Among women aged 15 to 44 in mainland China, cervical cancer is the third most common malignant tumor, and has become the second largest cause of cancer death in women of this age group in mainland China, and the incidence of cervical cancer in mainland China is younger and rising.
However, cervical cancer is currently the only cancer in the world with a clear etiology, early detection, early prevention and early treatment! It takes years or even decades to develop HPV infection into cervical cancer, and early screening and early treatment are particularly important for health.
Regarding HPV, HPV vaccine, cervical cancer and the relationship between the three, there must be many people who have questions: will HPV infection inevitably lead to cervical cancer? Is the HPV vaccine still useful after age? Already have sex, does the HPV vaccine still work? Can I get the HPV vaccine during pregnancy? ......
Dr. Zhu Honglan, deputy chief physician of Peking University People's Hospital- Gynecology Department of Peking University, specially invited to this issue of Dr. Zhu Honglan to explain to us: what you should know about cervical cancer prevention and HPV vaccine.
Cervical cancer at high risk with early symptoms
Cervical cancer, also known as cervical invasive carcinoma, referred to as cervical cancer, is gradually developed from precancerous lesions, and is currently the only malignant tumor with clear etiology (HPV infection) that can be prevented.
According to Dr. Zhu Honglan, cervical cancer is a common gynecological malignancy, the incidence rate ranks second in female malignant tumors, China has 131,500 new cases every year, and 53,000 deaths per year, accounting for 18.4% of all female malignant tumor deaths.
The central and western regions are high-incidence areas for cervical cancer, and the countryside is higher than the city, and the mountainous area is higher than the plain.
Cervical cancer is unique to three
The only cause is clear
The only one that can be prevented and treated early
The only cancer that can be basically eliminated
The high incidence age of cervical cancer in situ is 30-35 years old, and the high incidence age of invasive carcinoma is 45-55 years old, and there has been a trend of rejuvenation in recent years.
People at high risk of cervical cancer
People at high risk of HPV infection
Have a history of HIV infection or sexually transmitted diseases
smoker
Early childbirth
Prolific
Start sex too early (
Multiple sexual partners
High-risk men: suffering from penile cancer, prostate cancer, and their sexual partners have had cervical cancer
Reduced immunity
Previously treated for precancerous cervical lesions
Early cervical cancer generally has no obvious symptoms, and as the disease progresses, vaginal bleeding, increased vaginal secretions, urinary frequency, urgency, constipation, pain and other symptoms may occur.
Common symptoms
Contact bleeding: after sex
Irregular vaginal bleeding: intermenstrual bleeding, postmenopausal bleeding
Abnormal vaginal discharge: increased vaginal discharge, abnormal discharge Serous discharge, late stage: rice swill, watery
Cervical cancer screening is effective in reducing the incidence of cervical cancer. Cervical cancer occurs in women who have never been screened or under-screened, and about 50% of cervical cancer patients have never had cervical cytology, and 10% of patients have not been screened within 5 years before diagnosis.
(There is a huge gap between China's cervical cancer screening coverage rate and developed countries)
After the widespread adoption of cervical cancer screening in the United States, the incidence of cervical cancer has decreased by more than 50% over the past 30 years.
A significant reduction in the incidence of cervical cancer may not be seen until 20 years after the widespread use of the HPV vaccine. Cervical cancer screening and treatment of precancerous lesions and early cervical cancer remain the best means to reduce cervical cancer mortality.
The WHO Basic Practical Guidelines for Integrated Cervical Cancer (Second Edition) clearly state that every woman of appropriate age is recommended to have at least one cervical cancer screening.
(Significance of cervical cancer screening)
Cervical cancer screening methods include: 1) cervical cytology: TCT or LCT; 2) HPV test.
According to the age characteristics of cervical cancer onset in mainland China, the recommended starting age of screening is 25 to 30 years old (married or sexually active).
HIV-infected people or immunocompromised women may advance as appropriate.
The recommended screening intervals are as follows:
Women 25 to 29 years: Cytology every 3 years.
Women aged 30 to 65 years may choose any of the following options for screening:
Cytology and HR-HPV testing every 5 years;
1 cytology examination is performed individually every 3 years;
HR-HPV testing is performed separately every 3 to 5 years;
VIA screening is performed every 2 years.
Women over 65 years of age: those who have had 3 consecutive cytological tests negative every 3 years in the past 10 years, or 2 or more consecutive HPV tests and cytological tests negative every 5 years, and no history of cervical intraepithelial tumors, stop screening. Women (removed due to benign lesions) may not be screened after total hysterectomy.
What is HPV?
