HPV and Cancer

Risk Factors:
Studies show that anal cancer is more common in cis men who are gay, bi, or have sex with other guys than in other population. For those people living with HIV, anal cancer is many times more likely still.  

There’s not a lot of data on whether trans men and nonbinary people with front holes/vaginas who have sex with guys are impacted by anal cancer at the same rates as cis men. We do know that having a history of cervical and vulvar pre-cancerous lesions and cancers makes it likelier that anal cancer develops.  

Research suggests that trans women experience anal cancers caused by HPV at rates similar to cis men who have sex with men.

 Anal Dysplasia and Anal Cancer:
Anal cancer usually develops over several years. It first appears as what is called anal dysplasia. Anal Dysplasia is when cells around the anus change and become abnormal. These abnormal clusters of cells are called lesions and can be either just inside the anus or on the skin just outside of the anus. These kinds of anal dysplasia are usually caused by certain types of HPV, which interfere with our body’s ability to stop anal dysplasia from happening.  

Anal dysplasia is considered precancerous, meaning the cells in question are likelier to develop into anal cancer than regular cells if those precancerous cells they aren’t treated.  

Not all cases of anal dysplasia progress to cancer: some will go away, go away and come back, or simply stay as lesions. A lot of people get diagnosed with dysplasia, but few of end up developing cancer, especially if the dysplasia is treated. Treatment can include topical creams, or electro- or laser surgery. 

If you have anal dysplasia and are also living with HIV, it’s important that the dysplasia is monitored regularly since it’s more likely to develop into anal cancer. 

Prevention/Gardasil:
The HPV vaccine Gardasil 9 guards against the types of HPV associated with anal cancer and precancerous conditions like anal dysplasia, including HPV types 16 and 18. 

Overall, Gardasil 9 prevents infection by the HPV types that cause over 90% of genital warts, 80-90% of anal cancers, over 90% of cervical cancer, and a significant proportion of vaginal and vulvar cancers. Research also suggests the vaccine can help prevent penile and mouth cancers. 

Find out how to GetGarded with Gardasil, including for free through BC’s provincial program, private insurance, and a program for people with limited financial resources. 

Symptoms:
Anal dysplasia doesn’t have many visible symptoms and is hard to detect through routine examination. This can make it difficult to screen for anal dysplasia meaning that it’s often not detected until it has developed into anal cancer. Digital anorectal exams (when a doctor inserts their finger into the anus to feel for anything abnormal) can find lumps that may be cancerous, but dysplasia may not be noticeable to the touch. 

Screening:
Examination with an anoscope or an anal pap test are more effective options of detecting anal dysplasia. An anoscope is a short hollow tube, usually with a light, inserted into the anus to allow the doctor to closely examine the lining of the anal canal. In some health care centres, the examination is done under magnification using a special microscope (called high-resolution anoscopy). An anal pap test, like a cervical pap test (also called a pap smear), is when a swab is taken from the lining of the anal canal, and the cells collected on the swab are examined for abnormalities. 
 
Due to a lack of research, there are currently no guidelines on how often someone at higher risk for anal cancer should be screened with an anal pap test. There are no established guidelines, but it has been suggested that screenings should happen once every three years, or once a year for people living with HIV. You can speak to a trusted doctor or health care provider if you think regular anal pap tests or other examinations should be part of your health care routine. 

Treatment:
If anal cancer is discovered and confirmed, treatment will depend on the cancer’s severity and stage of development. The earlier anal cancer is detected, the more effectively it can be treated. Usual treatment for anal cancer includes surgery, often with radiation and/or chemotherapy, though can be difficult to treat depending on the severity.  

Talk to a doctor or trusted health care provider about screening for dysplasia and anal cancer, and what they recommend for screening and following steps.  

Risk Factors:
Almost all cases of cervical cancer are related to certain types of HPV. Other factors that can make cervical cancer likelier are having had multiple full-term pregnancies, smoking, long-term use of oral birth control (‘the pill’), having had certain other STIs, and living with HIV or having an otherwise weakened immune system. 

Prevention/Gardasil:
The HPV vaccine Gardasil 9 guards against the types of HPV associated with cervical cancer, including types 16 and 18 which cause 70% of cervical cancers and the pre-cancerous of cervical dysplasia. Gardasil 9 also prevents HPV types 31, 33, 45, 52, and 58, which account for an additional 10% to 20% of cervical cancers. 

