Cervical cancer, or cervical carcinoma as the technical term is known, develops as a result of infection with human papillomaviruses (HPV), of which HPV strains 16 and 18 are considered particularly critical. Tikbow spoke with a gynecology specialist about early detection, vaccination and prevention.
How to get HPV?
In the course of an HPV infection, cell changes can occur, especially in the area of the cervix. These so-called dysplasias can be the precursor of a breast-like disease. But how do you get infected? According to Dr. med. Jürgen Klinghammer, a specialist in gynecology, women who frequently change partners and do not protect themselves with a condom during sexual intercourse are particularly at risk. Men are primarily carriers of the virus, but in rare cases they also develop cancer, for example in the anus.
Depending on the individual’s immune system and general health status, HPV infection – and thus the risk of cervical cancer – may decline on its own. For this purpose, Dr. Klinghammer recommends to his patients, for example, lactic acid bacterial cures to build up and strengthen the vaginal flora. The risk of pathological cell changes increases if the vagina is not in balance or is colonized with other pathogens (bacteria, fungi).
No immunity after HPV infection is over
It is possible to be vaccinated against HPV and consequently against cervical cancer. The measure is recommended for young women before their very first sexual contact, as they cannot be HPV-positive at this time. Since 2007, health insurance companies have covered the costs of vaccination for girls between the ages of nine and 14, and in some cases even up to the age of 26. Since 2018, HPV vaccination has also been a health insurance benefit for 9- to 14-year-old boys.
Important: "Even if a woman or man is already sexually active and has already undergone infections with the human papilloma virus (HPV), an HPV vaccination can still be useful", explains the Professional Association of Womenärzte on the net. After an HPV infection one is – differently than for example after a measles illness – not immune: It can come again to an infection and consequently to an increased danger that Gebärmutterhalskrebs develops.
Skepticism about HPV vaccination apparently unfounded
According to Dr. Klinghammer, it is assumed that a single HPV vaccination is sufficient to provide immunity for a lifetime. It is therefore all the more incomprehensible that only a few girls and women in Germany take advantage of this opportunity. In connection with HPV the "Ärzteblatt" explains this "Impfmüdigkeit" with circulating rumors, the vaccines could "cause chronic Müdigkeit or even autoimmune diseases such as multiple sclerosis (MS) as side effects". In the meantime, however, it is known that the HPV vaccines on the market are safe and well tolerated.
Also according to Dr. Klinghammer’s assessment, there is no risk of significant side effects, "at most local irritation at the injection site". Since 2007, the Standing Commission on Vaccination (STIKO) has recommended HPV vaccination for girls, and since 2018 also for boys. Professional associations such as the German Cancer Foundation welcome this recommendation and are strongly in favor of vaccination.
Regular screening important
In general, women should go for regular gynecological cancer screening, usually one appointment per year is sufficient. With HPV, a so-called Pap test is advised every six months, which is performed with a so-called portio smear. The gynecologist scrapes cells from the cervical canal with a small brush and prepares this sample so that it can be sent to the laboratory, where it can be analyzed for an existing HPV infection or for pathological changes.
The results are given in numbers, in ascending order of concern: Pap 1 stands for an undetectable finding, Pap 2 for indications of inflammation or benign changes. From Pap 3 onwards, i.e. more severe inflammation and suspicious changes (dysplasia), which can develop in a benign manner, Dr. Klinghammer recommends special attention and closer follow-up every three to four months. "Dysplasia can develop into cancer at some point", the doctor says.
Treatment of cervical cancer
From Pap 4 on, one is dealing with cervical cancer or its preliminary stage. To confirm the diagnosis, the patient undergoes conization, i.e. a conical tissue sample is taken from the cervix and sent for histological examination. This is to remove any cells of concern and prevent the condition from worsening. "If only dysplasia is found during the evaluation, further treatment provides for regular checks as before", says Dr. Klinghammer. If it is cancer, a much more time-consuming operation may be required;
We are talking about the Wertheim-Meigs operation. This is usually performed through a large transverse or longitudinal incision in the abdominal cavity and involves the removal of the uterus as well as potentially affected lymph nodes. In the case of HPV infection, it may be advisable to follow up the procedure with radiation therapy.
Symptoms of HPV infection or cervical cancer
Sometimes HPV infection is accompanied by skin changes, such as warts in the genital area. In addition, the cell changes can make themselves felt with intermittent bleeding, discharge and discomfort/bleeding during sexual intercourse.
Dr. Klinghammer emphasizes that the risk of HPV infection increases with the number of changing sexual partners. Without existing vaccination protection, a condom should therefore be used as a matter of urgency – not only, but also to protect against cervical cancer.
- Ärzteblatt (2019): International cancer researchagency rejects reservations about HPV vaccination. (retrieved 23.08.2021)
- Professional Association of Womenärzte e.V. (2014): HPV vaccination also useful in adults. (retrieved 08/23/2021).
- German Cancer Foundation (2019): statement on HPV vaccination. (retrieved on 08/23/2021).
- Interview Ärztezeitung (2018): "We want HPV vaccination in schools". (retrieved 08/23/2021)
With expert advice from Dr. med. Jürgen Klinghammer, specialist in gynecology and obstetrics.