Cervical cancer: HP viruses - the underestimated risk

Human Papillomaviruses are widespread. And they are dangerous because the viruses can cause cervical cancer. But you can prevent. The most important information.

When Anna Schäfer (name changed) went to the gynecologist because of ongoing bleeding, she was not really worried. The regular cuts to cancer screening - so-called Pap smears - had always been inconspicuous in the 33-year-olds.

"The last time it blew, it was suddenly so bleeding that I came to the hospital as an emergency," she says. After surgery, it was clear she had a malignant tumor: cervical cancer. She did not expect that.

Since cervix cancer usually develops slowly, cancer detection should detect cell change even before cancer develops. "Unfortunately, the smear is not as sensitive as we would like it to be," says Prof. Christian Dannecker, Deputy Director of the Department of Gynecology at LMU Munich. So changed cells can also be overlooked. "The test, therefore, offers a high level of safety only with regular attendance".

For women over the age of 35, early detection will soon be changed: only a smear every three years, but an additional test for human papillomavirus (HPV).

How is HPV transmitted?

Human papillomaviruses are transmitted via direct human-to-human contact. Sexual intercourse is the main transmission route.

According to the Robert Koch Institute (RKI), most sexually active people get infected with HPV at least once in their lives.

For the majority of infections, the immune system successfully fights the viruses. If this fails, the infection can develop into cancer. The use of condoms can partially reduce the risk of infection, but not prevent it.

What consequences can an infection have?

If the immune system fails to fight the virus, cervical cancer can develop over years from HPV infection.

It is now known that HPV is responsible for around 90 percent of cervical cancers. In men, an infection can lead to anal and penile cancer as well as other forms of cancer.

Almost every person gets infected with HPV once in their lives, many of them at the first sexual contact through the skin.

"In women under 30, a positive HPV test is almost normal," says Dannecker. The body will usually cope with the virus itself. Therefore, the new test will only be done on women over 35 years old.

Test shows cancer precursors

If the doctor finds altered cells on the cervix, this is not yet a cancer diagnosis. Only at an advanced stage are they usually surgically removed.

In the so-called conization, the doctor uses an electric sling to separate the altered tissue on the cervix. Pregnancy is still possible, but the risk of premature birth is only slightly increased in this minimally invasive technique.

It was different with Anna Schäfer. She would have liked to have children of her own, but she no longer has a womb. Her doctor advised a complete removal because the tumor was already so big.

In a seven-hour operation, doctors also removed nearly 30 lymph nodes from their lower abdomens to make sure there were no cancer cells hiding there. Because that was not the case, the young woman did not need chemo. "It is trying to treat unimodally, so either with an operation or with radiation chemotherapy, so as not to burden the patient twice," said Dannecker.

Schäfer's illness is soon to be a thing of the past. Various vaccines are said to boost immune defense and antibody production, especially against the high-risk variants HPV 16 and 18, which are responsible for 70 percent of these cancer cases. The latest HPV vaccine prevents infection with the nine most common types.

Vaccination for girls and boys

The vaccine for girls is recommended before the first sexual contact. Because: "On an existing infection, the HPV vaccine no longer has any influence," says Dannecker. Then the body has to cope with the viruses.

The Standing Vaccination Commission (STIKO) at the Robert Koch Institute recommends it for girls between 9 and 14 years old before the first sexual intercourse. If a girl was not vaccinated at the intended age, vaccination should be made up to the age of 17, according to the Institute for Quality and Efficiency in Health Care (IQWIG).

The Stiko also advises to vaccinate boys.

For girls, the costs are already covered by the statutory health insurance. However, individual funds are already paying the costs for the boy's vaccine.

Study: Vaccination protects well against cancer
The vaccine protects young women quite well from pre-cervical cancer, according to a large review. Especially women who were vaccinated at the age of 15 to 26 years, therefore, have a much lower risk of developing such precancerous lesions - so-called lesions - reports the Cochrane Library.

In addition, there was no evidence that the vaccine has serious side effects and increases the risk of miscarriage.

The information portal for evidence-based medicine looked at the results of 26 randomized trials worldwide for meta-research. More than 73,400 women from all continents had participated for over three and a half to eight years.

Worldwide, cervical carcinoma causes approximately 266,000 deaths and 528,000 first-year diagnoses each year. (Fab / dpa)


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