Over 80% of Canadians will have one form or another of this virus in their lifetime. A person comes into contact with HPV through any skin-to-skin sexual contact below the waistline with fingers, mouth, or other body parts – even without penetration. Condoms give good protection against sexually transmitted infections (STIs), unwanted pregnancies and HPV in general BUT do not fully protect people from this virus because there is still direct skin-to-skin contact. 

Sexual contact includes inserting a penis or an object into a vagina or anus, as well as rubbing skin-to-skin against each other below the waistline without any penetration. This type of touching puts people in direct contact with this virus due to the skin-to-skin touching and exchange of bodily fluids (pre-cum and semen that comes from a penis each time a male ejaculates and vaginal discharge from a female). Unfortunately, there typically are no signs or symptoms of this virus for either partner, regardless of sex or gender. 

This virus could appear as genital warts or could lead to cancers of the head, neck, throat, tongue, cervix, vagina, anus, and penis. Genital warts can be found anywhere from the waist down to the knees, at the front and back of a person’s body. Genital warts are small, raised, hard lumps that grow in clumps. They are usually painless but may cause itching, burning, or light bleeding.  

This virus can be asleep in a person’s body for up to 30 years. This means what we do in our teens, 20s, 30s, or 40s can affect us in our 50s, 60s, 70s, and 80s simply because it can take up to 30 years before developing symptoms. It is clear that HPV is highly contagious. The good news is that there are preventative methods. Everybody should be protected from this virus with the HPV vaccine. There are benefits for people of all ages. The vaccine protects people from being affected by different types of the virus with which they have not already come into contact. If a person has cleared an HPV-related infection (genital warts or an HPV-related pre-cancer), the vaccine will help against reinfection. Furthermore, if you have a cervix, getting routine screening, whether vaccinated or not, can help detect cervical cancer earlier.  

Anybody who has ever been sexually active is at risk of contracting HPV. People come into contact with this virus, through any skin-to-skin sexual contact below the waistline with fingers, mouths, or other body parts, including genital-to-genital contact, anal intercourse, and oral sex… even without penetration. 

Condoms give good protection against sexually transmitted infections (STIs), unwanted pregnancies, and HPV in general BUT do not fully protect people from this virus because there is still direct skin-to-skin contact. 

The time from exposure to the virus until the development of warts or diseases is highly variable and the virus can remain dormant in some people for long periods of time. Often, it is not possible to determine exactly when or from whom the infection originated. 

High-risk HPV infections are very common and individuals with HPV will have no symptoms; therefore, it is very difficult to tell whether you have the virus or not.  

Around 1,408 new cervical cancer cases are diagnosed annually in Canada ((Koutsky L. 1997. Epidemiology of genital human papillomavirus infection. Regular cervical screening provides a high degree of protection against developing cervical cancer. Not receiving cervical screening is one of the biggest risk factors for developing cervical cancer.
Cervical screening is NOT a test to find cancer. It is a screening test to detect abnormalities (pre-cancer) at an early stage in the cells of the cervix.
Cervical screening is the process of taking a sample of cells from the cervix, which are then examined to detect abnormalities that could develop into cancer in the future. Screening can detect these precancerous/abnormal cells. The detection and successful treatment of these cells usually prevent the occurrence of cancer. Changes in these cells are generally caused by certain types of human papillomavirus (HPV). Testing for the HPV virus itself can also be done on the same sample that is examined under the microscope. For more information on HPV testing, see the HPV TESTING tab above. 

Cervical Screening (Pap Test, also known as: Pap Smear)

Cervical screening is NOT a test to find cancer. It is a screening test to detect abnormalities (pre-cancer) at an early stage in the cells of the cervix.
Cervical screening test is the process of taking a sample of cells from your cervix, which are then examined to detect abnormalities that could develop into cancer in the future. The sample of cells is placed in a liquid so that it can be analysed in the laboratory. This process is called Liquid-Based Cytology (LBC). Screening can detect precancerous/abnormal cells. The detection and successful treatment of these cells usually prevent the occurrence of cancer. Changes in these cells are generally caused by certain types of human papillomavirus (HPV). Testing for the HPV virus itself can also be done on the same LBC sample that is examined under the microscope. To learn more, visit the cervical screening guidelines across provinces and territories in Canada.

Those with Compromised Immune Systems

If you have a cervix and a severely compromised immune system, such as HIV, you may need to be screened annually as you are more likely to develop a persistent infection of HPV which can cause cervical abnormalities over time. Being HIV positive increases the need to attend screening every year. The screening test is usually taken outside of the National Screening program. Check with your health care professional for further information on screening and vaccination. 

