THEDiseases associated with human papillomavirus (HPV) remain an important public health problem. Globally, it is the fourth most common cancer in women and the second leading cause of death in women under the age of 44. Gynecologist and obstetrician Cristina Nogueira-Silva, from Braga Hospital, warns that 260,000 women die each year from invasive cervical cancer, with a higher incidence among smokers, immunosuppressed and transplant recipients . He therefore argues that it is necessary to continue to raise awareness of the most common sexually transmitted infection in the world.
“Marking International HPV Awareness Day is an opportunity to alert the public and to remember the path of research, improved care and awareness traveled over the past 35 years, but also to attract pay attention to what remains to be done”, says the specialist, who is also a professor at the Faculty of Medicine of the University of Minho.
The doctor explains that there are over 200 different types of HPV, some of which have carcinogenic potential. It is estimated that approximately 75-80% of sexually active people will have an episode of HPV infection in their lifetime. “HPV infection can be associated with benign but potentially recurrent diseases that induce poor quality of life and anxiety, such as oropharyngeal warts and anogenital warts, as well as malignant pathology,” adds gynecologist Cristina Nogueira-Silva.
HPV is a human carcinogen, being recognized as the cause of approximately 5% of all cancers (more than tobacco): almost all (99.7%) of cases of cervical cancer, 70% of vaginal cancers and 40% of the vulva, 47% of penile cancers, 90% of anal cancers, up to 72% of oropharyngeal cancers and 10% of laryngeal cancers.
According to the expert, “the development of prophylactic recombinant HPV vaccines has proven to be an effective, cost-effective and safe primary prevention strategy, with multiple studies demonstrating seroconversion rates of 97-100% of the vaccinated population and a clear impact on reducing the burden of disease associated with HPV.” He also points out that the ninth-valent vaccine “has the potential to prevent 89% of HPV-associated cancers and 82% of precancerous lesions” of the cervix, vulva, vagina and anus.
“Despite these findings, HPV-associated diseases remain an important public health issue that cannot be left in the background. HPV is also responsible for 284,000 to 540,000 new anogenital precancerous lesions per year. In Portugal, every year it is estimated that 865 women are diagnosed with cervical cancer and 379 die from it, being the third most common cancer in women between 15 and 44 years old”, he points out.
And what makes the cervix so susceptible to HPV infection?
Cristina Nogueira-Silva explains that the cervix is made up of an area receptive to infection, called the transformation zone, in which cells remain in differentiation. “The human papillomavirus infects the cells of this area of the cervix, which it accesses by microtrauma, especially during sexual intercourse. Persistent HPV infection of so-called high-risk types plays a crucial role in malignant transformation. However, he points out that “the process of development of malignant disease is slow, which provides an opportunity for intervention.” For this reason, “it’s so important for women to see their doctor and get cervical cancer screening, which involves taking cells from the cervix, to look for the presence of HPV and/or detect changes in these cells (Pap smear).
Wait to see how it evolves or intervene?
According to the doctor, different scientific societies, such as the American Society of Colposcopy and Cervical Pathology and the Portuguese Society of Gynecology, maintain that in the face of the evolution of screening tests, there can be a clinical (surveillance) or expectant therapeutic approach. . , depending on the degree of risk that the infection will become malignant.
According to him, the expectant approach should indeed be recommended in many clinical cases. However, she acknowledges from her clinical experience that the diagnosis of a change in cervical cancer screening test is associated with high levels of anxiety on the part of women, which sometimes makes it difficult to acceptance of the so-called “wait and see” strategy. , i.e. wait and see how it develops. Therefore, he admits that therapeutic intervention strategies, such as products for vaginal application, can be used as a way to stimulate natural tissue regeneration and, at the same time, reduce anxiety levels.
“In recent years, beta-glucan vaginal delivery products approved for the treatment and prevention of low-grade cervical lesions caused by HPV have been developed. Scientific studies show that beta-glucan, in addition to activating the immune system, promotes epithelialization and stimulates cervical regeneration,” he points out. He cites as an example a study involving approximately one thousand women in which a vaginal spray formulation of carboxymethyl-betaglucan and polycarbophil gel showed a 95.7% regression of low-grade lesions at 6 and 12 months, i.e. a regression of 1.3 times higher than the expectant approach.
In summary, the expert specifies that the decision for a surveillance or intervention approach must be analyzed on a case-by-case basis, i.e. according to the individual risk of malignancy, the evolution of the disease and the level of anxiety a woman faces with a change in a cervical cancer screening test.