transmitted disease and therefore, prevention comes through lifestyle changes that decrease the risk for sexual transmission. So, this can be the use of safe sex practices and all factors that would decrease the possibility of sexual transmission.
Host: But what I'm really thinking then is if a woman has this, for example, not to transmit it to her partner, it'd be important to use a condom or vice versa if a man has it.
Dr. Alagakiozidis: Of course. Yeah, this falls into the safe sex practices modifications.
Ioannis Alagkiozidis, MD (Guest): modifications.
Host: Is there anything else you'd like to tell us, sir?
Dr. Alagakiozidis: , just, try to relay the point that cervix cancer is a preventable cancer and the combination of effective screening strategy through cytology and HPV testing, with the vaccination for HPV, has decreased the incidence and the mortality of cervix cancer dramatically. Over the past 50 years there have been a decrease, of about 75% in the incidence and the mortality of cervix cancer, through these two interventions; effective screening and HPV vaccination. So, it's very important message to relate to the community that screening for cervix cancer is of paramount importance and also HPV vaccination for the young adults and the children is critical in order to prevent this disease and hopefully eliminate this disease in the future.
Host: Yes. That's the one thing I guess we didn't talk about is that particularly young girls now, and maybe boys too, can be vaccinated for HPV.
Dr. Alagakiozidis: Yes. There is HPV vaccine that is available to children and young adults from the age of nine after the age of 26. And it has been demonstrated that it decreases the risk for preinvasive disease of the cervix and also other conditions that are associated with HPV virus, such as condylomas. It's a very effective way to prevent cervical dysplasia and cervical cancer and it should be recommended to all children and young adults up to the age of 26.
Host: And that's both male and female?
Dr. Alagakiozidis: Exactly. That's a both for male and female. The incidence of genital malignancy in male is less than compared to female, but since it is a sexually transmitted, by targeting the HPV infection in male eventually decrease the incidence of cervical cancer in women by decreasing the possibility of transmission of t HPV virus.
Host: One more question on this vaccination, if you just happen to be an adult walking around later in life, and trying to avoid this and you've been tested and you don't have it, would it be a good idea for someone who's older to get this vaccination?
Dr. Alagakiozidis: There is a window of opportunity to vaccinate older adults over the age of 26. Currently, there is a recommendation to vaccinate up to the age of 45. This will be relevant for some patients that may not have been exposed to the virus previously. So, in many cases, it will be reasonable to consider this option. Sometimes it's difficult to get approval through the patient's insurance to cover for the vaccine in older adults. But, definitely specific patients that have not had an HPV infection, HPV vaccine can be recommended in older ages.
Host: Well, that sounds very hopeful. Thank you so very much for talking with us.
Dr. Alagakiozidis: Thank you. Thank you. It was my pleasure.
Host: Dr. Ioannis Alagkiozidis is
the director of the gynecologic oncology department
Alyne Ellis (Host): at my Montes medical center,
Host: you can learn more about HPV and cancer at this link. Maimo.org/gynecologiconcology That's maimo.org/gynecologic oncology. is Maimo Med Talk. I'm your host Alyne Ellis. Thank you for listening.