Men and anyone with a penis and a severely compromised immune system are also at higher risk of contracting HPV. Therefore, check with your health care professional for further information on vaccination. 

Not Eligible for Cervical Screening – Under 25

Cervical cancer is the 3rd most common female cancer for women aged between 14 and 44 years old in Canada¹. 

Why does cervical screening start at 25?

HPV is very common in females under 25 years of age. Persistent infections after the age of 25 years are more likely to turn into an HPV-related cancers. Most cases of high-risk HPV will clear within 12 to 18 months and then the cervical abnormalities will return to normal. However, medical experts do not currently have a way to understand which abnormalities will clear on their own and which could turn into cancer. However, they do know that if you are older than 25 years old and the abnormal cells in your cervix have not cleared up on their own, there is a greater need to offer treatment. 

So, if young women and those with a cervix are more likely to have abnormal cells, this means they will be more likely to be sent for treatment to remove the abnormal cells following a screening test.
Treatment for cervical abnormalities has been shown to increase the risk of preterm labour and cause unnecessary anxiety for the woman.²((Bouvard et al., 2009. A review of human carcinogens – Part B: biological agents. Lancet Oncology 10, 321 – 32))((Winer RL et al., 2003. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. American Journal of Epidemiology 157 (3), 218-226))((Dunleavey R (2009) Cervical Cancer: a guide for nurses. Wiley-Blackwell, UK. pp)). 

Diagnosis and treatment for cervical abnormalities have been shown to cause significant psychological trauma and, considering the majority of abnormalities will clear without treatment, it means screening and subsequent treatment for abnormalities could cause more harm than the benefits of screening can provide. 

Additionally, cervical screening has been shown not to be very effective in young women and those with a cervix. In countries where screening starts at 20 years old, rates of cervical cancer in those under the age of 25 years are not significantly different from countries in which screening starts at 25 years old ((Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B, Valencia S, Brotons M, Mena M, Cosano R, Muñoz J, Bosch FX, de Sanjosé S, Castellsagué X. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in Canada. Summary Report 2014-12-18)). 

The International Agency for Research on Cancer also recommends that cervical screening should not start before the age of 25. 

Summary 

1. Cervical cancer is very rare if you are under 25 years old. 
2. Abnormal vaginal bleeding can be a symptom of cervical cancer – there are guidelines in place for the under 25s with abnormal bleeding. You should see your GP if you are bleeding outside of your period or after sex. 
3. Cervical screening (the Pap test) is not recommended for women under 25. 

Females thirty years old and over can find out for certain if they have a high-risk strain of this virus by getting an HPV test. It is performed like a pap smear. There is approximately a $100 fee for the HPV test and you get the results typically within two weeks. You must request the HPV test from your health care provider as this is not a routine test. There are many strains of the virus and some strains of this virus lead to cancers, such as cervical cancer. Anyone with a cervix thirty years old or over should get an HPV test instead of a pap smear because it is more accurate. 

Unfortunately, there is no test that exists to know if a male has HPV. The only way a male can know is when treating the symptoms of this virus that may come out as genital warts or HPV-related cancers, such as head, neck, throat, tongue, anal or penile cancer. We can assume that if one person in the relationship has HPV, the other person probably has it too because of how easy it is to come into contact with. 

The results of an HPV test combined with cervical screening cytology (examination of the cells under a microscope) enable faster investigation of anyone at higher risk of developing cervical cancer and provide reassurance to those at very low risk. The test can also reduce the number of unnecessary screening appointments and colposcopies among women and those with a cervix who have borderline or mild cervical screening cytology results or who have been treated for abnormal cells. If you are interested in getting an HPV test, ask your doctor about getting one with your next Pap test. 

The HPV test is carried out using the same sample of cells taken during a cervical screening test. In the laboratory, the cells are analyzed for current HPV infection. 

For more details on HPV facts, please view WHAT IS HPV in the first tab above.

Our bodies are made up of trillions of cells grouped to form tissues and organs. Genes inside the nucleus of each cell tell it when to grow, work, divide and die. Normally, our cells follow these instructions and we stay healthy; however, when there is a change in our DNA or damage to it, a gene can mutate. Mutated genes don’t work properly because the instructions in their DNA get mixed up. This can cause cells that should be resting to divide and grow out of control, which can lead to cancer. Here are some signs and symptoms of cancer:

Abnormal bleeding doesn’t mean you have cancer, but you should see a health care provider as soon as possible.

