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

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.

Dr. Amanda Selk, gynecologist at Women’s College Hospital, discusses the difference between a Pap and an HPV test, and shares information on how you can protect yourself against developing cervical cancer with Pap tests and 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 any patients who are on immunosuppressing drugs. Smoking can also 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 it takes many 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 changes if necessary before they become cancerous.”

Protection begins with the Pap

For optimal protection from cervical cancer, regular screening is necessary, especially since most people show no signs of the virus. The tool currently used for this screening process is cervical cytology, often referred to as a Pap smear, which looks for precancerous cells before they become cancer. Ultimately, Paps are used to test for problems that HPV has already caused.

“Over the last 60 years, cervical 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 Paps aren’t perfect, and they do not test for HPV, but only the precancerous changes caused by HPV that may indicate a need for additional tests and treatment.

During your Pap test, the doctor will examine your cervix and take samples. The Pap test itself consists of a brush of the cervix, however many doctors also do swabs for sexually transmitted infections like gonorrhea and chlamydia at the same time. “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 publishes cervical cancer screening guidelines. The guidelines advise that individuals 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, those who have had three normal Pap tests in the preceding 10 years can stop screening. More frequent tests are recommended, for example if you have a history of abnormal cervical cells or a suppressed immune system, so speak with your healthcare provider about what is best for you.

Getting vaccinated

HPV vaccination has been approved in Canada since 2006 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 vaccine candidates are children before they have any sexual contact. Each province has a different vaccination program where the vaccine is covered for both boys and girls. The vaccine does not suddenly stop working as you age and 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 100 strains of HPV, the vaccines typically only cover two or nine of these strains. Gardasil 9 covers strains #6 and #11, which cause 90 per cent of genital warts, and 7 high risk strains of HPV which overall contribute to 90 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.” The National Advisory Committee on Immunization (NACI) recommends Gardasil 9 in females and males age 9-27 including women who have had pap test abnormalities, cervix cancer and genital warts. They also recommend the vaccine in individuals over the age of 27 if they have ongoing HPV exposure. Cervarix is approved for use in females aged 9-45 and has not been approved for use in males in Canada.

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

1. Gardasil 9

  • protects against nine strains of the virus (#6, #11, #16, #18, #31, #33, #45, #52, #58)
  • coverage consists of three shots, each approximately $190 per shot, without insurance
  • this vaccine is approved for girls, boys, women and men over age 9.

2. Cervarix

  • only covers two strains of the virus (#16 and #18) which cause 70% of cervix cancers.
  • coverage consists of three shots, each approximately $110 per shot, without insurance
  • the vaccine is only approved for girls and women aged 10-25

Vaccination consists of three shots except in people aged 9-15 when only two doses are required. At present time, 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.

This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: May 24, 2019.

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