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HPV & Cancer Risk
Good Afternoon Doctor,
I have become concerned after reading the post below from yesterday as this situation closely matches my own. Please don't think I'm questioning your advice, I know you're both leaders in your field and respect your opinions greatly.
http://www.medhelp.org/personal_pages/my_home
However, as this gentleman seems to be worried about, having checked some of the official UK sites it seems that it’s felt that regular pap screening isn’t as effective as you suggest? Some quotes below:
- ‘Regular cervical screening can prevent about 7/10 cervical cancers developing but it does not prevent every case’ - Macmillan Cancer Trust
- Early detection & treatment can prevent around 75% of cancers developing’ – NHS
- Cervical Cancer Screening is 80% - 90% reliable and can prevent 70% of cases. This means that approx 7 cases can be prevented out of every 10 who would have developed cancer of the cervix.” – Jo’s Trust
Like the gentleman who posted yesterday, these figures don’t read particularly well and it suggests that if my female partner were to have been infected with a higher risk strain of HPV that doesn’t clear on it’s own then there is a 30% chance of her developing cervical cancer?
Specific Questions:
- Would you agree that this information on official UK sites is confusing and not aligned to your advice that essentially if a female partner is screened at regular 3 yearly intervals that she is safe for all practical purposes? Am i missing something obvious?
- I have had unprotected sex 20 times with my partner after getting back with her after a short split in which I had a string of unprotected encounters. Would it be too late now for me to worry about infecting my partner with HPV anyway as I would have passed any infection on already?
- Why is it always mentioned that partners will have most likely had it in the past – is this because if they’ve already had a particular strain they can’t get it again?
Many thanks
I have become concerned after reading the post below from yesterday as this situation closely matches my own. Please don't think I'm questioning your advice, I know you're both leaders in your field and respect your opinions greatly.
http://www.medhelp.org/personal_pages/my_home
However, as this gentleman seems to be worried about, having checked some of the official UK sites it seems that it’s felt that regular pap screening isn’t as effective as you suggest? Some quotes below:
- ‘Regular cervical screening can prevent about 7/10 cervical cancers developing but it does not prevent every case’ - Macmillan Cancer Trust
- Early detection & treatment can prevent around 75% of cancers developing’ – NHS
- Cervical Cancer Screening is 80% - 90% reliable and can prevent 70% of cases. This means that approx 7 cases can be prevented out of every 10 who would have developed cancer of the cervix.” – Jo’s Trust
Like the gentleman who posted yesterday, these figures don’t read particularly well and it suggests that if my female partner were to have been infected with a higher risk strain of HPV that doesn’t clear on it’s own then there is a 30% chance of her developing cervical cancer?
Specific Questions:
- Would you agree that this information on official UK sites is confusing and not aligned to your advice that essentially if a female partner is screened at regular 3 yearly intervals that she is safe for all practical purposes? Am i missing something obvious?
- I have had unprotected sex 20 times with my partner after getting back with her after a short split in which I had a string of unprotected encounters. Would it be too late now for me to worry about infecting my partner with HPV anyway as I would have passed any infection on already?
- Why is it always mentioned that partners will have most likely had it in the past – is this because if they’ve already had a particular strain they can’t get it again?
Many thanks
MEDICAL PROFESSIONAL
US screening recommendations recently were changed and are now quite close to those used in the UK. I'm sure both approaches are similarly effective.
Thanks Doctor, I assumed the same with your thoughts about the 7/10 figure but it's on NHS & Macmillan Cancer (major UK Cancer Charity sites) hence the concern. To close this thread it would be appreciate if you could just confirm that the US screening procedure is no more effective than the UK as I wonder if this could explain a higher rate of cervical cancer in the UK and thus the 7/10 prevention figur or are both countried roughly the same in the occurrence of cervical cancer?
Thanks for your advice and I assure you that this will end the thread.
Thanks for your advice and I assure you that this will end the thread.
MEDICAL PROFESSIONAL
I dont' know the source of the 70% statistic you report and I don't believe it. But if it is accurate, then it has to be CIS, not invasive cancer. If it were the latter, the rate of invasive cervical cancer would have to be much higher than it is.
Yes, paps detect carcinoma in situ.
Oral sex is lower risk for HPV than genital intercourse, both in frequency of transmission and likelihood of any significant health problem.
As I already said, it s believed that people are immune (or at least highly resistant) to HPV strains with which they have been infected. Therefore, repeated exposure in a couple is not believed to result in repeated transmission.