Signs and symptoms of tonsil & vocal cord cancer:

Signs and symptoms of tongue cancer:

The throat (pharynx) is a muscular tube that runs from the back of your nose down into your neck.

Signs and symptoms of throat cancer:

Abnormal bleeding doesn’t mean you have throat cancer, but you should see a health care provider as soon as possible.

The anus is part of the digestive. Stool leaves the body through the anus. It is the muscular opening at the end of the large intestine after the rectum. Cells in the anal canal sometimes change and no longer grow or behave normally. These changes may lead to non-cancerous, or benign, conditions such as anal warts, polyps or skin tags. In some cases, changes to cells in the anal canal can cause cancer. Anal cancer usually starts in round, flat cells called squamous cells. You do not need to have had anal sex to have anal cancer.

Signs and symptoms of anal cancer:

Abnormal bleeding doesn’t mean you have anal cancer, but you should see a health care provider as soon as possible.

Cervical Cancer

Cervical cancer forms in the tissues of the cervix. The cervix is an organ that connects the uterus and vagina. It is usually a slow-growing cancer that may or may not have symptoms but can be prevented through regular screening (a procedure in which cells are taken from the cervix and looked at under a microscope).

Cervical cancer is not thought to be hereditary.³((Lacey CJ et al., 2006. Chapter 4: Burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine, 24 (3), S3/35-41))((Giuliano AR et al., 2008. Epidemiology of human papillomavirus infection in men, cancers other than cervical and benign conditions. Vaccine, 26 (10), K17-28))

99.7% of cervical cancers are caused by the persistent high-risk human papillomavirus (HPV) infection which causes changes to the cervical cells. HPV is an extremely common virus; around four out of five people are exposed to the virus. Anyone who is sexually active can be infected with HPV at some time and the body’s immune system will usually clear it up. Generally, most people don’t even know they have contracted the virus.

Cervical abnormalities are caused by persistent high-risk HPV infection. These abnormal cells found through cervical screening are not cancerous but, given time (often years), they may go on to develop into cancer. However, the cells often return to normal by themselves.

The most effective method of preventing cervical cancer is through regular cervical screening which allows for the detection of any early changes of the cervix. For younger women, the HPV vaccination can help prevent seven out of ten cervical cancers (70%). Cervical cancer is largely preventable and, if caught early, survival rates are high.

Symptoms of Cervical Cancer

Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina.

Signs and symptoms of cervical cancer:

Abnormal bleeding doesn’t mean you cervical cancer, but you should see a health care provider as soon as possible.

Causes of Cervical Cancer

Almost all cases of cervical cancer are caused by persistent high-risk HPV. HPV is a very common infection that four out of five sexually active adults will come into contact with in their lives, without any symptoms. This is why it is so important to attend your regular cervical screening. 

See our section on HPV 

Cervical cancer is not caused by promiscuity or infidelity, however, it makes sense that the more sexual partners you have and the younger you are when you have your first sexual encounter, the more likely you are to come into contact with the more dangerous types of HPV these are called high-risk types. Whilst these factors are considered to increase your risk of developing cervical cancer, many women who have only had one sexual partner in their lifetime become infected with high-risk HPV and may go on to develop abnormal cell changes/CIN or cervical cancer. 

Similarly, as with most cancers, smoking can also pose an increased risk. Smoking stops your body’s immune system from working properly, leaving you more likely to get infections and therefore can cause abnormalities in the cells of the cervix. 

Other risk factors involved with cervical cancer:

• Weakened immune system
• Having children at a very young age
• Giving birth to many children
• If your mother was given DES (infertility drug) when pregnant with you
• Long-term use of the contraceptive pill (more than 10 years) can slightly increase the risk of developing cervical cancer but the benefits of the pill outweigh the risks for most women.

Types of Stages of Cervical Cancer

If, after receiving the results of your biopsy, you are diagnosed with cervical cancer, your consultant will order more tests to find out to what type of cervical cancer you have, the extent the cancer has progressed and if the cancer cells have spread to other parts of the body. 

There are two main types of cervical cancer:

• Squamous cell – eight out of 10 (80%) cervical cancers are diagnosed as squamous cells. Squamous cell cancers are composed of the flat cells that cover the surface of the cervix and often begin where the ectocervix joins the endocervix.
• Adenocarcinoma – more than one in 10 cervical cancers are diagnosed as adenocarcinoma (15 – 20%). The cancer develops in the glandular cells which line the cervical canal. This type of cancer can be more difficult to detect with cervical screening tests because it develops within the cervical canal.