Overall, Gardasil 9 prevents infection by the HPV types that cause over 90% of genital warts, 80-90% of anal cancers, over 90% of cervical cancer, and a significant proportion of vaginal and vulvar cancers. Research also suggests the vaccine can help prevent penile and mouth cancers. 

Find out how to GetGarded with Gardasil, including for free through BC’s provincial program, private insurance, and a program for people with limited financial resources. 

The HPV vaccine Cervarix is also approved in Canada. It also guards against types 16 and 18 of HPV, but does not guard against the seven additional types covered by Gardasil 9. Gardasil 9 is more commonly used and is what you will receive in BC through free programs. 

Cervical Dysplasia:
Cervical dysplasia is when cells in the surface of the cervix change and become abnormal. The areas with these abnormal cells are called lesions. Some cases of cervical dysplasia are precancerous, meaning the abnormal cells are more likely to develop into cancer if they aren’t treated.  

Early lesions are referred to as “low-grade”, and often clear up on their own. In some cases, they develop into ‘high-grade’ lesions that can then become cervical cancer. If discovered, high-grade lesions are usually treated immediately, unless a person is pregnant. Lesions are very common and having them does not mean that a person has or will have cancer. 

Not all cases of cervical dysplasia always progress to cancer: some will go away, go away and later return, or simply remain as lesions. A lot of people get diagnosed with dysplasia, but few of these people end up having cancer, especially if they are treated. 

Screening:
The current standard for cervical cancer screening in BC is a pap test (also called a pap smear). A pap test is when a small sample of cells is taken from the surface of the cervix and “smeared” on a glass slide where it’s examined. Because cell changes tend to happen very slowly, pap tests are recommended every three years after the age of 25. If we’re living with HIV, they are recommended more frequently: twice in the year following HIV diagnosis and once or twice a year after that. 
 
The presence of cervical dysplasia or abnormal cells is very common and does not mean those cells are cancerous or precancerous. If abnormalities are found, you may need further tests, whether another pap test, a colposcopy (allowing for a close examination of the cervix with a microscope) or taking a small sample for closer examination. 
 
Some places around the world test directly for types of HPV that can cause cancer. These tests have the advantage of detecting HPV that can cause cancer even before dysplasia occurs. These tests are not the current standard of care in BC and are only available at certain private labs and have to be paid for out of pocket. Cervical screening with pap tests is still considered highly effective at detecting cervical cancer. 
 
The changes to the cells in the cervix caused by HPV can also happen to the anus and lead to anal dysplasia and possibly anal cancer. That’s why if abnormalities are detected in your cervix, your health care provider might recommend that you also get an anoscopy, which is an examination of the anus and anal canal for anal cancer.

Symptoms:
There usually aren’t symptoms for cervical dysplasia or early stages of cervical cancer. When cervical cancer is more advanced, possible symptoms include foul-smelling frontal/vaginal discharge, frontal/vaginal bleeding between menstrual periods, pain in the abdomen and lower back, and pain and bleeding during penetrative frontal/vaginal intercourse, among others. These symptoms are not exclusive to cervical cancer, and anyone experiencing any of these symptoms may want to consider talking to a trusted health care provider. 

Treatment:
If cervical cancer is detected and confirmed, treatment depends on the cancer’s severity and what stage of development it’s in. Usual treatment for cervical cancer includes surgery, radiation therapy, and chemotherapy. The earlier cervical cancer is detected, the more effectively it can be treated. If you have a cervix, talk to a doctor or trusted health care provider about cervical dysplasia and cancer, and what they recommend for screening and next steps. 

Risk Factors:
People who are circumcised have fewer cases of penile cancer than those who are uncircumcised, though the evidence is not clear if circumcision has any effect on HPV transmission (which we believe causes many cases of penile cancer). Penile cancer tends to be more common in older people, and four out of five diagnosed cases of penile cancer in the United States are in people over 55. People living with HIV, or who have a weakened immune system, may also have a higher likelihood of developing penile cancer. 

Prevention/Gardasil9:
The HPV vaccine Gardasil 9 guards against HPV types 16 and 18, which are linked to penile cancer. Though it is not currently approved for this use, some evidence suggests that Gardasil 9 may help prevent precancerous conditions and penile cancer for people that do not already have these types of HPV. 