HPV is an abbreviation for The Human Papilloma Virus, so named for its ability to cause a variety of benign papillomas or warts. The virus gene family is huge, there are more than 300 subtypes of HPV known, more than 200 species can infect humans, easy to infect the human epidermis and mucosal squamous epithelium.
According to the size of the pathogenic force or the size of the carcinogenic risk of each genotype, HPV virus can be divided into high-risk and low-risk types. Most people infected with HPV are asymptomatic, but some of these infections can cause health problems.
High-risk HPV: persistent infection and high viral load can lead to cervical cancer and precancerous lesions (CIN I-CIN III). There are 13 common high-risk hpvies, namely HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 66.
Low-risk HPV (LR-HPV) infection can cause benign lesions such as genital warts and recurrent respiratory papillomatosis. Common low-risk HPVs are HPV 1-4\6\7\10\11\13\28\32\41\42-44 and so on.
Studies have found that 80% of > CIN, 95% of cervical squamous cell carcinomas >, 90% of cervical adenocarcinomas > have HPV infection, and 75% of cervical cancers in mainland China are caused by HPV16 and 18.
HPV route of infection
Genital HPV infection is more often transmitted through sexual contact
Viral particles within exfoliated stratum corneal cells or squamous epithelial cells are released, in direct contact with the site of the lesion, or indirectly with contaminant products
Asymptomatic latent infection of the genital tract of HPV has become the main source of HPV infection, which is a very common cause of HPV infection
Infection with carcinogenic (or high-risk) HPV is a necessary but inadequate condition for cervical intraepithelial neoplasia. HPV infection is common in adolescents and women in their 20s, and the rate of infection decreases as they age.
Most HPV infections are transient. Most young women (
A small number of infections are persistent, regardless of age, and persistent infection for 1 and 2 years strongly predicts the risk of progression to CIN3 or cervical cancer.
Only a small percentage of women infected with HPV develop severe cervical lesions or cervical cancer.
Most transient infections will be cleared within 12 months, according to different research reports, 60% of HPV-positive, liquid-based cytology-negative women will clear the infection within 6 months, 67% of patients will clear the HPV infection within 1 year, 47% of women will continue to be HPV-positive within 1 year, and 21% of those who have been infected for 1 year will develop CIN2 or higher grade lesions within 3-4 years.
Risk factors for persistent infection
HPV genotyping: the most important determinant of persistent HPV infection and disease progression
HPV-16 has the strongest carcinogenic potential, with approximately 55-60% of all cervical cancer cases worldwide associated with it
HPV-18 is the only one, with 10-15% of patients associated with it
Known synergistic factors also include: smoking, immune system deficiencies, and HIV infection.
women > 30 years of age are more likely to present with persistent HPV infection
How to prevent HPV infection?
HPV infection is mainly transmitted through sexual transmission, in addition to towels, bedpans, etc. may also lead to transmission, in life, the prevention of HPV infection is mainly concentrated in the following aspects:
Improves immunity: diet, sleep, exercise, mood
Eliminate unclean sexual behavior: condoms, fixed sexual partners
Avoid indirect transmission: hygiene habits, not using other people's clothes, bathing, washing hands, disinfection
Suspend sexual activity if necessary
Get vaccinated against HPV
To be clear, HPV positive does not necessarily lead to cervical cancer, so don't worry about it. Only high-risk HPV infection can lead to cervical cancer, and most people are infected with HPV for a period of time, and the body's immunity will clear the virus.
Even if high-risk HPV infection persists, if regular screening, cervical lesions will be found in time and treated in time, and less than 1% of infected people will develop cervical precancerous lesions and cervical cancer.
When HPV is positive, a combination of screening, TCT/LCT+HPV testing, and colposcopic biopsy if necessary. If it is only HPV infection and no cervical lesions, regular review is sufficient.
If cervical low-grade squamous intraepithelial lesions: follow up semi-annually. Persists for 2 years without subsidation, further treatment. If there is a high-grade squamous intraepithelial lesion of the cervix, cervical LEEP or cold knife cone is required.
Regarding the issue of pregnancy preparation, Dr. Zhu Honglan said that HPV positivity itself does not affect pregnancy, but if it causes cervical lesions, it will affect pregnancy, and even aggravate the lesions during pregnancy.
If it is only a simple HPV infection, there is no lesion in the cervix, and you can try to conceive. If it is HPV infection + high-grade cervical lesions, it is necessary to surgically remove the lesions first, follow up regularly, and only after half a year of no abnormalities can you prepare for pregnancy;
HPV vaccination is effective in preventing cervical cancer
Almost all cervical cancers are caused by persistent infection with high-risk HPV, the most common of which are HPV16 and 18, so HPV vaccination is effective in preventing cervical cancer.