Adenosquamous cancers are tumours that contain both squamous and glandular cancer cells. Other rare types of cervical cancer can include clear cells, small cells undifferentiated, lymphomas and sarcomas.

Cervical cancer staging

You may be asked to have various diagnostic tests which help understand your cancer better. These could include a pelvic examination, an MRI or PET-CT, chest x-ray or blood tests. Your consultant needs information to understand the extent your cancer has progressed and if the cancer cells have spread to other parts of the body. This process is called staging. Knowing the stage of the disease helps your consultant plan treatment. 

Carcinoma of the cervix: staging cervical cancer (primary tumour and metastases) The following stages are used to describe cancer of the cervix:

• Stage 1a: Cancer involves the cervix but has not spread to nearby tissue. A very small amount of cancer that is only visible under a microscope is found deeper in the tissues of the cervix.
• Stage 1b: Cancer involves the cervix but has not spread nearby. A larger amount of cancer is found in the tissues of the cervix.
• Stage 2a: Cancer has spread to nearby areas but is still inside the pelvic area. Cancer has spread beyond the cervix to the upper two-thirds of the vagina.
• Stage 2b: Cancer has spread to nearby areas but is still inside the pelvic area. Cancer has spread to the tissue around the cervix.
• Stage 3: Cancer has spread throughout the pelvic area. Cancer cells may have spread to the lower part of the vagina. The cells also may have spread to block the tubes that connect the kidneys to the bladder (the ureters).
• Stage 4a: Cancer has spread to other parts of the body, such as the bladder or rectum (organs close to the cervix).
• Stage 4b: Cancer has spread to distant organs such as the lungs.

Cervical Cancer Treatments

In most hospitals, a team of specialists will work together to decide which treatment is best for you. This multidisciplinary team (MDT) will include:

• a surgeon who specializes in gynaecological cancers (gynaecologist or gynae-oncologist)
• a clinical oncologist (chemotherapy and radiotherapy specialist)
• a pathologist
• a radiologist

and may include a number of other healthcare professionals such as:

a nurse specialist

• dietician
• physiotherapist
• psychologist or counsellor.

Depending on what stage your cancer is and your specific needs, your team will consider the following treatments. In order to fully understand which treatment will be right for you, you will need to discuss this with your consultant at your next appointment.

The vulva is the part of the female genital reproductive organs that can be seen from outside of the body (pubis, labia majora to the perineum and everything until the opening of the vagina). The vulva opens into the vagina. The vulva protects the internal genital organs and gives sexual pleasure. Vulvar cancer starts in the cells of the vulva.

Signs and symptoms of vulvar cancer:

Abnormal bleeding doesn’t mean you have vulvar cancer, but you should see a health care provider as soon as possible.

The vagina is a muscular tube that goes from the cervix to the outside of the body. Vaginal cancer starts in the cells of the vagina.

Signs and symptoms of vaginal cancer:

Abnormal bleeding doesn’t mean you have vaginal cancer, but you should see a health care provider as soon as possible.

It most commonly starts in the skin cells in or on the penis. A cancerous (malignant) tumor is a group of cancer cells that can grow into and destroy nearby tissue. It can also spread (metastasize) to other parts of the body.

Signs and symptoms of penile cancer:

Abnormal bleeding doesn’t mean you penile cancer, but you should see a health care provider as soon as possible.

The Vaccines

Your health care provider or pharmacist can give you a prescription to get the HPV vaccine, called Gardasil9. It is given in 1 to 3 doses over a 6-month period of time, depending on your age and where you live. It is good for people from the age of 9 years and up. There is no upper age limit to get the HPV vaccine. This vaccine is a cancer prevention tool; it is the only way to protect people from getting this virus that can lead to genital warts and HPV-related cancers. The benefits of you personally being vaccinated is protection from getting different strains of the virus you have not already come into contact with from a new partner. Another benefit of getting the HPV vaccine is that if you already have the virus, research is starting to show that it will slow down and limit the damage of this virus on your body. It is important to know this vaccine will not take away this virus. If both partners are vaccinated, there is no reason why you can’t have healthy sexual relationships 

There are currently two vaccines which protect against HPV infection. These are called Gardasil and Cervarix. Cervarix is only for women and people with a cervix. 

• Gardasil9 is designed to protect against nine different types of HPV. 
• HPV types 16, 18, 31, 33, 45, 52 and 58 that cause cervical cancer 
• HPV types 16, 18, 31, 33, 45, 52 and 58 that cause vulvar and vaginal cancer 

• HPV types 16, 18, 31, 33, 45, 52 and 58 that cause anal cancer 
• HPV types 6 and 11 that cause genital warts 
• HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58 that cause abnormal and precancerous anal lesions 
• HPV types 16, 18, 31, 33, 45, 52, and 58 that cause oropharyngeal and other head and neck cancers 
• Cervarix is designed to protect against HPV types 16 and 18. If you have a cervix, it also helps protect you between the ages of 10 and 25 against precancerous conditions and cancers of the cervix. 

