Physical problems, come and ask Dr. Clove.

cervixIt is the second most common malignant tumor in women after breast cancer. In recent years, with the spread of awareness, more and more people have begun to know that cervical cancer is associated with a virus called HPV (human papillomavirus).

More than 90% of cervical cancer patients are infected with HPV [1]. Being infected with HPV means a higher risk of developing cervical cancer. But it's not that scary.

I. HPV positive, not so scary

In fact, most people have been infected with HPV at one time or another, with approximately 80% of adult Americans infected with HPV at least once in their lifetime [2], with no data available domestically.

But even if you do nothing, 90 to 95 percent of the HPV virus is usually cleared by the body's immune system within 1 to 2 years. In other words, in most cases, HPV positivity does not cause cervical cancer.

Second, what about high-risk HPV?

In fact, high-risk HPV may still be cleared by the body's immune system on its own, so don't panic too much, you should cooperate with your doctor for further examination and keep watch.

There are more than 100 types of HPV, which usually do not cause any disease. If it does cause disease, the most common are hand and foot warts. More than 40 types of HPV are spread through the reproductive tract:

1. Low-risk HPV:Some of these are low-risk HPV types that do not cause cervical cancer, but may cause genital warts or very subtle cervical cell changes.

2. High-risk HPV:There are 13 common high-risk HPV types, of which HPV16 and HPV18 are the most common and are associated with about 70 to 75 percent of cervical cancers.

C. How should I face HPV infection?

After HPV infection, the body's immune system will attack the virus, and in most cases the virus will be cleared within one to two years. Even if the HPV virus is not cleared, regular pap smears coupled with colposcopy can help detect pre-cancerous cervical lesions in time to kill the cancer in its infancy.

One thing to remember is that there is no cure for the HPV virus itself. If you are tested positive for HPV and some unscrupulous doctor tells you that you can get rid of the virus with some medication, this is definitely a scam!

Of course, it is possible to treat diseases caused by the HPV virus, such as genital warts, hand and foot warts. This is called "treating the disease, not the virus".

In addition, it is important to go to a regular hospital and follow your doctor's advice to have a pap smear if you need one, a colposcopy if you need one, and to remember to have regular checkups. For women who are not infected with HPV, Dr. Clove also recommends regular HPV testing.

Fourth, why do I need an HPV test?

HPV testing can detect pre-cancerous cervical lesions in a more timely manner, is sometimes even more sensitive than Pap tests, and can help to rule out false-positive Pap tests.

When the pap smear shows ambiguous results, if the HPV test is negative, malignant disease can be basically ruled out, and you only need to repeat the pap smear after one year, which can save a lot of unnecessary worries and more testing costs.

If the pap smear and HPV test are both negative, you can basically rest assured that the risk of cervical cancer in this case is very low. These women, if they lead a healthy lifestyle (e.g., balanced diet, regular exercise, safe sex), do not even need to have yearly pap smears, and can be retested after 3 years.

The point of the HPV test is that if you know you have the virus, you should keep an eye on it while you are carrying it, so that any abnormalities you find can be dealt with in time to prevent progression towards cancer.If you have been infected with the same subtype of HPV for more than two years, you need to be vigilant.

The majority of HPV infections are transient, with the average duration of HPV infection lasting 8 months, with 70% of women clearing the virus within 12 months and 81% clearing it within 24 months. However, there are still about 20% of HPV infected people who are unable to clear HPV due to autoimmune factors or other factors, and develop a persistent HPV infection, so it is almost safe to say that HPV infections cover the majority of the female population. However, there is no way to predict who is the 20% of infected people who cannot clear the virus, so it is important to have regular checkups, maintain follow-up, active prevention, proper treatment and management in order to effectively prevent cervical cancer.

