HPV Vaccination &
Cervical Cancer Screening
Cervical Cancer Screening
HPV Vaccine Overview
Human papillomavirus (HPV) is a virus that causes cervical cancer and genital warts. Three HPV vaccines (brand names: Gardasil, Gardasil-9, and Cervarix) are globally available to prevent infection with types of HPV known to cause cervical cancer. These vaccines are safe, and they reduce the incidence of cervical abnormalities (“pre-cancer”) that can lead to cancer.
- Bivalent (Cervarix: effective against HPV 16, 18),
- Quadrivalent (Gardasil: effective against HPV 6, 11, 16 & 18),
- Nanovalent (Gardasil 9: effective against nine high risk virus)
Out of these three vaccines, quadrivalent is easily available in India. It is 95-100% efficacious to provide protection against HPV 16 & 18 infection (if given before the HPV infection or starting of sexual activity). In short, HPV vaccine prevent cervical cancer because >83% cervical cancer associated with HPV 16 & 18 infection in Indian women. Additionally Gardasil provides protection against genital wards with efficacy of 99-100%. Nanovalent vaccine is not easily available in India.
What is hpv?
Human papillomavirus (HPV) is a virus that is spread by skin-to-skin contact, including sexual contact. There are more than 100 types of HPV virus. Among them HPV 16 & 18 type virus are responsible for cervical cancer in more than 83% cases.
Who should be vaccinated?
Maximum benefit of vaccination is achieved between 9 to 14 years of age in adolescent girls (as per American cancer society guidelines 2020).
– Females <15 years of age at the time of first dose: 2 dose schedule (0, 6 months) is recommended. (If interval between doses is shorter than 5 months then 3rd dose should be given at least 6 month after the first dose).
-Female ≥15 years of age at the time of first dose: 3 dose schedule (0, 2, 6 months) is recommended.
-If person with immunocompromised state or HIV infection (AIDS) then 3 dose schedule is necessary.
How long am I protected after HPV vaccination?
Information about how long the vaccine protects against HPV infection is not available. However, there has been no evidence to suggest that the HPV vaccine loses any ability to provide protection over time.
Do I need cervical cancer screening after HPV vacciantion?
As per guidelines, regular cervical cancer screening is generally recommended beginning at age 25 to 65 years of age .
However, getting the HPV vaccine does not mean that you can skip cervical cancer screening in the future. Cervical cancer screening is required because vaccine neither eliminates infections acquired prior to vaccination nor provides protection from uncommon type HPV virus infection.
HPV Vaccine side effects and Precautions
Like any medicine, vaccine can have side effects. Side effects are mild and get better within 1-2 days. HPV vaccine dose not have effect on fertility of young girls.
Common side effects are
– pain, redness or swelling at injection site
– fainting or dizziness (which happen with any vaccine)
– Headache or Nausea
– Muscle or Joint pain
The vaccine is not currently recommended during pregnancy, although there are no known risks to a fetus if the vaccine is given.
How effective is the vaccine?
Studies have shown that:
- HPV vaccination in females is very effective in preventing HPV infections and cervical abnormalities (pre-cancers lesion).
- HPV vaccination in females reduces the risk of genital warts.
- HPV vaccination in males reduces the risk of developing genital warts and penile HPV infection, which may decrease the spread of HPV to sexual partners.
- HPV vaccination also reduces the risk of anal cancer in both males and females.
Where to get more information.
Your health care provider is the best source of information for questions and concerns related to your specific medical problem.
The most important risk factor for cervical cancer is infection with the human papillomavirus (HPV). There are over 100 different types of HPV; however, most types of HPV do not cause cancer. In most cases, the body’s immune system clears the HPV virus infection before it does harm.
What is cervical screening and why is it important?
Cervical screening is procedure to detect potential cervical abnormalities or diseases by some test or examinations, in people who do not have any symptoms of disease.
In cervical cancer, there is interval of around 10 years from HPV infection to development of cervical cancer. In short, there is long period before cervical cancer development. Hence, regular check-up with screening test can detect cervical cancer in very early or precancerous stage. So, this will help your physician to provide better treatment in early stage of cancer.
Cervical cancer screening can be done with different methods.
There are two tests available for cervical cancer screening.
- HPV test (RT-PCR)
This is newer technique which detect HPV infection of cervix. This is preferred test for cervical cancer screening. As per screening guidelines, this test needs to be done every five years interval. This is more accurate in detection of HPV infection & precancerous cervical lesion in comparison with PAP smear.
- PAP smear test: Traditional method for cervical cancer screening. This is appropriate test for screening in resource poor setting. As per screening recommendation, this test needs to be done every three years interval. This is less sensitive to diagnose precancerous cervical lesion in comparison with HPV test.
Method for collection of sample for screening test
Sample collection technique is very easy & fast which may take around 3-5 minutes. It may be uncomfortable but usually it is not painful.
Who should be screened for Cervical Cancer and when?
According to ACS (American Cancer society 2020) guideline,
– Women from 25 to 65 years of age
– Screening should be done even after HPV vaccination
- HPV-only testing also called primary HPV testing) every five years if all results are normal (see ‘HPV test’ above)
- A Pap test every three years if all results are normal (see ‘Pap test’ above)
After age 65 — Most experts feel that many people can stop having cervical cancer screening after the age of 65, though it depends on their risk factors.
Screening test results
- Pap test — If a Pap test was done as part of your cervical cancer screening, the results from your Pap test will be available after 5-7 working days of your visit. Pap test results may be reported as:
– Negative – Pap tests that have no abnormal, precancerous, or cancerous cells.
– Abnormal results – Cervical cells may appear abnormal for a variety of reasons (e.g. cervical infection, precancerous area and cervical cancer).
- HPV test — If a human papillomavirus (HPV) test was done as part of your cervical cancer screening, the results will be available after 5-7 working days of your visit. The results may be reported as:
– Negative – There are no high-risk HPV strains present.
– Positive – There are high-risk HPV strains present.
Follow-up testing — If your Pap or HPV test results are abnormal, you may need follow-up testing; the best strategy will depend on several individual factors.