One of the most devastating experiences a physician faces is to see a patient with a condition that is completely preventable and treatable—but because the patient presented it too late in the course of the disease, that condition is no longer curable, or can only be partially treated even with the most invasive/aggressive techniques. Cervical cancer is exactly that kind of condition.
Cervical cancer is the result of an infection by the Human Papillomavirus (HPV)—anyone who is sexually active (including vaginal, anal, or oral sex) is at risk. Even having sex just once can put someone at risk, although repeated contact at a young age with different partners does pose a much higher risk.
There are many types of this virus, including about 40 that cause the majority of infections leading to cervical cancer in women and penile warts or cancer in men. Two of the types that are especially harmful (causing the most cancers) are HPV type 16 and 18. Cervical cancer is the second most common cancer in Vietnamese women after breast cancer.
HPV infection has two stages: (1) a person is exposed to it; and (2) the body responds to it. If it can fight the infection off, the person will not develop cancer; otherwise the HPV will overcome the person's immune system and cause cancerous changes in the person's normal cells and malignant transformation of those cells. It can take many years between exposure and the development of cancer.
“Wait a minute,” you might ask, “wouldn't I know if someone I'm having sex with someone who has a raging ‘HPV infection”?
Unfortunately, no—most people who have an HPV infection do not show any outward signs until it’s too late. First of all, the cervix where the infection/cancer initially occurs is not visible to the naked eye, being well-hidden inside the vaginal canal. Secondly, even where early malignant changes do occur, it is still not visible to the naked eye. Thirdly, this infection does not cause any symptoms until the cancer has progressed. Once that happens, symptoms such as irregular menstrual bleeding, bleeding after sex, and pain can occur, depending on the size and location of the cancer.
So what can be done to prevent or treat cervical cancer/penile warts in the early stages so that it doesn’t progress to a point that is harder to treat or incurable?
There are two methods—receiving the HPV vaccine, and detecting the onset of cancer at an early stage when it is completely curable (compared to cancer that has progressed to the later stages, becoming bigger in size and infiltrating the surrounding organs).
At this time, there are three vaccines that are FDA approved—all three of them targeting types 16 and 18, the most virulent strains of the HPV virus. Receiving one of these vaccines is recommended in the U.S. for girls and boys starting from 11 to 26 years old to help your body make antibodies that fight against HPV virus when your body is exposed to them, which is why it’s better to get it before someone becomes sexually active.
“So if I'm 21 years old and already have had sex, can I still benefit from this vaccine?”
Absolutely! Just because you’ve had sex already does not mean that you’ve been exposed to the strains of HPV that are virulent, such as types 16 and 18—and if you do get the vaccine, your body still has a chance to make antibodies that can fight against the virus if you’re exposed to it in future. The vaccine is also recommended for gay and bisexual men up to the age of 26 years old, as well as anyone who has a condition that makes their immunity low (such as HIV).
“Now that I’m 28 years old, have not received the HPV vaccine and am sexually active, what can I do to prevent cervical cancer?”
It is now possible to be directly tested for HPV 16 and 18 infections as well as the other strains most commonly associated with cervical cancer. This screening test has now been shown to be more effective than traditional Pap smear testing. Many institutions, including our own medical centers, have made the transition to replace routine Pap testing with HPV screening.
Condom use can be beneficial in preventing the spread of HPV, but are not enough to protect against all HPV infections—as any skin-to-skin contact can spread the virus.
The HPV vaccine, HPV testing and Pap smear testing are all available in Vietnam.
There is a lot of information available on this topic, and we’re not able to include it all in one sitting; also, information is changing at a rapid pace, so new updates are available all the time. Please keep yourself updated, and don't hesitate to contact a healthcare professional with any further questions.
Remember, cervical cancer is preventable!
Dr. Jane Shadwell-Li - Internist, Family Medical Practice Ho Chi Minh City