Having genital HPV, including repeated infections, is a normal consequence of human sexuality and has always been so. It is similar to carrying staph and strep on our skin. Those bacteria are normal and unavoidable, and most of the time cause no problem -- even though they sometimes cause serious and even fatal infections. HPV is much the same. It isn't worth obsessing about. Follow the advice I suggested above and then forget about it.
That will wind up this thread. I hope you can move on without worry.
Yes, paps detect carcinoma in situ.
Oral sex is lower risk for HPV than genital intercourse, both in frequency of transmission and likelihood of any significant health problem.
As I already said, it s believed that people are immune (or at least highly resistant) to HPV strains with which they have been infected. Therefore, repeated exposure in a couple is not believed to result in repeated transmission.
Having genital HPV, including repeated infections, is a normal consequence of human sexuality and has always been so. It is similar to carrying staph and strep on our skin. Those bacteria are normal and unavoidable, and most of the time cause no problem -- even though they sometimes cause serious and even fatal infections. HPV is much the same. It isn't worth obsessing about. Follow the advice I suggested above and then forget about it.
That will wind up this thread. I hope you can move on without worry.
Thanks for the above detail Doctor, very useful. However, I might have not articulated myself well enough as my confusion was around the fact that the UK sites aren't talking about PAP screening reducing the number of invasive cases by 75% or each specific test being 70% sensitive, the sites I've quoted suggest that even if people are screened regularly, for those that may be at risk (ie. high risk HPV carriers) PAP screening will only prevent 7/10 cancers from developing - this then reads that if you were a carrier iof a more serious strain of HPV that doesn't clear on its own there is a 30% chance of you developing cervical cancer?
A couple of questions on this and for further clarification arising from your response:
- Do you think the fact that these sites talk about 'cancer developing' they're likely to be talking about CIS as you mention and not invasive cancer? My worry from how the quotes read is that there is a 30% chance of invasive cancer for those at risk even for those who have regular PAPs
- Does the PAP smear detect CIS as well? If not how would this be detected? My understanding was that a PAP detects pre-cancerous cells only.
- Like the other recent poster, I had a recent break from my partner and had 4 separate encounters with different women. 3 of which were cunnilingus only, is there a real risk that I could have pickled up a higher risk strain of HPV from performing cunnlingus that I could have past to my partner now that we are back together, or is this theoretical only?
- Is it possible to contiinually infect a partner with the same HPV strain whilst she carries it thus making it more difficult to clear - ie. if i had passed HPV16 to my partner, could I infect her multiple times with the same strain or is it a case of once you have it you have it?
Thanks for your clarification on these points Doctor,
A couple of questions on this and for further clarification arising from your response:
- Do you think the fact that these sites talk about 'cancer developing' they're likely to be talking about CIS as you mention and not invasive cancer? My worry from how the quotes read is that there is a 30% chance of invasive cancer for those at risk even for those who have regular PAPs
- Does the PAP smear detect CIS as well? If not how would this be detected? My understanding was that a PAP detects pre-cancerous cells only.
- Like the other recent poster, I had a recent break from my partner and had 4 separate encounters with different women. 3 of which were cunnilingus only, is there a real risk that I could have pickled up a higher risk strain of HPV from performing cunnlingus that I could have past to my partner now that we are back together, or is this theoretical only?
- Is it possible to contiinually infect a partner with the same HPV strain whilst she carries it thus making it more difficult to clear - ie. if i had passed HPV16 to my partner, could I infect her multiple times with the same strain or is it a case of once you have it you have it?
Thanks for your clarification on these points Doctor,
MEDICAL PROFESSIONAL
Noted.
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
I disagree with your negative interpretation of pap smear performance and UK guidance on pap smears. First, widespread pap testing has been almost single-handedly responisible for roughly a 75% reduction in invasive cervical cancer in the US, UK, and other industrialized countries -- from around 40 cases (up to the 1960s) to around 10 cases per 100,000 women per year currently. The remaining cases are almost entirely in women who don't get regular pap smears; they are not the result of failure of paps to pick up cases.
Second, as Dr. Hook said, 70% sensitivity for a single pap in picking up cancer or pre-cancerous changes translates to well over 90% in women who have several pap smears over the years. Third, when a pap "fails" and cancer is then detected, it has rarely progressed to a point that carries any danger. It is only invasive cancer that presents any important health risk, not simply the presence of cancerous cells ("carcinoma in situ") -- and the average time from CIS to invasive cancer is several years, providing an additional margin of safety.
