Screening is a vital component in preventing HPV-associated cancers. HPV slowly causes abnormal changes in the cells it infects. These abnormal cells can eventually turn into cancer, and screening for precancerous cells can help prevent the progression from precancer to cancer. HPV can cause abnormal cell changes that lead to cancer in multiple locations including the anus, cervix, vagina, vulva, penis and head and neck. While only one of these locations is screened routinely (the cervix), there are screening tests that you can request from your doctor for the other locations.
On this page we discuss why you should get screened, the screening process for both women and men, and screening for anal cancer and precancer.
For most individuals, HPV will be cleared by one’s immune system. It is important to consult a physician if you notice any abnormalities on your genitals or anus including warts, lesions, bumps, lumps or blisters. Sexually active individuals should discuss their sexual health with their medical providers and partners.
Men and women who have an HPV infection are recommended to carefully monitor their body and obtain regular check-ups post-diagnosis.
Screening has proved extremely effective in decreasing the prevalence of cervical cancer, which in the United States is caused by HPV 96% of the time. In the United States, incidence rates for cervical cancer fell approximately 70% from the 1940s to the 1980s. In the 1940s, about 26,000 women died annually from the disease, while in 2015 there are estimated to be 4,100 deaths.
The primary reasons for this decline are better screening practices and methods, including regular check-ups and cervical Pap smears. The cervix is the only location where HPV-related cancers can occur that is routinely screened. HPV-associated cancers in other sites, such as the anus, remain on the rise in part due to a lack of widespread screening protocols.
There are specialists who can screen for HPV-related cancers in other areas of the body, however. There are also ongoing studies hoping to determine the best screening and treatment methods for these other cancers.
If you have already had one HPV-related cancer or precancer, continued screening is very important. A previous diagnosis of one HPV-related cancer may increase your chances of developing another. For example, one predictor for vulvar cancer is a previous diagnosis of cervical cancer, and it is believed that this is linked to the shared risk factor of HPV.
SCREENING FOR HPV-RELATED CANCERS IN WOMEN
HPV can cause anal, cervical, vaginal, vulvar and head and neck cancer in women. Screening looks for cancer as well as the precancerous lesions that lead to cancer.
US AND UK SCREENING PROTOCOLS FOR CERVICAL CANCER
In the US, women between the ages of 21-65 are recommended to have cervical pap smears and HPV tests (for women over 25) during regular gynecological visits to test for HPV-associated lesions and other abnormalities. HPV DNA tests are not blood tests but look for HPV DNA in the cervical cells. This is contrary to the pap which looks for abnormal changes to the cell that can be seen though a microscope. These DNA tests can help determine whether a woman has any of the high-risk HPV strains. Her physician can then recommend an appropriate course of action to prevent cancer.
In the UK, women from the ages of 25-65 receive a free cervical screen every three to five years. The screen checks for the presence of abnormal cells caused by HPV through the pap smear. HPV DNA tests are also not part of routine screenings, but may be implemented if abnormalities are found during a pap.
SCREENING WOMEN FOR HPV-RELATED VAGINAL, VULVAR, ANAL AND HEAD AND NECK CANCERS
At this time, women are not routinely screened (i.e. at your annual visit) for vaginal, vulvar, anal and head and neck cancers and precancers although there are often tests available if you are concerned. See your physician if you are concerned about any abnormal growths on your anus, vagina, vulva or mouth.
The pap smear will not test for the presence of vaginal and vulvar cancers, although pelvic examinations as part of regular checkups may help alert your doctor to the presence of abnormalities. Be sure to let your physician know if and when you are experiencing something out of the ordinary and that it may be a sign of vaginal or vulvar cancer.
Women are not currently routinely screened for anal cancer. According to the American College of Obstetricians and Gynecologists (ACOG), at this time, digital rectal exams (DREs) are not a required part of the routine pelvic exam, so you may need to request this specifically from your doctor. DREs do not appear to be part of routine gynecological visits in the UK. There is a growing trend in the medical community to call DREs digital anorectal exams (DAREs) to emphasise that the clinician is checking the anus for cancer and precancer as well as the rectum. While anal cancer is not screened for routinely, there are methods to screen for it if you are concerned, below.
