Human papillomavirus (HPV), or Human papillomavirus infection, is one of the most common infections in the world. Most people will be exposed to HPV at some point in their lives, usually without even knowing it. In many cases, the immune system controls the virus naturally, although the virus can appear and disappear during someone’s lifetime. When HPV remains active in the body for years, it can lead to abnormal cell changes that may eventually become cancer.
HPV is responsible for nearly all cervical cancers and is also linked to cancers of the throat, anus, vagina, vulva and penis. Because of this connection, researchers and doctors have spent decades working to improve prevention, screening and treatment options.
Today, there is growing optimism. Advances in vaccination, screening and newer treatments—including immunotherapy—are helping improve outcomes and offering new hope for patients.
Tufts Medicine, in collaboration with Tufts University School of Medicine, has built a team of leading experts in HPV treatment, research and prevention.
This collaboration includes experts from gynecology, radiation oncology, colorectal cancer, infectious diseases and pathology all working together to prevent HPV infections, improve patient care and experience and collaborate on research, training and treatment.
Why HPV matters
“According to the Centers for Disease Controls and Prevention, more than 80 percent of people will be exposed to HPV during their lifetime,” said Jessica DiSilvestro, MD, a gynecologic oncologist at Tufts Medical Center and Assistant Professor of Medicine at Tufts University School of Medicine. “Most infections never cause problems, but persistent infections can quietly develop into cancer over time.”
Cervical cancer often develops slowly, sometimes taking 10 to 20 years after an HPV infection to appear. That long timeline creates important opportunities for prevention and early detection.
Each year in the United States, roughly 13,000 to 13,500 people are diagnosed with invasive cervical cancer. The encouraging news is that cervical cancer is one of the most preventable forms of cancer when HPV vaccination and regular screening are used consistently.
The importance of HPV vaccination
The HPV vaccine has dramatically changed the fight against HPV-related cancers.
Vaccination is recommended for boys and girls beginning around ages 9 to 12 and protects against the strains of HPV most likely to cause cancer. Studies have shown that vaccination during adolescence can reduce HPV-related cancer rates by more than 90 percent.
The vaccine helps protect against cancers involving the:
- Cervix
- Vagina
- Vulva
- Anus
- Penis
- Tonsils
- Tongue
Children ages 9 to 14 typically receive two doses, while those vaccinated later generally need three doses. Adults up to age 45 may still benefit from vaccination depending on their health history and risk factors.
Experts stress that vaccination works best when given before age 15.
Screening saves lives
Regular screening remains one of the most effective tools for preventing cervical cancer.
There are two primary screening methods:
- Pap testing, which looks for abnormal cells in the cervix
- HPV testing, which looks directly for the virus itself
“For many adults over age 30, HPV testing is now the preferred screening approach because it can identify risk earlier,” said Rebecca Perkins, MD, a gynecologist at Tufts Medical Center and Professor of Obstetrics and Gynecology at Tufts University School of Medicine.
Doctors are also increasingly using self-swab HPV testing, allowing patients to collect their own vaginal sample after receiving instructions from a healthcare provider. This option may help increase screening access and comfort for many patients.
Healthcare experts emphasize that screening should continue through age 65 unless the individual has had surgery to remove their uterus and cervix (hysterectomy). Since cervical cancer can take many years to develop, stopping screening too early may allow cancers to go undetected.
Treatment is improving
Treatment for HPV-related precancers and cancers depends on how advanced the disease is and where it occurs.
Precancerous cervical changes are often treated with procedures that remove abnormal tissue before cancer develops. These outpatient procedures typically take about 15 minutes and are more than 90% effective at preventing precancerous changes from progressing to cancer.
Women who are treated for precancerous changes retain their fertility, and usually do not need additional treatments.
If cancer does develop, it may be treated with surgery, chemotherapy, radiation or combinations of these treatments. Many of these treatments do make future childbearing very difficult.
Doctors are also working to make treatment less invasive whenever possible. In some patients with early-stage cervical cancer, newer approaches may reduce the need for extensive surgeries while still providing excellent outcomes. Healthcare teams are paying closer attention to quality of life after treatment, including long-term sexual health and recovery support for survivors.
The growing role of immunotherapy
According to Dr. DiSilvestro, one of the biggest developments in HPV-related cancer care is the use of immunotherapy.
“Unlike traditional treatments that directly remove or destroy tumors, immunotherapy helps the body’s own immune system recognize and fight cancer cells,” she said.
HPV-related cancers are especially good targets for immunotherapy because they contain viral proteins that make them easier for the immune system to identify once properly activated.
Researchers are studying several immunotherapy approaches, including:
- Therapeutic vaccines designed to treat existing HPV-related disease
- Checkpoint inhibitors that help immune cells attack cancer more effectively
- Personalized immune cell therapies.
Some immunotherapy drugs are already being used for advanced HPV-related cancers, while many others are still being studied in clinical trials.
“HPV is remarkably effective at hiding from our immune defenses,” said Dr. Perkins. “In many people, the immune system clears the virus naturally, but in persistent infections the virus can suppress immune responses and remain in cells for years. Researchers are studying immunotherapies because they may ‘reawaken’ immune cells that no longer recognize HPV-infected tissue.”
Although research is continuing, these treatments are creating new possibilities for patients who previously had limited options.
Awareness beyond cervical cancer
While cervical cancer receives the most attention, doctors are also concerned about rising rates of other HPV-related cancers, especially cancers of the throat and anal cancer.
Experts say greater public awareness is needed because many people do not realize HPV affects both men and women and can lead to several different types of cancer. Regular medical care, conversations with healthcare clinicians and awareness of symptoms remain important parts of prevention and early detection.
Looking ahead
The progress being made in HPV prevention and treatment is significant. Vaccines are preventing cancers before they start. Screening is helping detect disease earlier. With vaccination, screening, and treatment of precancerous lesions, more than 99% of cervical cancers can be prevented. And newer therapies, including immunotherapy, are expanding treatment options for patients facing HPV-related cancers.
The takeaway message remains clear:
- Get vaccinated if eligible,
- Stay current with recommended screenings
- Talk with your clinician about any concerns
HPV-related cancers remain a serious health issue, but advances in medicine are giving patients and families more hope than ever before.
Protect yourself against HPV-related cancers
HPV vaccination and regular screening remain the most effective ways to prevent cervical cancer and other HPV-related cancers. Whether you're due for screening, have questions about vaccinations or need expert care, the specialists at Tufts Medicine are here to help.
