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Common Questions about Cervical Cancer and HPV Vaccines

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1. What is cervical cancer?

 

2. How to prevent cervical cancer?

 

3. What is a cervical smear?

 

4. What is colposcopy?

 

5. Where can I arrange a cervical smear in Hong Kong?

 

6. How can pre-cancerous changes be treated?

 

7. What is human papilloma virus (HPV)?

 

8. How will I get infected with HPV?

 

9. I only have one sexual partner. Will I be susceptible to HPV infection?

 

10. Will all women infected with HPV develop cervical cancer?

 

11. I have heard that vaccination against HPV is available. How useful is the vaccine in preventing HPV infection and cervical cancer?

 

12. I was recently diagnosed of having HPV effect on my cervical smear test; will vaccination with HPV vaccine help to kill the virus?

 

13. When should I receive HPV vaccination?

 

14. How could the vaccine be given?

 

15. How long could such protection last?

 

16. Can I stop having cervical smear test after I have received the vaccine?

 

17. Are there any side effects after receiving the vaccine?

 

18. Does HPV vaccine provide any contraception effect?

 

19. If I got pregnant while I was receiving the HPV vaccine or soon after, will the vaccine affect my baby?

 

20. Does HPV vaccine provide any protective effect against other viruses like herpes or HIV?

 

21. Will there be protection if I do not complete all the three doses of HPV vaccine?

 

22. Are HPV vaccines safe? 

 

23. What is the optimal time for one to have the HPV vaccine?

 

24. What happens if you miss a dose?

 

25. Are there any contraindications to the HPV vaccination?

 

26. Do I need to have a cervical smear screening before receiving the vaccine?

 

1.     What is cervical cancer?

 

Cervical cancer is a cancer that starts in the cervix (the lower part of womb). It can spread to adjacent structures such as vagina, pelvic organs and then to distant organs e.g. liver, lung or brain.

 

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2.     How to prevent cervical cancer?

 

The proven way to prevent cervix cancer is to have regular testing (screening) to find pre-cancers, as it takes several years before they can turn into invasive cervical cancer. The cervical smear is the screening test to detect for early pre-cancer change, which can be well treated before cancer develops. HPV vaccine is also a proven effective preventive method.

 

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3.     What is a cervical smear?

 

A cervical smear is a sample of cells from the outside of the cervix (or neck of the womb) that allows detection of pre-cancerous abnormalities of the cervix. It is simply a screening tool, which indicates that more investigation should be considered at the cervix.

 

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4.     What is colposcopy?

 

Colposcopy is a more detailed examination of the cervix. Instead of looking at the cervix with the naked eye, a special magnifying binoculars is used to see the changes at high magnification. Sometimes a picture is taken for comparison in the future for the progress. The examination may take a little longer than a standard smear test.

 

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5.     Where can I arrange a cervical smear in Hong Kong?

 

Service providers include general practitioners, family medicine physicians, and gynaecologists in public or private sectors. A comprehensive list can be found at the following link: http://www.cervicalscreening.gov.hk/tc_chi/cs/cs_where_search.php

 

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6.     How can pre-cancerous changes be treated?

 

Pre-cancerous changes are also called Cervical Intraepithelial Neoplasia (CIN). The main treatment option for CIN is LLETZ (Large Loop Excision of the Transformation Zone). Laser can be used to cut the cone as an alternative to LLETZ. All treatment methods are effective.

 

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7.     What is human papilloma virus (HPV)?

 

It is a very common virus that comprises of about 200 types. The most well known type is probably the one that causes common warts, commonly found on the hands and feet. There are about 30 types of HPV affecting the genital area; these include both the 'low risk' and the 'high risk' HPV types. The low risk HPVs sometimes cause genital warts but they do not cause cervical cancer. In contrast, the high risk HPVs may cause abnormal cellular changes in the uterine cervix, called 'cervical intraepithelial neoplasia ("CIN")'. While low grade CIN may sometimes regress, high grade CIN may eventually develop into cervical cancer if appropriate treatment is not given.

 

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8.     How will I get infected with HPV?

 

HPV is transmitted via close skin contact and sexual intercourse.

 

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9.     I only have one sexual partner. Will I be susceptible to HPV infection?

 

Yes. According to studies on young female in UK and USA, including college students, around 50% will be infected by HPV within 5 years after sexual experience, even with a single partner.

 

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10.  Will all women infected with HPV develop cervical cancer?

 

According to studies in the US Centers for Disease Control, the lifetime risk of HPV infection is at least 50% among sexually active men and women. About 70% of new cases with HPV infections, including those with the high-risk HPV types will regress within one year. CIN and cervical cancer will only develop in a portion of women with persistent infection by high-risk HPV types. HPV is therefore a necessary, but not the only factor for the development of cervical cancer.

 

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11.  I have heard that vaccination against HPV is available. How useful is the vaccine in preventing HPV infection and cervical cancer?

 

Since almost all cases of cervical cancer are caused by HPV infection, protection against HPV infection will naturally protect women from cervical cancer. The majority of HPV vaccines available today offers more than 90% protection for women against infection with HPV type 16 and 18, which are the two types of high risk HPV that cause approximately 70% of cervical cancer throughout the world. So the vaccine cannot protect 100% against cervical cancer. Although it offers very good protection against 70% of the cervical cancer, there are still 30% not covered by the vaccine.

 

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12.  I was recently diagnosed of having HPV effect on my cervical smear test; will vaccination with HPV vaccine help to kill the virus?

 

The HPV vaccines available currently, or in the near future, are for prophylaxis only. In other words, they are useful for protecting women from HPV infection and cannot be used to cure current HPV infection.

 

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13.  When should I receive HPV vaccination?

 

Since these vaccines are for prophylaxis, ideally they should be given before exposure to HPV infection, i.e. before sexual exposure. However, it may still offer protection if you have sexual exposure because the degree of protection varies depending on whether there had been prior infection with HPV16 and/or HPV18 at the time of vaccination.

 

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14.  How could the vaccine be given?

 

By three intramuscular injections within six to seven months, i.e. at 0, 1 (or 2) and 6 months.

 

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15.  How long could such protection last?

 

According to a recent study (2013 data), the protection could last for at least 9.4 years.

 

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16.  Can I stop having cervical smear test after I have received the vaccine?

 

No, since the current vaccines could only provide 70% protection against cervical cancers which are caused by HPV types 16 and 18, one could still be infected with other high risk HPV types that also cause cervical cancer. Perhaps, there may be a need for modification of the screening programme in future but it is currently too early to comment.

 

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17.  Are there any side effects after receiving the vaccine?

 

According to the current data on clinical trials, no significant serious side effects have been encountered. However, mild to moderate pain and redness at the sites of intramuscular injection may develop, similar to vaccination against other diseases. Occasionally, fever was reported as a systemic side effect.

 

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18.  Does HPV vaccine provide any contraception effect?

 

HPV vaccine does not provide any contraceptive effect. Women receiving the vaccine should use a proper method for contraception.

 

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19.  If I got pregnant while I was receiving the HPV vaccine or soon after, will the vaccine affect my baby?

 

No conclusive data is available at the moment. While preliminary data did not reveal any significant adverse effect on pregnancy and infant, women are advised to adopt contraception till the completion of the three doses of vaccines.

 

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20.  Does HPV vaccine provide any protective effect against other viruses like herpes or HIV?

 

HPV vaccine does not protect against other types of sexually transmitted diseases. Other preventive measures, such as condom, should be used.

 

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21.  Will there be protection if I do not complete all the three doses of HPV vaccine?

 

No formal data is available. Women are encouraged to complete the whole vaccination programme, i.e. all three doses.

 

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22.  Are HPV vaccines safe? 

 

Most clinical studies show that the HPV vaccines are safe. The manufacturers use empty viral particles to make the viral like particles as to induce immune response in host. In another words, one would not find live virus or viral DNA inside the vaccine.

The minor side effects that may associate with the vaccines include fever, headache, swelling over the site of injection. Most of the above are usually mild.

 

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23.  What is the optimal time for one to have the HPV vaccine?

 

Some studies claim girls of around 9 to 10 years old are ready to have the injection. It is best to have the vaccine before one acquire the HPV virus. The Joint Committee for Vaccination and Immunization in UK recommended routine vaccination for girls aged around 12-13 years after they conducted a detailed review on HPV vaccination.

 

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24.  What happens if you miss a dose?

 

One should continue and complete the course of immunization. The 3 dose schedule that currently adopted aim to deliver the best protection.

 

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25.  Are there any contraindications to the HPV vaccination?

 

If one have severe allergic reaction or hypersensitivity to yeast or to any component contained in the vaccine, she should not have the vaccination. For those who have high grade fever and those who are pregnant also best to postponed the injection.

 

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26.  Do I need to have a cervical smear screening before receiving the vaccine?

 

No. Cervical smear is not necessary before the vaccine administration. However, regular cervical screening is still recommended even after vaccination. 

 

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© 2017 The Hong Kong Society for Colposcopy and Cervical Pathology