The US Preventive Service Task Force is currently evaluating its recommendations for HPV-related head and neck cancer screening in both men and women. As of now there are no standard or routine screening tests in either the US or the UK, but several professional organisations such as the National Health Service (UK), the American Cancer Society, and National Institute of Dental and Craniofacial Research (US) recommend thoroughly screening the oral cavity as part of routine check-ups. This will check for early stages of oral cancer. Effective screening tests for oral precancerous lesions are still being researched. For example, there are studies underway to determine whether HPV DNA tests can help in diagnosing these cancers. To learn more about screening for oral cancer, we suggest visiting The Oral Cancer Foundation’s website.
If precancerous lesions are found, more information on treatment options is available here.
SCREENING FOR HPV-RELATED CANCERS IN MEN
HPV can cause anal, penile and head and neck cancer in men.
There is no routine screening or testing protocol for HPV in men for any location where the virus can cause cancer. HPV, if unresolved by the body’s immune system and left untreated, can eventually cause anal, penile and head and neck cancer in men.
Unfortunately, there is minimal education about men and HPV. Any man who is sexually active will likely have at least one HPV infection during his lifetime. While the immune system generally fights off HPV, and most men don’t realise they have it, men can also develop precancerous lesions that should be monitored to ensure they don’t develop into cancer.
The HPV-related cancers that have seen the largest increase over the last decade are HPV-related cancers in men; specifically in the head and neck and anus. Today more women than men have HPV-related cancers in the US and UK, although that ratio is expected to switch in the coming decade.
Although screening men for HPV-related cancers does not happen routinely, there are methods, especially for the penis and anus, that can detect whether an abnormality or lesion is HPV-related. Men should seek advice from their doctor as soon as they notice any abnormalities on their penis, in their anus or mouth.
Both men who have sex with women (MSW) and men who have sex with men (MSM) have HPV infections in their anus, although MSM are among those who are most at risk for acquiring anal HPV infection. More recently, the medical community is improving efforts to screen MSM for anal HPV, but these efforts vary among different practitioners and municipalities.
There are currently no standardised penile cancer screening guidelines for men in either the US or the UK. Because most penile cancer starts in the skin, it is relatively easy to see. Men should visit their medical provider as soon as they notice an abnormality.
The US Preventive Service Task Force is currently evaluating its recommendations for HPV-related head and neck cancer screening in both men and women. As of now there are no standard or routine screening tests in either the US or the UK, but several professional organisations such as the National Health Service (UK), the American Cancer Society (US), and National Institute of Dental and Craniofacial Research (US) recommend thoroughly screening the oral cavity as part of routine check-ups. This will check for early stages of oral cancer. Effective screening tests for oral precancerous lesions are still being researched. For example, there are studies underway to determine whether HPV DNA tests can help in diagnosing these cancers. To learn more about screening for oral cancer, we suggest visiting The Oral Cancer Foundation’s website.
If precancerous lesions are found, more information on treatment options is available here.
SCREENING FOR ANAL PRECANCER AND CANCER
A provider may use DAREs, anal pap smears, anoscopies or high-resolution anoscopies (HRA). HRA is the most precise, which is a procedure using a high resolution magnifying instrument to identify abnormal cells (similar to a colposcope used to identify cervical abnormalities). Exams to test for anal precancer and cancer use similar mechanisms as exams that screen for cervical precancer and cancer. For more specific information on screening for anal cancer, please see our Anal Cancer Prevention page.
There has been mounting evidence of ‘spontaneous regression’ of high-risk precancerous anal lesions (often called HSIL or AIN2/3) in recent years. This means that, instead of progressing to full-blown cancer, doctors and researchers are seeing more cases of HSIL actually improve on their own, and be downgraded in severity, rather than worsen and require treatment. HIV-positive individuals tend to be less likely to experience such regression than those who are HIV-negative, however. Much more research is needed on these findings before they can be turned into recommendations for clinical practice.
If you believe you are at risk of anal HPV infection or have anything that seems abnormal, you should ask your doctor if he or she can implement appropriate screening procedures. Ask your doctor about these procedures. Do not expect your doctor to suggest these for you.