2023-10-09 08:49:17
by Giorgia Mangili
Most papillomaviruses cause benign lesions. A small percentage, however, if left untreated, can develop into a tumor form
I have had high risk HPV for five years. I periodically carry out checks (colposcopy, Pap test and HPV DNA test) which fortunately always come back negative. In the last check-up the colposcopy was negative, but the typing detected the most dangerous strains (33, 59, 68): am I risking something serious? Is it true that after five years you are guaranteed to develop a tumor?
Answered by Giorgia Mangili, head of oncology gynecology, San Raffaele Hospital, Milan (VAI AL FORUM)
HPV (Human Papilloma Virus), or Papillomavirus, represents a family of viruses made up of over two hundred genotypes. Most HPVs cause benign lesions (warts and condylomas, which affect the skin, or papillomas, which affect the genital and oral mucous membranes). A small percentage, however, if left untreated, can slowly evolve towards a tumor form. The HPVs responsible for genital infection are divided into two groups: low and high oncogenic risk. Those at low risk cause genital lesions with reduced capacity for malignant transformation and/or high capacity for spontaneous regression and those at high oncogenic risk (Hpv 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 , 59, 66, 68) can instead determine the progression of the lesions into malignant tumors. It must be underlined that the evolution into carcinoma is generally a slow process; furthermore, the presence of the infection does not imply the certainty of developing a malignant tumor.
HPV test positive
In your specific case, the finding of infection by different HPV genotypes (33,59,68) is due to the high diffusion of the virus and the high genomic diversity of its family. The positive HPV test for high-risk genotypes detects the presence of the virus, not necessarily associated with preneoplastic or neoplastic cellular alterations. That is, to answer your question, there is no certainty (even if HPV has persisted for several years) of developing a tumor. In fact, from the data present in the literature, the risk of high-grade squamous intraepithelial lesion (High-SIL/HSIL) which includes CIN2 (moderate dysplasia) and CIN3 (severe dysplasia or carcinoma in situ), in women with HPV alone positive test and negative cytology by 5.2-9.2% while in the case of HPV positive test plus abnormal cytology the risk increases to 37.8-42.4%.
The control process
According to national guidelines, screening for cervical cancer in a woman under 30 years of age involves performing a Pap test every three years, while an HPV test is carried out in a woman between 30 and 64 years of age. every five years. In the case of a woman with a positive HPV test, she will have to undergo a Pap test: if this is negative, the patient will have to perform a new HPV test 12 months later; if further negative, the patient returns to the screening process with an HPV test performed in 5 years. However, if the 12-month test is positive, the woman will have to undergo colposcopy with targeted biopsy. If the latter tests negative or detects CIN-1, the patient will repeat a new HPV test after 12 months; however, if the colposcopy with biopsy is positive/abnormal, specific treatment will need to be carried out depending on the type of lesion.
The treatments
On the contrary, a patient with a positive HPV test and an abnormal or inadequate Pap test will have to undergo colposcopy with biopsy and possible specific treatment. If the targeted biopsy during colposcopy shows a low-grade squamous intraepithelial lesion (SIL) including CIN 1 (mild dysplasia), colposcopic follow-up will be performed. For a CIN1, ablative treatment with laser vaporization using CO2 laser or diathermocoagulation or cryotherapy is performed, if the lesion persists after at least two years or if it shows progression before two years; while an excisional treatment is carried out with diathermic loop conization (LEEP: loop electrosurgical exicision procedure) or laser conization (a method that uses the laser beam as a cutting function) or cold blade conization if the lesion is completely or partially endocervical.
Recommended vaccine
In case of high-grade squamous intraepithelial lesion (High-SIL/HSIL) which includes CIN2 (moderate dysplasia) and CIN3 (severe dysplasia or carcinoma in situ), excisional treatment is mandatory (in most cases a LEEP is performed ). This procedure uses a high-frequency electrical energy generator attached to a thin loop wire that, when stimulated, works like an extremely precise and rapid scalpel. It is also recommended to get the HPV vaccine, because there is evidence that it is also recommended for those who have already contracted the infection.
October 9, 2023 (modified October 9, 2023 | 09:17)
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