Monday, November 29, 2010

HPV Vaccine

Recently, some state legislators have taken up action against the mandatory administration of the HPV vaccine in young girls. In light of the vaccine’s high success rate in preventing cervical cancer many states passed laws which added Gardasil to the already existing list of mandatory vaccinations required for children to enter school.

A number of things have changed since those laws were enacted. First off, the FDA approved the vaccine for use in boys and young men, a step forward in helping to prevent the ramifications of HPV in that age group. Secondly, there has been much more attention paid to foamites.

Foamites are inanimate objects which can harbor the virus particles and carry them from place to place. An example of this can be as simple as one’s finger but can include other simple objects as well.

People have been asking for some time if the virus can be contracted from such things as underwear or towels and the answer appears to be a resounding yes. The virus has been found on the underwear of women known to have HPV and towels are just another material source through which the virus may be transferred.

Unfortunately, this is a very virulent (strong/aggressive) virus and one that is very difficult to destroy even at very high temperatures. This brings us back again to the question of removing the vaccine from the mandatory vaccination list for school-age children.

One such legislator in Virginia has stated that HPV does not have the likelihood of being transmitted between these children as with other diseases for which we already provide mandatory vaccinations. Apparently she is not considering the significant research pointing to foamites transmission of HPV when considering putting forth this legislation.

HPV has already been found in saliva, amongst other bodily fluids such as urine, breast milk, seminal fluid and others. How often do school-aged children share that can of soda or other drink – a perfect example of foamites. So before considering rescinding this legislation these legislators, most often not medically oriented, need to become far more educated and up-to-date when it comes to HPV vaccination.

It has taken years for the FDA to approve the use of the vaccine in the prevention initially of cervical cancer. This was then expanded to include vaginal and vulvar dysplasia and cancers. They are on the verge of deciding, this month, whether or not to include anal dysplasias and anal cancer onto that list.

With all the progress that has been made in the five years since the vaccine became available, hopefully legislators will not rescind that progress as a result erroneous information and lack of thorough research.

Wednesday, November 24, 2010

HPV and Oral Cancer

For as long as the media has been mentioning HPV in its articles and news segments, it has been in relation to its sexually transmitted status and as causing dysplasia (cell changes) and cancer in the genital region. This included predominantly the cervix but was also mentioned to include the vagina, vulva and anus. Rarely did the media cover HPV in men and its connection to penile cancer and also anal cancer in men.

Well now, the media has another area on which to focus when it comes to HPV – the mouth. In recent studies at Johns Hopkins, studies have shown at 25 percent head and neck cancers are indeed caused by HPV. Of that 25 percent, 90 percent have been isolated and shown to be HPV strain 16.

Listed as one of the “high risk” strains of HPV, HPV16 causes 50 percent of all cervical cancer, at least half, with the remainder attributed to HPV18 at 20 percent and a combination of others making up the difference.

Many parents who have been against the HPV vaccine being included as part of the mandatory childhood vaccinations offer for their opposition the fact that HPV is not transmitted as many other virus are, such as air-borne. However, so much new information is coming to light about HPV that this may end up being more of an excuse than anything else.

Using the herpes virus as an example, we have been told many things over the years which have since be proven to be untrue. An example of this is the fact that the virus cannot be spread unless the individual is having an active outbreak.

When it comes to HPV, one of the most significant findings of late has been fomites. These are inanimate objects which can carry the virus and transmit it to another individual. Fomites can be totally non-sexually related. The human papillomavirus has been found in various body fluids, among them saliva. What grade-school student hasn’t shared a soda or other drink? What athlete hasn’t shared a water bottle at a sports event?

Until recently, HPV was believed only to be sexually related but now even kissing is in question when it comes to transmitting the disease. This recent discovery that HPV constitutes one-quarter of oral cancers (head/neck) certainly does shed new light on beliefs held less than a decade ago, and while oral HPV can be contracted via oral sex, it requires us to question just how extensive the virus is, and to accept the fact that it is no longer just genitally based.

Monday, November 15, 2010

FDA Should Expand HPV Vaccines' Age Limit

The next few months will be a very significant time, not only for women but for the Gardasil vaccine as well. This is because the FDA (Food and Drug Administration) is holding hearings into whether or not to extend the use of the vaccine. Currently, Gardasil is approved for administration between the ages of nine and twenty-six. When all is said and done, that high age range will be extended to forty-five.

Gardasil is administered in three doses with the cost hovering around $350 for the series. You can often find a physician who is willing to administer the vaccine “off label”, meaning outside of the standard protocol. As a result, the patient ends up having to carry the cost. So why would anyone really care?