Patients often ask me, "How long will it take for my HPV infection to turn into cervical cancer? What are the chances of getting cervical cancer? Can it clear itself?" People with HPV are always on edge because of this, but there is no need to be. HPV infection is very common, and reports have shown that genital HPV infection can be detected in 50% of women within two years of starting to have sex if they are closely tested. The probability of genital tract HPV infection in a woman's lifetime is 80%, of which 5% develop warts, 25% develop uterine intraepithelial neoplasia (CIN), and less than 1% develop cervical cancer. The occurrence of cervical cancer is not only closely related to HPV, but also synergistic with personal immunity, sexual behavior, prolificacy, smoking, other gynecological inflammatory diseases or STDs, etc. Therefore, paying close attention to the status of HPV infection as well as the course of CIN, and actively preventing it with the correct treatment is one of the correct ways to prevent cervical cancer.

HPV infection is the leading etiologic factor in the development of cervical cancer, particularlyHigh-risk HPVThe risk of cervical cancer is high, but it is not necessarily causal. However, there is no necessary causal relationship between the two.

First understand what HPV is.

HPV is shorthand for human papillomavirus, and more than 100 different subtypes have been isolated. About 54 types can infect the mucous membranes of the reproductive tract. Depending on the risk of causing disease in humans, they can be categorized into low-risk and high-risk types, among which the mucosal high-risk types, which are closely associated with the development of cervical cancer, are mainly the following subtypes: HPV-16, 18, 31, 33, 35, 39, 45, 51, 56, 58, 59, 68. especially withHPV 16, 18Closest.

High-risk, which refers to a long-term persistent state of infection, has a chance of inducing cervical carcinogenesis. The most important of these are types 16 and 18.

Low-risk, which means that there is a chance of inducing the production of some epithelial neoplasia (redundant organisms) in the long-term, persistent presence of the infection; types 6 and 11 are the main representatives of this group, which have the risk of causing cancer, but the chances are low.

Clinical recommendations: 1. Women over 30 years of age (married or unmarried but sexually active) should undergo high-risk HPV testing, and cytology combined with HPV co-testing is recommended if available; 2. If the test is found to be positive for HPV type 16/18, colposcopy is recommended regardless of cytology results.

As you can tell from the above, high-risk HPV infection is the leading cause of cervical cancer development, but not the only one. Other possible causative factors include:

1. Sexual disorganization, poor sexual hygiene, sexually transmitted diseases;

2. Menstrual and maternity factors: poor hygiene during menstruation and puerperium, early marriage, early childbearing, multiple pregnancies and multiple births;

3、Smoking

4. Cervical fissure, ectropion and chronic inflammation long-term stimulation

5. Genetic susceptibility

6. Poor nutritional status and nutritional disorders. Such as vitamin A, C deficiency, imbalance of trace elements.

HPV belongs to a kind of virus, there is no specific anti-viral drug, but the infection is generally self-limiting, that is, self-curing, interferon therapy has a certain therapeutic effect. So once found the existence of HPV infection, there is no need to be too nervous, the main thing is to pay attention to regular cervical examination, the current cervical TCT, for the discovery of early neoplasia (CIN) and malignant changes have an important value.

The answer is that you don't necessarily get cervical cancer if you are infected with HPV, but cervical cancer is definitely the result of being infected with a high-risk type of HPV.

It is persistent, high-risk HPV that can cause cervical cancer.

There are three words to keep in mind here: high-risk type, persistent, and possible.

high risk

There are dozens of nearly 100 types of HPV. The diseases they cause are also different, causing cervical cancer, condyloma acuminatum, flat warts, infectious molluscum contagiosum, and so on. In general, the dozens of HPV are divided into two categories, one is related to malignant tumors, called high-risk HPV; the other is not related to malignant tumors, only cause benign lesions, called low-risk HPV. if the test for HPV found that there is no high-risk type of infection, but only low-risk type of HPV infection, then do not have to worry about cervical cancer. The test report will usually indicate which type of infection is present.

sustainability

From high-risk HPV infection to the development of cervical cancer, there are many pathologic processes in between, and these processes take about 10 years. As for HPV infection, it is possible that it is transient, and when one's immunity improves, the HPV will be eliminated, and then this long cancerous process will be terminated. And some HPV infections can be long term and persistent. Persistent infection is what keeps this pathologic process going and eventually leads to cervical cancer.