Finally, the pap guidelines (in both the UK and more recently in the US) also take into account patients' ages. Cervical cancer (both CIS and invasive) is rare before age 30 (and especially before 25) and also becomes increasingly uncommon as women age beyond 45-50 -- part of the reason for safety in stopping routine paps after a few negative tests.
Obviously, paps aren't perfect, and nobody recommends paps as the only strategy to prevent cervical and other genital cancers. The development of effective HPV vaccines is an extremely important development. It will have its main benefit in countries where health infrastructures and costs prevent widespread pap, but will also have important benefits in industrialized countries.
We don't really know how quickly HPV is shared in relationships, but after several episodes of unprotected vaginal sex, if one partner has genital HPV, the other can expect to have been infected.
As for "most partners" having had HPV in the past, don't confuse whether Dr. Hook or I are speaking about HPV in general (in which case the statement is obviously true) or about a specific HPV type, in which case it may or may not be true, depending on the circumstances in a forum user's particular question. It is also true that repeat infection with the same HPV type appears to be uncommon, if it occurs at all.
The bottom line is that all persons should be immunized against HPV, preferably before they become sexually active (i.e. as pre- or early-teens), or up to age 26; women should follow standard pap smear guidelines, in countries where that service is readily available; and condoms should be routine for new or casual, non-monogamous partnerships. And of course every person should be aware of his or her body, and of course get unusual bumps, skin lesions, etc professionally examined. Together, these strategies will effectively prevent the vast majority of adverse health outcomes from HPV. Beyond those things, nobody should go through life worried about important health impacts from HPV.
Regards-- HHH, MD
I disagree with your negative interpretation of pap smear performance and UK guidance on pap smears. First, widespread pap testing has been almost single-handedly responisible for roughly a 75% reduction in invasive cervical cancer in the US, UK, and other industrialized countries -- from around 40 cases (up to the 1960s) to around 10 cases per 100,000 women per year currently. The remaining cases are almost entirely in women who don't get regular pap smears; they are not the result of failure of paps to pick up cases.
Second, as Dr. Hook said, 70% sensitivity for a single pap in picking up cancer or pre-cancerous changes translates to well over 90% in women who have several pap smears over the years. Third, when a pap "fails" and cancer is then detected, it has rarely progressed to a point that carries any danger. It is only invasive cancer that presents any important health risk, not simply the presence of cancerous cells ("carcinoma in situ") -- and the average time from CIS to invasive cancer is several years, providing an additional margin of safety.
Finally, the pap guidelines (in both the UK and more recently in the US) also take into account patients' ages. Cervical cancer (both CIS and invasive) is rare before age 30 (and especially before 25) and also becomes increasingly uncommon as women age beyond 45-50 -- part of the reason for safety in stopping routine paps after a few negative tests.
Obviously, paps aren't perfect, and nobody recommends paps as the only strategy to prevent cervical and other genital cancers. The development of effective HPV vaccines is an extremely important development. It will have its main benefit in countries where health infrastructures and costs prevent widespread pap, but will also have important benefits in industrialized countries.
We don't really know how quickly HPV is shared in relationships, but after several episodes of unprotected vaginal sex, if one partner has genital HPV, the other can expect to have been infected.
As for "most partners" having had HPV in the past, don't confuse whether Dr. Hook or I are speaking about HPV in general (in which case the statement is obviously true) or about a specific HPV type, in which case it may or may not be true, depending on the circumstances in a forum user's particular question. It is also true that repeat infection with the same HPV type appears to be uncommon, if it occurs at all.
The bottom line is that all persons should be immunized against HPV, preferably before they become sexually active (i.e. as pre- or early-teens), or up to age 26; women should follow standard pap smear guidelines, in countries where that service is readily available; and condoms should be routine for new or casual, non-monogamous partnerships. And of course every person should be aware of his or her body, and of course get unusual bumps, skin lesions, etc professionally examined. Together, these strategies will effectively prevent the vast majority of adverse health outcomes from HPV. Beyond those things, nobody should go through life worried about important health impacts from HPV.
Regards-- HHH, MD
Sorry Doctor, it might help if I attached the correct link to the post I refer to from yesterday! - Many thanks
http://www.medhelp.org/posts/STDs/Cervical-Cancer-Risk-/show/1772057
http://www.medhelp.org/posts/STDs/Cervical-Cancer-Risk-/show/1772057
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