At present, the HPV vaccines that can be developed and listed include domestic bivalent (Cinchone), imported bivalent (GlaxoSmithKline in the United Kingdom), imported four-price and imported nine-priced (Merck Company in the United States).
The nine-valent HPV vaccine is made by highly purified and mixed virus-like particles composed of the main capsid proteins of HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58. The vaccine is suitable for women aged 16 to 26 years, can prevent 90% of cervical cancer, and is currently the most comprehensive vaccine.
Bivalent vaccines target HPV16 and 18, and international research data show that more than 70% of cervical cancers are caused by these two viruses.
Quadrivalent vaccines can prevent HPV 6, 11, 16, and 18 infections, and although HPV 6 and HPV 11 are not high-risk hpV viruses for cervical cancer, they can cause genital warts in the vulvar. Both quadrivalent and bivalent are suitable for women aged 9 to 45 years.
The earlier the HPV vaccine, the better, preferably before sex, WHO says 9 to 14 years old is the best age to vaccinate against HPV. The priorities are as follows: girls over 9 years of age who have not started sex> women who have already had sex> boys> men.
If pregnancy is discovered after HPV vaccination, there is no need to terminate the pregnancy due to this vaccination, and the unfinished vaccination can be continued after childbirth.
Vaccination is possible during lactation, but is generally not recommended if there are no cervical lesions on preconception tests.
Relevant studies have shown that the protection time of HPV vaccine can be as long as 4 years, and the antibody levels of HPV 16 and 18 in the body after 8.4 years of follow-up after vaccination are still more than 10 times the baseline level, but its lifelong protective effect is unknown.
Finally, it should be noted that the HPV vaccine does not prevent all types of HPV infection, no vaccine is 100% effective, and even if the HPV vaccine is vaccinated, cervical cancer screening is carried out regularly.
Interactive Q&A session
Q
How soon does high-risk HPV infection turn into cervical cancer?
Dr. Zhu Honglan: First of all, it is not as long as you are infected with cervical cancer, first look at the HPV model, if it is 16, 18, it is recommended to carry out joint screening, if there is no cervical lesion, regular review can be. Persistent high-risk HPV infection if never screened, may develop cancer after 5 years or 10 years, if regular screening, the lesion can be removed in time to avoid cervical cancer.
May I ask a 50-year-old woman infected with HPV, with interferon for a long time does not turn negative, in addition to interferon, is there any other treatment?
Dr. Zhu Honglan: First see which type of HPV, it is recommended to do a colposcopic biopsy first, if the biopsy is not a problem, just simple HPV infection, do not rush to use the drug, do a colposcopy once a year can be done; if there is still some vaginal inflammation, you can cooperate with anti-inflammatory drugs, improve the body's immunity, help the body clear HPV.
How do the three HPV vaccines differ in their preventive effects?
Dr. Zhu Honglan: Nine-valent coverage of HPV subtypes is more, the scope of protection will be wider, if the age is not caught up, has exceeded 26 years old, vaccination with quadrivalent and bivalent vaccines is also enough.
What symptoms should be paid attention to after menopause?
Dr. Zhu Honglan: If there is vaginal bleeding after menopause, it must be paid attention to, and postmenopause is a high incidence stage of various tumors, and it is necessary to continue to conduct gynecological screening regularly.
What should I pay attention to after vaccination?
Dr. Zhu Honglan: General vaccination sites will tell you, such as vaccination sites for 24 hours do not touch water, do not eat spicy and irritating food, if there is fever and discomfort to see a doctor in time, in addition, even if the vaccine should pay attention to regular screening.
Does HPV infection in a woman affect her spouse?
Dr. Zhu Honglan: If there is no protective measures for sexual life, men may also be infected with HPV, so it is recommended to have no room during the treatment period, or use condoms to do protective measures throughout the process.
Could pool water be one of the ways of infection?
Dr. Zhu Honglan: The possibility of this infection is very low, on the one hand, hpv virus survival requires conditions, on the other hand, the mucous membrane is damaged before it can be infected.
Go to the hospital for early cervical cancer screening, but it seems that you need to take a small piece of tissue from the cervix for pathological examination, feel quite painful, there are other convenient, painless screening methods?
Dr. Zhu Honglan: Early cervical cancer screening will be performed TCT/LCT and HPV testing, both of which are painless, and only after the problem is found, will further colposcopic biopsy be performed.
Does the virus affect the fetus? Mother-to-child transmission?
Dr. Zhu Honglan: If it is a high-risk type, causing cervical cancer or precancerous lesions, it will not be transmitted from mother to child, and if it is a low-risk type, such as a disease that causes genital warts, it may be transmitted to the newborn through vaginal delivery.
Edit: Dr. Spring Rain
Image source: Expert live courseware