Ultimately having girls immunized prior to the onset of sexual activity would be optimal but what about the teenagers and women in their early twenties, the ones who have the highest incidence of HPV infection? Their immunizations would require knowledge of the vaccine in addition to the ability to cover the expense (although Merck does provide financial assistance under certain criteria). Until age twenty-six, insurance would continue to pick up the cost of the vaccine.

So what then becomes of those women over age 26? The highest incidence of cervical cancer occurs in a woman’s thirties and forties. Presumably she has been exposed to the virus for some time, at this point, and if she continues to remain HPV positive (persistent infection), carries a much higher chance of developing cancer. By this point in time, if a woman is going to have HPV she would have shown symptoms by now, say some. Not necessarily. Symptoms of high risk HPV are often so minimal that they are missed or attributed to something else. Because many of the initial signs resolve rather quickly, the woman usually doesn’t give it a second thought.

It is important that the FDA decide to extend the use of Gardasil beyond age twenty-six to the proposed forty-five. A vast majority of women are married and have had children. They no longer need to be concerned that a pregnancy may set off an HPV infection. Having been in a monogamous relationship, their chances of having acquired the human papillomavirus are less than that of those having had multiple sexual partners during that time frame. However, what happens when this couple now divorces? When after fifteen or twenty years of marriage, the woman suddenly finds herself back on the dating scene? Is she not entitled to receive the same protection from this cancer causing virus as younger women? The answer to that question is a resounding yes, and hopefully before year’s end, the FDA will agree.

Monday, November 8, 2010

HPV and Anal Cancer

In the 1980s, we still had not been introduced to the Internet. Who would have thought everyone would spend countless hours playing solitaire for the sole purpose of watching the cards spring from the page. There was no electronic mail or GPS devices, no iPods, iPhones or iPads and no “Google.” There was however one very significant discovery. After decades of devoting his life to research, Professor Harald zur Hausen, MD (photo featured above) discovered that it was the human papillomavirus (HPV); more specifically HPV strains 16 and 18, which were responsible for 70 percent of cervical cancers.

Unlike bacteria, a virus is capable of remaining dormant in the body for months or even years and it does not respond to antibiotics. By the close of the 1980s, medical science was able to test for the virus along with the Pap smear and also to do more in depth studies to determine just which strain of the virus a person had. The request had been made by Professor zur Hausen to work on the development of a vaccine against this virus but was declined.

It was October 1991 when I was diagnosed with HPV-induced cancer even though my initial diagnosis was in 1987. From 1987 until 1991 the precancerous lesions caused by this virus had remained localized mainly to the vulva though there was the occasional vaginal and cervical lesion. Imagine my utter shock when I was informed, after what was to be a routine hemorrhoidectomy after the birth of my daughter, that I had invasive anal cancer.

As an RN I had very close ties to the medical community, I even managed a local radiology practice in Northern New Jersey making physicians in New York within easy reach. My boss became my radiation oncologist as I endured both radiation and chemotherapy. I was 33.

My treatment was complicated by the fact that there was no vast wealth of knowledge regarding HPV related cancers nor was the information which existed, easily accessible. Never-the-less, that treatment, along with surgery and regular post-treatment follow-ups, kept me cancer free – at least temporarily.

In 2008, seventeen years later, I was once again diagnosed with invasive anal cancer. I thought that now things would surely be different. We had the Internet, a means of disseminating all the research results culminated in the almost two decades prior. A means for the average individual, in the comfort of their own home, to “Google” for HPV and cancer.

Don’t get me wrong, it’s not that there wasn’t information to be found. It’s just that the information I found to often be incorrect, misleading and in some cases downright wrong! Women in particular still were not urged to obtain the vaccine against the two most proliferative strains of the virus which had since been developed, and doctors in general were remiss in their overall knowledge of HPV – frighteningly so.

It was for this reason that I decided to write Any Mother’s Daughter. I was not only upset, but angry over the fact that after two decades it was as difficult for women to find out about the virus and the dangers it posed as it had been initially for me in 1991 and this had to change.

I chose to incorporate my own story into the book, allowing the reader someone with whom to connect, while at the same time learning about the virus, how it causes cancer, the diagnosis, treatments and procedures accompanying the diagnosis of high risk HPV. It became my goal, to educate women and others (men and the healthcare professionals) regarding HPV, as well as, to become advocates for their own healthcare in the process.

Bonnie was recently featured in the Orlando Woman Newspaper:
Any Mother's Daughter~One Woman's Lifelong Struggle With HPV: Page 8: