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Pap, HPV and vaccination: what it is and why it’s important

April 19, 2012

By Sarah Folk

Did you know that about 70 to 80 per cent of the population gets a human papillomavirus (HPV) infection at some point in their life? Most of the time, your body reacts to the virus and fights it off before you even know you had it. However in some cases, HPV can develop into cervical cancer.

The good thing about cervical cancer caused by HPV is that it has a fairly slow development process, making it easy to prevent with regular screening. The problem with this, however, is that many women don’t feel the need to get screened regularly, or don’t understand what the Pap test is or what it is used for.

Dr. Amanda Selk, staff gynecologist at Women’s College Hospital, discusses the difference between a Pap and an HPV test, and gives information on how you can protect yourself against developing cervix cancer with the HPV vaccination.

HPV and Paps

The HPV strains that are linked to cervical cancer are part of one of the most common families of viruses in the world today. These types of strains are transferred between partners through genital skin-to-skin contact and can result in genital warts, skin warts, precancerous lesions and cancer.

HPV is not necessarily transmitted through intercourse, and is extremely contagious. For that reason, condoms may decrease the risk of transmission, but cannot prevent it. Those at higher risk for infection include individuals with HIV, organ transplants or lupus patients who are on immunosuppressing drugs. Furthermore, smoking can make HPV worse, and so smokers who already have the virus are at an increased risk of persistent or long-term infection.

“HPV has a slow precancerous stage where on average it takes 10 years between getting a cancer causing strain of HPV and actually developing cancer ” explains Dr. Selk. “That is why it is so important to get screened. If your doctor finds precancerous cells or changes, they can treat the virus before it becomes cancerous.”

Protection begins with the Pap

For optimal protection from cervix cancer, regular screening is necessary, especially since most women show no signs of the virus. The tool used for this screening process is a Pap test, often referred to as a Pap smear. The objective of this test is to find precancerous cells and changes that may indicate the development of cervix cancer. Ultimately, Paps are used to test for problems that HPV has already caused.

“Over the last 60 years, cervix cancer rates have decreased by 70 to 80 per cent in Canada due to the use of the Pap,” says Dr. Selk. It is important to remember that a Pap does not test for HPV, but only the precancerous changes caused by HPV that may indicate a need for additional tests and treatment. An HPV test is a separate followup exam used only on those with abnormal cells, and is not covered in Ontario. The cost of this test is $90.

During your Pap test, the doctor will examine your cervix and take samples. The Pap test itself consists of only one swab, however many doctors choose to perform multiple swab tests during your exam. “Generally, if you’re under 30 your doctor is probably testing for sexually transmitted infections (STIs),” says Dr. Selk. She advises us to talk to our doctors throughout the process in order to understand what they are testing for and why. 

Cancer Care Ontario recently updated its cervical cancer screening guidelines. The new guidelines advise that women in Ontario who are, or have ever been, sexually active should have a Pap test every three years from age 21 through 70. After age 70, women who have had three normal Pap tests in the preceding 10 years can stop screening.

Getting vaccinated

HPV vaccination began approximately eight years ago after undergoing the most rigorous clinical trial processes of all vaccines available in Canada. The goal of the vaccination is to create a resistance before infection occurs. For this reason, ideal candidates for the vaccines are young girls between the ages of nine and 13 before they have any sexual contact. Each province has a different vaccination program where the vaccine is covered.  You can also opt to pay for the vaccine yourself or see if it’s covered by your private health insurance if you have any.

Even though there over 200 strains of HPV, the vaccines typically only cover two or four of these strains. These include strains #6 and #11, which cause 90 per cent of genital warts, and strains #16 and #18, which contribute to 70 per cent of cervix cancers.

“Despite being older, you may still receive some benefit from the vaccine,” explains Dr. Selk. “Even if you have had HPV previously, you may not have had all the strains the vaccines cover and the vaccine may still help prevent transmission.”

There are two main vaccines available and approved for use in Canada, however some provinces vaccination programs may not cover both.

1.       Gardasil

  • protects against four strains of the virus (#6, #11, #16, and #18)
  • coverage consists of three shots, each approximately $150 per shot, without insurance
  • this vaccine is approved for girls and women aged 9-45, and boys and men aged 9-26, however boys and men are not currently covered in Canada

2.       Cervarix

  • only covers two strains of the virus (#16 and #18)
  • coverage consists of three shots, each approximately $90 per shot, without insurance
  • the vaccine is only approved for girls and women aged 10-25

Vaccination consists of three shots. However since the vaccination is still fairly new, scientists and doctors are unsure of the effects of missing one shot or not taking it on time. If you miss a shot you might not have full coverage against the targeted strains.

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  • A publication of:
  • Women's College Hospital