Keeping HPV on the Agenda

This week marks HPV awareness week, when health providers, charities and other important stakeholders come together to raise awareness of HPV and its risk for cancer.

What is HPV?

Human Papilloma Virus, or HPV for short, is an extremely common virus that affects over 80% of the population during the course of a lifetime. HPV is transmitted by skin to skin contact and the vast majority of infections are completely harmless and transient in nature to the extent that most people will never know they have been infected.

There are over 100 different strains of HPV with 14 strains known to be high-risk in their ability to cause cancer. Examples of conditions caused by low-risk strains include warts and verrucas. Unfortunately, in some cases infection with a high-risk strain of HPV persist which in time results in the development of some cancers.

The most common malignancies caused by these high-risk HPV types are cervical, penile, and anal cancer, and more recently a type of cancer that affects cancers of the soft tissue in the mouth, back of the throat and base of the tongue, known as oropharyngeal cancer. Indeed it is estimated that 99% of all cervical cancers are caused by HPV.

What We Know About HPV in Wales

Between 2001 and 2015 the rates of cervical cancer In Wales have remained fairly stable – despite the increase in prevalence of HPV – with around 170 cases diagnosed each year. This stability is thought to largely result from the success of the national cervical screening programme in Wales.

However, evidence is emerging that cervical screening rates are dropping across the UK, particularly in areas of high deprivation. This has caused concern as cervical cancer is largely preventable when HPV vaccination is combined with regular screening.

A previously funded Cancer Research Wales study which examined the prevalence of HPV infection rates in Welsh women attending their first cervical screening at 25, demonstrated that over 25% of all samples were infected with HPV. This study was conducted in unvaccinated women and while most of these infections would be eliminated in time, the findings do highlight the commonality of HPV, and the need to safe-guard against complacency in this current era of HPV vaccination.

Other important studies funded by Cancer Research Wales have shown that the number of cases of oropharyngeal cancer caused by HPV in Wales has tripled over the last 20 years. Over 50% of newly diagnosed cases of this cancer type can be directly linked to the virus.

The Importance of HPV vaccination

The HPV vaccination programme began in 2008, with girls initially offered the vaccine from year 8. The vaccine now used across the UK is Gardasil and offers protection against HPV 6 and 11, in addition to strains 16 and 18. Long-term follow up has shown HPV vaccines to be very safe and very effective. Our important baseline study was able to demonstrate that up to 50% of cervical cancers could be prevented in future following adequate uptake of the HPV vaccine.

Based upon the critical evidence contributed by Cancer Research Wales funded HPV studies in head and neck cancer – which showed for the first time in the UK the impact of HPV on oropharyngeal cancer – boys as well as girls will now be offered the HPV vaccine across Wales from March 2020.

The Importance of Continued Cervical Screening

At the age of 25 all women will be asked to attend an appointment in which to undergo a simple examination to check for the presence of pre-cancerous, abnormal cells in the layer of cells that line the cervix. If detected, these abnormal cells can be easily treated before they have the opportunity to advance to an invasive cancer.

The cervical cancer screening programme is available to all women between the ages of 25 and 64. As cervical cancer is the main cause of cancer in women under the age of 35 it is important that cervical screening appointments are kept as it is largely preventable and easy to treat if caught early.

This week reports show that cervical screening is at an all-time low, with around 25% of women failing to attend. In young women, aged 25-49, it is found that up to 39% fail to attend. This has led to an observed increase in the number of cervical cancers reported, reversing the trends of recent decades. Wales also reached a similar low point with respect to cervical screening in 2017-18.

Research has tried to unpick the reasons why rates of cervical screening have fallen. Some of the main reasons include embarrassment and the stigma surrounding HPV. We would like to reassure you that there is no need to die from embarrassment and there is no more shame in catching HPV, as there is the common cold.

In order to keep the pressure up against HPV related cancers, please do ensure that children take up the HPV vaccine when offered, and for women to attend regular cervical screening when called. If anyone has any concerns then please do speak to your GP or other local health-care providers.