If an HPV test is done and it is found to be positive for the high-risk type, then it is important to get tested every year. If the test is positive every year, then it is a persistent infection.

Generally adolescents are sexually active and have a very high rate of HPV infection, but it is also usually a transient infection due to a strong immune system. Whereas after the age of 30, it is often a persistent infection due to their own resistance, so we do not recommend HPV testing for women under 30, especially under 26. A transient positive is detected and causes fearless panic.

likelihood

Even with persistent high-risk HPV infection, cervical cancer does not occur 100% of the time. Why? Medicine can't fully explain it yet, it could be related to other pathogenic infections or to autoimmunity. There are many contingent factors.

While not all HPV infections cause cancer, after all, thePersistent, high-risk HPV infection is a risk factor for cervical cancerThe patient must therefore be highly vigilant and regularly examined in a timely manner.Detection and treatment of precancerous lesions and early stage cancer, in order to prevent cervical or advanced cancer.

Author

Dr. Yuling Wang: Associate Chief Physician, Director of Obstetrics and Gynecology at Huangpu Maternal and Child Health Hospital. She has been engaged in the clinical work of Obstetrics and Gynecology for 25 years and has rich clinical work experience. She specializes in: endometriosis, chronic lower abdominal pain, dysmenorrhea, infertility, uterine fibroids, ovarian cysts, irregular menstruation, menopausal symptoms, cervical diseases, gynecological inflammation, and pregnancy-related diseases.

Famous author of popularization of science, Sina Weibo, today's headlines contracted self-media authors. In the past three years, he has published more than 300 popular science articles in newspapers, magazines and self media. She has 940,000 followers on Sina Weibo and has provided health advice to nearly 10,000 people. She is the author of the popular science bestseller "Be a Wise Mom-to-be" and "Secrets in the Uterus".

Current guidelines for screening for high-risk HPV are not recommended for anyone under the age of 30 because transient infections will be more common, and even if the screen is positive, there is a high likelihood that it will be cleared after some time.The 2013 New England Journal of Medicine journal summarized the norms of recent years, and presumably made the recommendations for screening the cervix roughly as follows:

1. Screening is not required under 21 years of age

2. Screening cytology every 3 years between 21 and 29 years of age

3. 30-65 years of age, combined HPV and cytology screening every 5 years or cytology every 3 years.

4. Over 65 years of age, screening can be discontinued if previous results are normal.

So it is probably understandable that HPV testing is not necessary under the age of 30.

Above 30 years old, even if found to have high-risk HPV infection, do not have to be too nervous, because although it is a high-risk type of virus, but it is not the same as you have cervical cancer, at this time the important thing is to screen cervical scraping, if there is no problem in the cervical scraping, it can be no need to be too worried about it, just need to continue to follow up on it, of course, if there are HPV typing test results, if found 16 and 18 subtypes of positive, there are also some Of course, if there are HPV typing test results, and if subtypes 16 and 18 are found to be positive, some scholars recommend direct colposcopy and biopsy to exclude cervical cancer.

According to international guidelines and research data, there is currently no effective treatment for HPV infection, and therefore treatment for HPV carrier status is not recommended. Previous exchanges with several international counterparts basically agree with this point of view. In recent years, a number of domestic hospitals to provide doctors with drugs for HPV treatment, I think there is no good research evidence to support, usually I want to understand whether a therapy is effective, not to listen to the manufacturers of publicity, it is important to see whether there is no literature published in the international journals on the relevant, if only the data provided by the manufacturers, there is a bias, in the case of the current situation, is not enough to support the practice of HPV treatment. Personally, I even think so HPV therapy is to capture the patient's fear of cancer, there is a suspicion of over-treatment. Do not rule out the possibility of the emergence of HPV treatments in the future, but at this stage, there is no good evidence to support.

More than 90% of cervical cancer cases are due to HPV infection, which means a higher risk of developing cervical cancer. However, it does not necessarily mean that you will get cervical cancer if you are infected with HPV. In fact, most people have been infected with HPV at some point in their lives - about 80 percent of adult Americans have been infected with HPV at least once in their lifetime, with no national data available. But even if you do nothing, 90% to 95% of HPV viruses are cleared by the body's immune system within 1 to 2 years.

Persistent infection with a high-risk type of HPV is required for the development of precancerous cervical lesions (cervical intraepithelial neoplasia), which then progress to invasive cervical cancer. This is a long process, with the time from infection with the HPV virus to the development of cervical cancer being about 8 to 15 years. Formal screening detects the vast majority (>99.7%) of lesions during this long developmental process, which is one of the reasons for the decline in the incidence of cervical cancer in developed countries.

That said, in most cases, HPV positivity does not lead to cervical cancer.

HPV tests can sometimes give false-positive results. Moreover, a positive HPV test does not mean that you have the dreaded cervical pre-cancer, but may simply be infected with the HPV virus. However, a positive HPV test result should not be ignored. The purpose of HPV testing is to detect precancerous cervical lesions and prevent cancer at an early stage. If your condition permits, consider the HPV vaccine.

Infection with HPV does not necessarily lead to cervical cancer.HPV is the English abbreviation for Human Papillomavirus (Human Papillomavirus), a DNA virus that mainly infects the basal cells in the complex layer of squamous epithelial tissue. This epithelial tissue is found in the luminal surfaces of the skin, mouth, esophagus, vagina, etc. HPV mainly infects the basal cells, the lowest layer of cells in the epithelial tissue, and so the infection usually occurs when the skin is scratched to expose the basal cells. Therefore, the cancers that may be induced by HPV infection are also not limited to cervical cancer.

There are more than 100 serotypes of HPV. The so-called serotypes are a way of categorizing the virus; there are many variants of HPV, and a group of viruses that are relatively similar in antigenicity is defined as a serotype. As you can see, there are many types of HPV viruses. Using Arabic numerals to label the serotypes of HPV gives us HPV1,..... , HPV100....... Many HPV infections are asymptomatic or self-healing. However, clinical studies have shown that two serotypes, HPV16 and HPV18, are causative for 70% of cervical cancers and cervical precancers ( 'Human papillomavirus (HPV) and cervical cancer'. WHO. June 2016. Archived from the original on 5 August 2016. Retrieved 10 August 2016). This group of HPV viruses that can cause cervical cancer is called high-risk HPV, while others that do not cause cancer or have not been shown to be associated with cancer are called low-risk HPV.The main principle behind HPV viruses causing cancer is that the viruses encode oncogenic proteins and may be integrated into the human genome. However, infection with high-risk HPV does not necessarily lead to cervical cancer, and there are many cases in which the body's immune system is able to clear the virus on its own or through antiviral treatment. It's just that a large percentage of patients who develop cervical cancer are infected with high-risk HPV, and HPV infection is therefore a cause of cancer. Cancer is also a gradual process. Therefore, if HPV infection is detected, the first step is to differentiate between high-risk and low-risk HPV types (many hospitals can do typing tests) and to carry out antiviral treatment, as well as to carry out cervical pathology to see if there is any lesion present. Women who are sexually active should undergo these types of gynecological examinations on a regular basis.

At present, the clinical use of interferon and other antiviral drugs for the treatment of HPV is still more effective, and should be treated at an early stage, do not wait until the condition is serious. In addition, HPV vaccination is recommended to prevent HPV infection. It is worth stating that HPV does not only infect women but also men, therefore, both men and women should correctly recognize and prevent HPV infection.

Hello, I'm happy to answer your question, and I hope my answers below are helpful.

At the end of the day's surgery, Brother Miao returned to the office as usual to irrigate himself with water to replenish water, and saw the nurse sister on duty came to Brother Miao with a sad face, and when she saw Brother Miao drinking water, she wanted to speak again and again. After gulping down a large glass of water, Miao asked, "Tell me, what has happened to you that makes you sad." The nurse on duty opened her own words, "Brother Miao, my cousin attended the free cervical cancer screening in the community not long ago and was found to be infected with HPV, didn't she say that HPV infection can lead to cervical cancer? What can we do about this, she is only 36 years old."

Miao looked into the mirror, organized his hair and said: "Miss, I glasses do not even hold, just serve you. Although studies have shown that women infected with high-risk human papillomavirus (HPV) is closely related to the occurrence of cervical cancer, but it does not mean that the infection of HPV will necessarily develop into cervical cancer! Don't worry, let's listen to Miao's detailed explanation."

First, not all HPV infections can lead to cervical lesions

HPV family is huge, currently found to have 160 members, but can cause cervical lesions and then develop into cervical cancer is still a minority, there are about 13 to 15 kinds of cervical cancer is closely related to the occurrence of cervical cancer, we will be able to cause lesions of the dangerous molecules are defined as high-risk types of HPV, of which HPV-16, HPV-18 is the most common high-risk types, the current cervical cancer vaccine include it! two. However, if you are infected with a non-high-risk group of HPV or if you are infected with a high-risk type of HPV that has a low probability of causing cervical lesions, not all of them will develop into cervical cancer.

Second, infection with high-grade HPV does not necessarily develop into cervical cancer

Even if one is infected with high-risk HPV, it does not develop into cervical cancer in one step; it takes more than ten years or even decades to develop, if there is a possibility of cancer. First of all, there is squamous intraepithelial lesion (SIL) of the cervix, which is a precancerous lesion and can be divided into low-grade lesion (LSIL) and high-grade lesion (HSIL), as mentioned in the article. About 60% of LSIL can subside naturally, with close follow-up and active treatment when treatment criteria are met; HSIL can also be treated with surgical excision of the lesion as a precautionary measure.

The nurse sister in charge nodded her head frequently after listening to Miao's words. After finishing his speech, Mr. Miao stroked his hair and summarized: HPV infection is not scary, what is scary is not paying attention to the disease. River suggests that women who have sex once a year to carry out a cervical cancer screening, if found HPV infection should be actively followed up for treatment. Women, to be better for themselves.

Does HPV infection always lead to cervical cancer?

Do you have to get liver cancer to carry the hepatitis B virus?

Do you always get in a car accident when you drive?

Do you have to drown to swim?

The reasoning is pretty much the same, don't say wind is rain.

The prevalence of HPV infection in the population is about 75%. That is, 75% of women have experienced HPV infection. If HPV infection is a sure way to get cervical cancer, is the planet alive?

In cross-sectional surveys, the prevalence of HPV among adult married women ranges from 7% to 20%. More than 90% of these are transiently infected. Of the remaining 10% or so of persistently infected women, a small proportion may progress to cervical cancer.

Regarding the risk of cervical cancer causation, remember two key words: high-risk type, persistent infection!

Women who are persistently infected with high-risk types of HPV are at risk of developing cervical cancer.

Please note that there is a risk of cancer, not a certainty of cancer.

It's the same thing as driving a car with the risk of getting into an accident, or swimming, with the risk of drowning.

For women with persistent HPV high-risk infections, there is no need to live with the burden. With regular and good screening, your risk of dying from cervical cancer in your lifetime is almost zero! Of course, those who are stupid and make their own deaths are not included in this list!

Some people are similar, some people die of illness, some people die in car accidents, and the stupidest way to die is to toss yourself to death, to get sick and scared to death.

As a veteran driver, it's impossible not to drive.

There is no specific cure for the HPV virus, and some people just might become elderly drivers who carry the virus for a long time. Of course, the odds of an older driver getting into a car accident are much higher than the odds of a driver who is just a usual substitute driver getting into a car accident. But older drivers have to live, and they can't do that without driving. Older drivers don't give up on life, they don't spend their days looking sad because of the high risks of their profession.

Is there any need to live with a sad face for older drivers who have had HPV for a long time?

Getting regular and good screenings won't guarantee that you won't get cancer, but it will ensure that you get the best possible outcome for your survival.

It's like an old driver who strictly abides by traffic rules and doesn't drive fatigued. I don't dare to guarantee that other people won't hit me, but at least don't get into a car accident because of your own reasons, so that the risk of accidents will be minimized, and there will be less liability for damages.

Author: Guo Mingchuan

Obstetrician and gynecologist.

She specializes in minimally invasive gynecological surgery, laparoscopy, hysteroscopy and transvaginal surgery.

She has extensive experience in the surgical treatment of ovarian cysts, uterine fibroids, adenomyosis, cervical cancer and endometrial cancer.

Cervical cancer is one of the most common gynecological malignant tumors and ranks second in the global mortality rate of women's cancers, and even first in some developing countries; each year, there are about 500,000 new cases of cervical cancer and about 200,000 deaths from cervical cancer globally, with 80 per cent of those deaths occurring in developing countries.

It can happen to women of all ages, but with a25 to 55 yearsIt is most common in women who are not in the same position as those who are not in the same position.

Cervical cancer is the only malignant tumor with a clear cause, and studies have shown that 99.7% of cervical cancers are associated with HPV infection.HPV (Human papilloma virus), or human papilloma virus. Speaking of which, people can't help but ask, once you have HPV virus infection, will you definitely get cervical cancer? In fact, HPV infection is not as scary as people think.

I. Classification of HPV

Clinically, HPV is categorized into two main types, low-risk and high-risk, based on the degree of pathogenicity or cancer risk:

1, low-risk HPV: generally can be cleared by the body's local immune system, such as 6, 11, 43, CP304, etc., there is the possibility of causing benign lesions, such as genital warts.

2、High-risk HPV: Its types are more than one hundred and ten, and the most dangerous ones in clinic are HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, etc. It can cause cancer of external genital organs, cervical cancer and highly cervical intraepithelial neoplasia.

II. Outcome of HPV infection

Research has found that 80% of women can be infected with HPV during their lifetime, with the peak of infection occurring in the 18-28 and 40-44 age groups. HPV infection is asymptomatic, and the vast majority of HPV infections (low-risk HPV infections) can be cleared by the body's autoimmune system, which can become a passer-by in your life, with a natural clearance rate of more than 60%. To use an analogy, it's like having a cold that recovers on its own.

However, it takes time for HPV to clear, about 50% may turn negative within 6 months, 70-80% may turn negative within 1 year, while the remaining 20-30% may take 2-3 years to become normal.

Less than 10% (high-risk HPV infection) of women, local immune function is impaired when the body can not be completely cleared of HPV, thus causing persistent infection, and high-risk HPV persistent infection is the most dangerous factors leading to cervical cancer, from normal squamous epithelium pre-cancerous changes in the cervical cancer, the whole process will take about 10 years to 20 years of time.

III. Prevention of cervical cancer

Cervical cancer is the only malignancy that can be effectively prevented, and the best screening option is cervical exfoliative cytology. Experts suggest that cervical cancer screening should begin at age 21, and girls under 21 should not be screened.

For women aged 21-29 years, cytology only is recommended. for women aged 30-65 years, a combined screening method of high-risk HPV testing + liquid-based cytology is recommended. Negative cytology, if only low-risk HPV infection, is no need for treatment, wait for natural recovery, but if it is a high-risk type (especially HPV16 and/or 18) infection, six months to one year to review the cytology and HPV, negative, then regular review; if the review results are still positive, it indicates a persistent infection, it is necessary to go to the hospital for further examination.

The bivalent vaccine (for HPV types 16 and 18) is expected to be available in China in early 2017, and the best people to be vaccinated are adolescents (optimal age for injection is 11-12 years old), who have no sexual experience. The bivalent vaccine does not prevent all types of cervical cancer, but relevant studies have proven that this vaccine is effective in preventing cervical cancer.

At present, although there is no clear and effective treatment drugs for HPV infection, but don't forget the body's immune system that works hard day and night, therefore, in order to stay away from the virus or remove the virus from the body, you must maintain a healthy lifestyle, nothing more than a smile, so that the body's immune function to maintain a normal state.

Hunan Medical Chat Contributing Expert: Lu Weiqian Xia Aimin, Department of Pathology, Hunan Provincial Hospital of Chinese Medicine Research Institute