2024-01-18 15:39:39
January 18, 2024
In cervical cancer screening, we use the genetic test called “HPV test”. But if it comes back positive from the medical analysis laboratory, several questions arise. Professor Jean-Luc Mergui, gynecological-obstetrician surgeon, president of the International Federation of Colposcopy and Cervical Pathology, answers it.
The HPV test, intended for cervical cancer screening, is used first-line from the age of 30. It looks for the presence of the virus responsible for cervical cancer: the papillomavirus. In the event of a negative result, the procedure ends. However, if the result is positive, we then move on to cytological analysis (“cytology”). This step allows any abnormal cells to be identified. This screening regimen is ultra-effective. It sometimes manages to detect cancerous lesions at an early stage, thus facilitating their treatment. It also makes it possible to identify precancerous lesions, with the possibility of treating them even before the appearance of cancer.
1. Does a positive HPV test mean I have a precancerous lesion or cancer?
Not necessarily. Only 7% of women with an HPV+ test actually have a lesion on the cervix. For the remaining 93%, no lesion is present. We know that if HPV persists following 11 years, there is an increased risk of high-grade lesions on the cervix (20 – 30% of women). Although most women screened for HPV+ at the start will not have any lesions, they must nevertheless be followed. The “triage” process following a positive HPV test involves examining the cells of the cervix (by cytology/smear) to detect any lesions. According to the results of this cytology, approximately 25% of patients with HPV + will present minor lesions, and only 10% will have high-grade, therefore precancerous, lesions.
Ultimately, in the event of a positive HPV test, only 1% of women will actually present a lesion that requires treatment at the cervix.
2. When did I get HPV infection?
Between the ages of 15 and 30, most of us are infected with high-risk HPV. Every year between the ages of 18 and 25, 17% of us are exposed to high-risk HPV, usually early in our sex lives. After five years of sexual activity, 80% of women have been exposed to HPV. However, the virus disappears naturally following regarding 14 months. After this period, 50% of women have eliminated the virus from their body. In summary, it is possible to be exposed to HPV early in your sexual life, but the virus is eliminated over time.
3. If my HPV test is positive, is it dangerous for my partner?
The partner has probably already been exposed to HPV. Transmission, which is difficult to prevent, occurs mainly through sexual intercourse, but also through touching with fingers (hence the poor effectiveness of condoms in preventing HPV infection). But overall the risk of transmission to the male partner is much lower than for women.
Let’s compare the figures: around 40,000 precancerous or cancerous lesions linked to HPV occur in women each year in France (2,900 cervical cancers, 1,100 anal cancers, 400 mouth and throat cancers “oropharynx”; figures 2015). There are 1,900 in humans (1,300/year).
Only oropharyngeal cancers are three times more common in men.
Note, the types of viruses present in couples are often not the same. Only 15% of couples harbor the same types of HPV viruses in the penis and vagina.
4. My HPV test is positive, how do I get rid of the virus?
Women often wonder how to treat high-risk HPV infection (types 16 or 18, in particular). Laser, conization (removal of part of the cervix, recommended in cases of precancerous or cancerous lesions), cryotherapy or even hysterectomy… Above all not! Although they can treat a lesion present on the cervix, these treatments are absolutely not effective in eliminating the simple presence of the virus.
Currently, there is no medical or surgical treatment for papillomavirus infection. We know that stopping smoking promotes the natural elimination of the virus. As for the vaccine, it is “prophylactic”, that is to say it prevents HPV infection, it does not treat it.
To find out more: Many “received ideas” exist regarding HPV infections. Answers from the French Society of Colposcopy and Cervico-Vaginal Pathology
Source: According to the follow-up to the press conference of the French Society of Colposcopy and Cervico-Vaginal Pathology (SFCPCV) on January 11, 2024.
Written by: Hélène Joubert; Edited by Emmanuel Ducreuzet
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