Do I still need regular screening after getting the cervical cancer vaccine?

"Jimei, have you taken the cervical cancer vaccine?" This sentence has become the most common topic among female friends. In addition to the annual Double Eleven and 618 shopping festivals, cervical cancer vaccines have also become a "short-selling king" with supply exceeding demand. So what is cervical cancer and why do people get cervical cancer? And what is the "sacred place" of the cervical cancer vaccine?

1. What is cervical cancer?

Cervical cancer is a malignant tumor that originates in the cervix of the uterus. The peak age of onset is 50-55 years old. It is the malignant tumor with the highest incidence in the female reproductive tract and the second leading cause of death among women in my country. Every year, about 130,000 women are diagnosed with cervical cancer in my country, of which about 53,000 die. Cervical cancer is so "dangerous" that its prevention should be taken seriously. Cervical cancer can be prevented through regular screening and vaccination.

In the early stages of cervical cancer, patients may experience pain during intercourse, or may not have any symptoms. As the disease progresses, patients may experience symptoms such as bleeding during intercourse. If these symptoms occur, patients should seek medical attention in a timely manner to confirm the diagnosis. Early detection, diagnosis, and treatment of cervical cancer are extremely important for the patient's prognosis. People at high risk of the disease need to undergo regular cervical cancer screening, such as HPV testing.

2. Why do people get cervical cancer?

The causes of cervical cancer are diverse, including behavioral factors such as early sexual activity, multiple sexual partners, multiple pregnancies, and various microbial infections such as bacteria, viruses, and chlamydia. However, the main cause is human papillomavirus (HPV) infection. Related studies have found that 99.7% of cervical cancers are caused by HPV, and HPV types 16 and 18 are closely related to the occurrence of cervical cancer [1]. In most cases, HPV infection can be cleared by the human immune system, but low immune function caused by smoking or other reasons may also weaken the body's defense against HPV. A small number of women are infected with high-risk HPV for a long time, which will lead to precancerous lesions and gradually develop into cervical cancer [2].

In addition, the occurrence of cervical cancer is also related to genetic factors, long-term reproductive tract infections, obesity and low intake of vegetables and fruits.

3. Classification of cervical cancer vaccines (bivalent, quadrivalent and nonavalent, etc.) and suitable populations.

The cervical cancer vaccine, also known as the HPV vaccine, is the world's first tumor vaccine. Like ordinary vaccines, it cannot treat HPV-related lesions or prevent lesion progression. Currently available HPV vaccines are divided into bivalent, quadrivalent, and nonavalent vaccines. The bivalent vaccine is designed to target HPV types 16 and 18, which are closely related to cervical cancer. The quadrivalent vaccine adds two subtypes, 6 and 11. The nonavalent vaccine is based on the quadrivalent 16, 18, 6, 11, and adds subtypes 31, 33, 45, 52, and 58. It mainly adds subtypes 52 and 58, which are the most susceptible to Asians [3].

In foreign countries, the applicable age range of the nine-valent HPV vaccine has been relatively expanded, and it can be used by women aged 9-45. In addition, men aged 9-45 can also use quadrivalent and nine-valent vaccines to prevent anal cancer and genital warts caused by types 6 and 11.

4. Do I need to undergo regular screening after vaccination? Why?

Cervical cancer screening should start at the age of 21. Women under 21 should not be screened unless they are infected with HIV. Women aged 21-29 should undergo cytology screening every 3 years. Women aged 30-65 are recommended to undergo combined cervical cytology and HPV testing every 5 years, or can choose to undergo cytology alone every 3 years. Women over 65 years old can stop screening if they have three consecutive negative cytology tests or two consecutive negative combined tests in the previous 10 years, and the most recent test was within 5 years [4].

HPV vaccine is a primary preventive measure for cervical cancer. It cannot replace regular cervical cancer screening, nor can it replace other measures to prevent HPV infection and sexually transmitted diseases. First of all, the HPV vaccine can only prevent a limited number of virus subtypes, but there are more than a dozen virus subtypes that are closely related to cervical cancer, which the HPV vaccine cannot fully cover; not all cervical cancers are caused by HPV infection, and cervical cancers caused by other reasons cannot be prevented by vaccines. Therefore, even if you have been vaccinated, you should still undergo regular screening~

For women over 45 who cannot receive the HPV vaccine, regular screening is the most effective measure to prevent cervical cancer!

5. Special reminder from the pharmacist: Things to note before and after vaccination.

The preparation and process before injecting HPV vaccine are similar to those of injecting other vaccines. If you have a fever before vaccination, it is recommended to postpone the vaccination. To prevent falls and injuries caused by allergic reactions or syncope after vaccination, it is recommended to observe for at least 15 minutes after vaccination. In addition, you need to pay attention to the following:

(1) Women with serious solid organ diseases, such as coronary heart disease, chronic renal failure, etc., cannot receive HPV vaccination;

(2) HPV vaccination is not recommended for women who are planning to become pregnant or are already pregnant. If a woman becomes pregnant after vaccination, it is recommended that she receive the remaining injections after delivery[5];

(3) Regarding the choice of vaccines, different groups of people can choose to receive bivalent, quadrivalent, or nine-valent HPV vaccines according to the advice of relevant medical staff. Be sure to note that they cannot be mixed;

(4) HPV vaccines are of little use to women who have already been infected, and HPV testing is recommended before vaccination;

(5) If immunoglobulin or blood products have been used recently, vaccination should be postponed until three months later;

(6) Cervical cancer screening should be performed after vaccination, and other measures to prevent HPV infection and sexually transmitted diseases should also be taken;

(7) Pay attention to personal hygiene, be cautious when having sexual relations, avoid multiple miscarriages and childbirths, and reduce the chance of HPV infection; avoid smoking, eat a balanced diet, and increase exercise to enhance the body's immunity, which can eliminate the state of persistent viral infection.

The advent of the HPV vaccine is of great significance to women's health, but the vaccine is not a panacea. The necessary screening must not be missed. The most effective protection than the vaccine is to protect yourself!

References

[1] Cao Ningning, Zhang Baoping. Analysis of the relationship between high-risk human papillomavirus (HR-HPV) viral load and clinical pathological factors of cervical cancer[J]. Clinical Research, 2019(04): 17.

[2] Yang Li, Ma Licong. Analysis of the clinical value of high-risk HPV virus load in cervical precancerous lesions[J]. Chinese and Foreign Medical Treatment, 2018(31): 25.

[3] Yuan Li, Chu Aiqin, Xu Anlan, et al. Analysis of the current status and influencing factors of human papillomavirus vaccination in women of childbearing age[J]. International Journal of Reproductive Health/Family Planning, 2020(03): 210.

[4] Yang Ni, Chen Fei, Shen Keng. Impact and implications of HPV vaccine on cervical cancer screening[J]. Advances in Modern Obstetrics and Gynecology, 2020(11): 862.

[5] Wang Anshi, Huang Yanlin, Liu Chang, et al. Effects of HPV vaccination during (peri)pregnancy on the risk of birth defects in offspring[J]. Chinese Journal of Prenatal Diagnosis (Electronic Edition), 2020(03): 34.