Overall, Gardasil 9 prevents infection by the HPV types that cause over 90% of genital warts, 80-90% of anal cancers, over 90% of cervical cancer, and a significant proportion of vaginal and vulvar cancers. Research also suggests the vaccine can help prevent penile and mouth cancers. 

Find out how to GetGarded with Gardasil, including for free through BC’s provincial program, private insurance, and a program for people with limited financial resources. 

People who have an uncircumcised penis can reduce their chances of developing penile cancer by practicing good genital hygiene and regularly rinsing the are under their foreskin (careful not to rub or use irritating soap, since that area is sensitive!). “Smegma”, a thick substance of dead skin, bacteria, and oily secretions, can build up under the foreskin, irritation the penis and causing inflammation, which increases the risk for penile cancer. 

Delopment:
Penile cancer most commonly starts in penis cells that stop growing or behaving normally. Sometimes, these changes can lead to precancerous conditions that can become cancer if they aren’t treated. In cases where cancer does develop, it most often starts in the cells in the skin of the penis, foreskin, and glans (the head of the penis). 

Symptoms:
Penile cancer will often present symptoms even in early stages. The most common symptom is a change to the skin on the penis head, foreskin, or shaft. These can include the skin becoming thicker or changing colour. Other common symptoms include strange lumps and growths, reddish rashes or irritation, and smelly discharge or bleeding. These symptoms are not always caused by penile cancer, so consult with a doctor or trusted health care provider if you’re experiencing these symptoms.

Screening:
Although we don’t have an effective screening process for penile cancer, cases of penile cancer are usually found early and before they spread to other parts of the body. That’s because almost all penile cancers start in the skin and cause visible changes.

Treatment:
If penile cancer is diagnosed, the most common treatment is surgery. Radiation or drug therapy may also be prescribed. What treatment makes most sense depends on how advanced the cancer is, where it’s located, and a person’s specific health needs and preferences.  

Risk Factors:
Aside from having an HPV infection, additional risk factors include having had cervical cancer or cervical dysplasia, vulvar cancer, anal cancer, or exposure to Diethylstilbestrol (also known as DES, a hormone drug that was in use from 1940 to 1971 to prevent miscarriages). Few people under 40 develop vaginal cancer, and almost half of cases are among people over 70 years old. People living with HIV or who otherwise have a weakened immune system may also be likelier to develop vaginal cancer.

Development:
Changes to cells of the front hole/vagina can make them abnormal or precancerous, meaning these cells can become cancer if they aren’t treated. Most people diagnosed with precancerous conditions are successfully treated and don’t develop cancer. In the cases where vaginal cancer does develop, it is often in the cells in the frontal/vaginal lining. Vaginal cancer is rare, and it is more common for other types of cancer (like from the cervix or vulva) to spread to the front hole/vagina than it is to have vaginal cancer. 

Prevention/Gardasi:
The HPV vaccine Gardasil 9 guards against HPV types 16 and 18, which are linked to vaginal cancer.  

Overall, Gardasil 9 prevents infection by the HPV types that cause over 90% of genital warts, 80-90% of anal cancers, over 90% of cervical cancer, and a significant proportion of vaginal and vulvar cancers. Research also suggests the vaccine can help prevent penile and mouth cancers. 

Find out how to GetGarded with Gardasil, including for free through BC’s provincial program, private insurance, and a program for people with limited financial resources.

Symptoms:
Most cases of vaginal cancer will not present symptoms during the early stages. As this cancer progresses, symptoms can include unusual frontal/vaginal bleeding after penetrative frontal/vaginal sex and between menstruation periods, pain during penetrative frontal/vaginal sex, a foul-smelling discharge that may have blood in it, and a lump inside the front hole/vagina that can be felt. These symptoms are not exclusive to vaginal cancer and consulting with a doctor or trusted health care provider can help determine the source of the symptoms and explore options for treatment.

Screening:
Vaginal cancer can sometimes be detected by a pap test meant to screen for cancer in the cervix. That’s because cells from the front hole/vagina will also be included in the sample taken. If someone is at higher risk for vaginal cancer, they can also be screened by undergoing a pelvic exam or a colposcopy. A colposcopy is a close examination of the front hole/vagina with a microscope.

Treatment:
The earlier vaginal cancer is detected, the more effectively it can be treated. What treatment is most appropriate will depend on how advanced the cancer is, where it is located, and a person’s specific health needs and preferences. Usual treatment for vaginal cancer includes surgery, radiation therapy, and chemotherapy.  

