Human Papillomavirus Infection and Cancer Risk in Periand Postmenopausal Women

Abstract

Human papillomavirus (HPV) infection is a necessary cause of cervical cancer. Contrarily to most preinvasive cervical lesions, the majority of cancers occur in the perimenopause or early after the menopause. Nevertheless, around 15% of cervical cancers occur after 65 years old. There are data suggesting that screening beyond this age can decrease cervical cancer-associated mortality. Screening in postmenopausal women is better accomplished with the use of high-risk HPV tests. Atrophy with thinning of the epithelium and regression of the squamous cellular junction to the endocervix can make colposcopy in postmenopausal women a true challenge. Prevalence of HPV infection decreases after the age of 25-30 years old, keeping stable from then on. In some countries, a later peak can be noticed in the fifth or six decade of life. Postmenopausal women are still at risk of acquiring new HPV infections, as well as of having reactivation of latent ones. The burden of disease associated with HPV is not limited to the cervix. It is also responsible for a significant number of vulvar, vaginal, anal, and even oropharyngeal cancers-beside benign and preinvasive disease. While HPV vaccination will totally change the epidemiology of HPV infection, vaccinating older women has a very limited role.