Both vaccines are licensed in Canada. 

The HPV vaccine works best if given before a person comes into contact with HPV, as the virus is transmitted through skin-to-skin sexual contact below the waistline even without penetration with fingers, mouths or other body parts. Condoms do not fully protect people from giving/getting this virus because the condom only covers the length of the penis and there are still other parts below the waist that will have direct skin-to-skin contact. To be clear, a person comes into contact with this virus when using their mouth, hands, or fingers below the waistline of a partner. As previously mentioned, this also includes putting a penis or an object in a vagina or anus, and rubbing against each other with skin-to-skin contact below the waistline even without any penetration.

In practical terms, the easiest and most effective way to reach everybody is for everyone to be vaccinated before they are sexually active. In Canada, the vaccination programs for HPV are implemented for everyone in schools between grades 5 and 8 depending on the province. Click here to know your province’s or territory’s school-based free HPV vaccination program. 

There is some evidence that the HPV vaccines provide cross protection for other types of HPV which may mean that it has a higher protection level than first thought((Koutsky L. 1997. Epidemiology of genital human papillomavirus infection. The American Journal of Medicine, 102 (5A), 3-8))((Lacey CJ et al., 2006. Chapter 4: Burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine, 24 (3), S3/35-41))((Giuliano AR et al., 2008. Epidemiology of human papillomavirus infection in men, cancers other than cervical and benign conditions. Vaccine, 26 (10), K17-28)). Research indicates that the HPV vaccine could prevent two-thirds of cervical cancers in women aged below 30 by 2025 but only if uptake of the HPV vaccination is at 80%⁴.

The Canadian national HPV immunization program was introduced into schools in 2007, 2008, 2009 and 2010, depending on the province. This program is offered to everyone, and first vaccination occurs between grades 4 and 8 depending on where you live (An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI)† Update on Human Papillomavirus (HPV) Vaccines)). Click here to know your province’s or territory’s school-based free HPV vaccination program. 
The vaccines are over 98% effective in preventing cervical abnormalities associated with HPV 16 and 18 in women anyone with a cervix who has all three doses and in those who do not yet have HPV³((Lacey CJ et al., 2006. Chapter 4: Burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine, 24 (3), S3/35-41))((Giuliano AR et al., 2008. Epidemiology of human papillomavirus infection in men, cancers other than cervical and benign conditions. Vaccine, 26 (10), K17-28))((Walboomers JMM et al.,1999 Human papillomavirus is a necessary cause of invasive cancer worldwide. Journal of Pathology, 189 (1), 12–19)).

If you are not eligible for the free vaccine you can pay for it privately, or it may be covered by your private insurance provider.  

The HPV vaccination will help reduce the number of cases of HPV related cancers and the number of individuals who have to be treated for genital warts or HPV-related cancers. Whether vaccinated or not, the best protection against cervical cancer is to continue going for regular cervical screening and HPV tests for women and people with a cervix over the age of 30 years. The combination of HPV vaccination and cervical screening can help reduce cervical cancer incidence in Canada. 

Free HPV immunization programs by province/territory :

Side Effects Caused by Vaccination

Thousands of girls and women of different ages took part in the clinical trials for the HPV vaccines⁵:

Very common side effects (side effects which may occur in more than one per 10 doses of vaccine) reported by girls who have received the vaccine are:

• Injection site problems such as redness, bruising, itching, swelling, pain or cellulitis
• Headaches

Common (side effects which may occur in less than one per 10 but more than one per 100 doses of vaccine):

• Fever
• Nausea (feeling sick)
• Painful arms, hands, legs or feet

Rare (side effects which may occur in less than one per 100 but more than one per 1,000 doses of vaccine):

• More than one in 10,000 people who have the Gardasil HPV vaccine experience:
  • An itchy red rash (urticaria)
• Fewer than 1 in 10,000 people who have the Gardasil HPV vaccine experience:
  • Restriction of the airways and difficult breathing (bronchospasm)

For information on the side effects of the HPV Vaccine, please see these websites:

1. HPV quadrivalent vaccine (HPV4): Gardasil^® adverse events

2. The HPV vaccine helps protect your child from certain HPV-related cancers

3. Cervarix