Risk Factors:
80% of cases of vulvar cancer develop in people over 50, and 50% in people over 70 years old, though cases linked to HPV tend to effect people younger than that. People living with HIV, have weakened immune systems, or have had cervical, vaginal or anal cancer are more likely of developing vulvar cancer. 

Development:
Vulvar cancer begins with the appearance and growth of precancerous cells called vulvar intraepithelial neoplasia (VIN). Not all cases of VIN will develop into cancer but monitoring for and early treatment of VIN can help avoid cancer. If it turns into vulvar cancer, it grows slowly over several years.

Prevention/Gardasil:
The HPV vaccine Gardasil 9 guards against the types of HPV associated with vulvar cancer, including types 16 and 18. 

Overall, Gardasil 9 prevents infection by the HPV types that cause over 90% of genital warts, 80-90% of anal cancers, over 90% of cervical cancer, and a significant proportion of vaginal and vulvar cancers. Research also suggests the vaccine can help prevent penile and mouth cancers. 

Find out how to GetGarded with Gardasil, including for free through BC’s provincial program, private insurance, and a program for people with limited financial resources.

Symptoms:
Most cases of vulvar cancer do not present symptoms during their early stages. As vulvar cancer progresses, symptoms can include thickened skin, lumps, or open sores on the vulva or in the opening of the front hole/vagina; unusual bleeding or discharge outside of menstruation periods; pain when peeing or during penetrative frontal/vaginal sex; and a persistent itching or burning sensation of the vulva, among others. These symptoms are not exclusive to vulvar cancer, and a doctor or trusted health care provider can help determine what’s causing the symptoms and explore treatment options.

Screening:
There is no screening program for vulvar cancer. People with a history cervical or vaginal cancer will often have careful inspections of their vulva as part of their regular follow-up.

Treatment:
The earlier vulvar cancer is detected, the more effectively it can be treated. Treatment depends on how advanced the cancer is, where exactly it is in the body, and a person’s specific health needs and preferences. Usual treatment for vulvar cancer includes surgery, radiation therapy, and chemotherapy. The health care providers working with a person with vulvar cancer will help them come to the best course of treatment for their needs and circumstances. 

Risk Factors:
Aside from HPV infection, drinking alcohol and smoking cigarettes are considered major risk factors for cancer of the mouth and throat, and are associated with heightened risk for cancer in general. People living with HIV or who otherwise have a weakened immune system may also be at higher risk.

Development:
Oral cancer is when cells in the oropharynx change and start growing and behaving abnormally. This may lead to non-cancerous conditions such as retention cysts or non-cancerous tumours. 

In some cases, abnormal cells can cause oropharyngeal cancer.

Prevention/Gardasil:
The HPV vaccine Gardasil 9 guards against the types of HPV associated with oral and throat cancer, including type 16. Though it is not currently approved for this use, some evidence suggests that Gardasil 9 may help prevent precancerous conditions and oral and throat cancers for people that do not already have these types of HPV. 

Overall, Gardasil 9 prevents infection by the HPV types that cause over 90% of genital warts, 80-90% of anal cancers, over 90% of cervical cancer, and a significant proportion of vaginal and vulvar cancers. Research also suggests the vaccine can help prevent penile and mouth cancers. 

Find out how to GetGarded with Gardasil, including for free through BC’s provincial program, private insurance, and a program for people with limited financial resources.

Symptoms:
Symptoms of oral and throat cancers can include ulcers or sores in the mouth that do not heal within a few weeks, discoloration of tissue in the mouth, a persistent sore throat, difficulty swallowing, a lump or mass on the neck, constant coughing, and an earache in one ear that goes on for several days, among others. These symptoms are not exclusive to mouth and cancer, and talking to a doctor or trusted health care provider can help determine the source of the symptoms and explore options for treatment.

Screening:
Screening for oral and throat cancer is generally done by examining the mouth and using a thin telescope through the mouth or nose to examine the back of the throat and surrounding area. Dentists will often do a visual screening for oral cancer as part of a routine check-up.

Treatment:
The earlier that mouth or throat cancer is detected, the more effectively it can be treated. What treatment is most appropriate will depend on how advanced the cancer is, where it is located, and a person’s specific health needs and preferences. Usual treatment for these cancers includes surgery, radiation therapy, and chemotherapy. Health care providers help people with these cancers decide the best course of treatment for their specific needs and circumstances.