Aim: The aim of this article is to provide a practical and informative focus on cervical cancer prevention.
Learning outcomes:
By the end of the article, the reader should be able to:
“HPV causes almost 5 per cent of cancers worldwide and 99 per cent of cervical cancer.”
The cervix is a muscular, tunnel-like organ. It’s the lower part of the uterus, and it connects the uterus and vagina. Cervical cancer begins in the cervix cells. It is often due to infection with the human papillomavirus (HPV). The HPV can cause cells in the cervix to become abnormal. The cells change slowly. In most cases, it takes 15 to 20 years for these cells to go from normal to abnormal to cancerous.
It primarily affects women aged 30 to 50 but can occur in anyone with a cervix who has had sexual contact. Although cervical cancer often has no signs or symptoms in its early stages, the most common sign is abnormal bleeding. Other symptoms of cervical cancer include:
Full information is available at hse.ie > Health A to Z > Cervical cancer.
Human papillomavirus (HPV) is a double stranded DNA virus that infects squamous epithelia including the skin and mucous membranes of the upper respiratory and anogenital tracts. There are more than 100 different types of HPV, most of which infect the cutaneous epithelium and are responsible for common skin warts (verrucae). Human Papilloma Virus (HPV) is transmitted through skin-to-skin contact, especially sexual activity, including oral sex. Most people will contract HPV at some point in their lifetime. An estimated 80 per cent of sexually active men and women become infected with at least one type of HPV by age 50 years. Most HPV infections clear spontaneously but persistent infection with the oncogenic or high-risk types may cause cancer of the oropharynx and anogenital regions. HPV causes almost 5 per cent of cancers worldwide and 99 per cent of cervical cancer.
There is a national cervical screening programme in Ireland called CervicalCheck. The Government funds this service and provides free screening to women aged 25 to 65. Cervical screening is designed to identify those at risk of developing cervical cancer. Cervical screening can detect cervical intraepithelial neoplasia (CIN) and cervical cancer at an early stage when treatment may be more successful. A new way of cervical screening was introduced to Ireland in March 2020. It is called HPV cervical screening. Screening first looks to see if the patient has any of the high-risk types of human papillomavirus (HPV) that cause cervical cancer. If HPV is found, the same test sample will be checked to see if the patient has any abnormal (pre-cancerous) cells in their cervix.
Prophylactic vaccination against HPV can prevent the development of the cancers listed above. In addition, HPV-screening and treatment of pre-cancer lesions is an effective way to further prevent cervical cancer. The first HPV vaccine was developed in the 1990s by researchers in Australia. As of 2022, 140 countries worldwide have introduced HPV vaccination into their national immunisation schedule with more than 50 introducing it on a gender-neutral basis.The impact of population wide HPV vaccination programmes has been demonstrated in a number of countries:
Similar results are mirrored in other countries, including Finland, Japan, New Zealand, Norway, Sweden and the US.
At the recent launch of the Cervical Cancer Action Plan in November 2024, HSE Chief Clinical Officer Dr Colm Henry said Ireland’s rate of cervical cancer is, “continuing to drop. According to our most recent data, for the year 2022, we are at 10.1 cases per 100,000, down from 15.8 in 2008.”
A 2023 study published in the Irish Journal of Medical Science provides early evidence of the potential impact of HPV vaccination on cervical disease in the Republic of Ireland. Women vaccinated through the initial catch-up HPV vaccination programme (2011/12 to 2013/14) first became eligible for cervical screening in 2019 at age 25; the study looked at detection rates in 25-year-olds screened from 2010 to 2022. Despite lower vaccination uptake in the initial catch-up group, it found “early signs of the positive protective effect of HPV vaccination in women at the time of their first cervical screening test”.
In 2019, Gardasil 9 was introduced into the national vaccination schedule for boys and girls in first year of secondary school to prevent infection from the most prevalent HPV types that are responsible for 90 per cent of HPV-related cancer. HPV vaccination is also offered to men and women infected with HIV up to and including 26 years of age, and for men who have sex with men (MSM), including MSM infected with HIV, up to and including 45 years of age.
Gardasil 9 is the vaccine of choice used within the National Immunisation Programme and is also available privately for non-funded vaccination. Gardasil 9 is indicated for active immunisation of individuals from the age of nine years against the following HPV diseases:
Alongside vaccination, screening and treatment are the main methods identified to support cervical cancer prevention and elimination.
There are a range of useful support documents available on this issue:
References available on request.
Sinéad McCool MPSI
Professional Services Department, IPU
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