Dear Alice,

I just found out I tested positive for high-risk HPV. My pap smears have been normal for years. I'm 45 years old and have had lots of basal cell skin cancer. I'm scared to death of getting cancers that are caused by HPV. I'm so stressed. What are the odds that I will actually get cancer, now that I am supposedly high-risk? It appears there it nothing I can do at all to prevent this from happening other than keeping up with my visits and pap smears and hoping I beat the odds. I just wonder at how much risk am I when they say I am HIGH-RISK???

Dear Reader,

Positive test results can be upsetting, whether it’s a diagnosis for basal cell carcinoma (BCC), which is one of the most common kinds of skin cancer (one that’s relatively low-risk) or testing positive for the human papillomavirus (HPV) that is often associated with genital warts and cervical cancer. The short answer to your question is that high-risk HPV strains are the culprits behind the bulk of cervical cancer cases. However, a one-time positive HPV test does not necessarily mean you will develop cervical cancer. For many, the body will fight off high-risk HPV within one to two years. It’s also good to note that in the event that it does begin to develop into cancer, it can take anywhere from one to three decades for a high risk HPV infection to develop into a small tumor. So, even with high-risk HPV, there’s data to support optimism. In addition, knowing a bit more about HPV, HPV tests, and risks factors can help you understand it and take steps to address it.

Time for a quick HPV refresher! HPV is a group of about 40 viruses that are highly infectious and spread very easily from person to person through sexual contact. Of these 40 strains, there are about a dozen that are grouped as “high-risk,” meaning they are associated with changes in the cervical cells and with developing cervical cancer. Two strains in particular, HPV-16 and HPV-18, account for most of the cervical cancer cases due to HPV infection. The “low-risk” HPV types are associated with genital warts, but not with cervical cancer.

You shared that your yearly Pap smear has been normal for some time and this is normal for many people. You can have a normal pap smear and still have high-risk HPV. A quick note on pap smears and HPV tests: the Pap test checks the cervix for abnormal cells that could turn into cervical cancer, whereas the HPV test checks the cervix for HPV that could CAUSE abnormal cells and lead to cervical cancer. So, your results (normal Pap, positive HPV) indicate that your cervical cells are normal, but high-risk HPV exists. If you do have an abnormal Pap test in the future, there’s no need to panic. A little less than half of the time, abnormal cervical cells that are seen after a high-risk HPV infection progress to invasive cervical cancer.

Because you mentioned your age, it’s worth noting that age can be a factor in monitoring HPV. For women under age 30, HPV is so common and cleared so often, that screening in that age group is not routine. In women over 30, however, it is more common for health care providers administer HPV tests and to monitor positive HPV results with regular Pap test. Since cell changes can occur slowly over time, a Pap test once a year is the recommended frequency for testing. However, if you tested positive for HPV-16 or HPV-18, your health care provider may also perform a colposcopy: in this procedure, s/he will look at the external vagina and cervix under magnification to check for any abnormal cells.

As a side note, it may interest you to know that research doesn’t show a correlation between cervical cancer due to HPV infection and most cancers, including the type of cancer you’ve had. Those who are at a greater risk of cervical cancer due to HPV infection include people who are severely immune suppressed, or who take immune suppressive drugs (to receive a transplant, those with Hodgkin lymphoma, or people who have had irradiation to the pelvis). In general, more research needs to be done in this area. But for now, your history of BCC doesn’t appear to be related in terms of your cervical cancer risk.

So, what else can you do to keep yourself healthy? Keeping up with your annual testing is one way to take care of your health with regard to your HPV, but it’s not the only thing you can do! Talking to others (e.g., friends, loved ones, or a counselor) can help you process and manage the anxiety you are feeling. Asking questions can help you learn more about a diagnosis, so props to you for reaching out! For some more specific info on cervical cancer, check out Cervical cancer info online in the Go Ask Alice! archives.

Alice!

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