Wednesday, October 26, 2011

ACIP Finally Recommends HPV Vaccine for Boys/Young Men

After two years of stalling, the ACIP (Advisory Committee for Immunication Practices) has decided to finally make the HPV vaccine recommended for boys and young men instead of approved for them which is where they left it over the past two years.

In the meantime, those same young boys have grown into young men who have inevitably passed on this virus to any of not all of the women with whom they have had any type of sexual contact. Even kissing is now being considered as one of the means of transmission for the virus.

It has truly been remiss on the part of the ACIP as well as the CDC for not having employed research information available more than two years ago and to finally get around to using it now. The damage they have done is irreparable and we can only hope that any campaigns which the CDC now develops in light of this will be sufficient to make up for the damage they have already caused. To follow is commentary by Director of the CDC's Infection Disease unit who refers to recent information. While additional information has been collected, this information to which she refers has been in existence of over two years. I'd like to know how Dr. Schuchat explains the CDC not having put pressure on the ACIP in addition to running their own campaigns (of which I've seen none) and allowing more American citizens to become at risk for the six cancers which HPV is now known to cause:

Thursday, October 20, 2011

New Cervical Screening Guidelines Introduced

It has been five years since the last series of guidelines regarding cervical screening were introduced. This was the culmination of newly acquired information from 2000 (the time of the previous guidelines) to 2005. Given that significant and substantial information has been gained in these past five years, release of these recommendations was certainly anticipated.

The means by which they have been released especially with regard to public comment is certainly unacceptable. Having been released two days ago, comments are only being accepted through November 15, 2011 at which time comments will be reviewed and final recommendations issued. The ACS will review all information and make its recommendations some time in 2012.

The individuals most affected by this virus (HPV) should certainly have the ablitity to comment of screening procedures and other relevant issues yet nothing has been promoted via any media outlets informing women of the opportunity to have their voices heard, nor has there been a more patient-friendly version of these recommendations provided that would clearly summarize the changes for the lay person.

One thing which strikes me is the fact that they admit they have no information available to determine how to incorporate known risk factors into these guidelines! One must ask, with all the research being conducted - why not?

As a registered nurse, a patient's risk factors for any disease were always considered with respect to that patient's follow-up and treatment, yet this isn't the case here. I disagree with the exclusion of testing of all women under 21 years of age. This blatantly disregards two of the known risk factors which can effect persistent disease; early sexual onset and multiple partners. Yet in the 2006 guidelines, this same organization stated: "Indirect evidence suggests most of the benefit can be obtained by beginning screening within 3 years of onset of sexual activity or age 21 (whichever comes first).." and "The USPSTF concludes that the benefits of screening substantially outweigh potential harms."

If this were a static situation and people never changed relationships perhaps these proposals would be more plausible but this simply isn't the case. By way of example, if a woman changed relationships a month after receiving her pap, she may then be dealing with a high risk strain of HPV for three years before being tested again. I have spoken to too many women, even those in monogomous relationships, whose HPV has advanced at a far faster pace than this.

They point to "notable limitations in the current evidence" as it relates to harms of HPV testing. Also mentioned is the need for more research to incorporate individual risk factors thereby preventing overdiagnosis and overutilization of resources. Are these the same risk factors which they have totally ignored in making their current recommendations. Even without specific and direct evidence, it is only common sense that a woman's risk factors play an obvious part in her treatment. How will the two risk factors of early sexual onset and multiple partners be accurately assessed if an entire cohort of women (those under 21) are being excluded from testing?

What these organizations also fail to take into consideration is that guidelines or not, many of the unnecessary treatments and procedures are made because of the total lack of knowledge and education with regard to HPV. Doctors recommending LEEP or other such procedures for CIN1 lesions which is clearly contradicted in the current guidelines since 90% of these regress within 24 months; total hysterectomies for CIN3, also contraindicated by current guideilnes but being done by physicians none-the-less. Where does the acknowledgement of a need for better training of these physicians come in?

A very interesting point is the total reversal of the recommendations made in the 2006 guidelines regarding HIV-infected women which, according to those guidelines, should be no different than the screening for non-infected women. This made no sense to me from the onset since HIV is know to reduce the body's immune system and leave the individual compromised regarding other infections including HPV.

The point here is not HIV but how organizations so convinced that they know what is right have now in essence acknowledged that they've had it wrong for the past five years. The new proposal states the following: "In contrast, women who are HIV positive are at such increased risk that the U.S. Public Health Service has issued separate screening guidelines suggesting that they be screened twice within the first year after initial HIV diagnosis and annually thereafter." This is quite a turn around from the recommendations which have been followed for the last five years. Can we afford to be waiting five years for these organizations to recognize the error of their ways with these newly proposed guidelines?

It was the initiation of pap screening (obviously in conjunction with the frequency of which it was performed) which has reduced the cervical cancer rate over the past fifty years in the area of 70%. It appears that women are in for a rude awakening if these guidelines are implemented by ACOG and ACS. It is truly unfortunate for those women whose precancerous and cancerous lesions would have otherwise been discovered will now have to joint the ranks of "survivors" if they make it that far. Why should we have to be waiting five years for a spike in cervical cancer as a result of these changes and the admitted lack of information being incorporated in them? No woman, or her surviving family should have to learn five years down the road that yet another mistake was made as it has in the case of women with HIV.

You can read the draft recommendations at the following link:

Please provide your comments before November 15th at the following link:

I will participating in the cervical cancer screening briefing by the US Preventative Services Task Force tomorrow afternoon and will provide any additional information after that time.

Monday, October 10, 2011

Would You Benefit from Support Regardng Your HPV?

If the answer to that question is yes, then please join us and register for The HPV Support Network Forum accessible from:

We look forward to seeing you there!

Wednesday, October 5, 2011

New HPV Support Network Forum Goes Live October 7th

The HPV Support Network has maintained an online presence for some years now. It provides significant informational resources for both patients nad providers and is certified by HONcode for providing medically accurate information.

The one thing the site has not had, until now, is an online forum to provide the all too necessary support and feedback that individuals can receive from each other.

On Friday October 7, 2011 the HPV Support Forum will go live and can be accessed directly from The HPV Support Network home page. We invite anyone with HPV or who has questions, concerns and/or needs support to please join us in making this forum the most beneficial it can be.

Unlike other sites which default posts to the Internet (which only serves to boost the sites ratings at the expense of people's privacy), this site is only accessible to registered users and posts are private by default. While raising a sites rankings does indeed make it more visible with respect to Internet searches, we believe there are other ways to achieve these ends without exposing one's private information.

Any suggestions for improvement or changes are welcomed as we navigate this new territory together.

Tuesday, October 4, 2011

Support Websites - When Rankings Outweigh Privacy

My website has been in existence for several years now. I have numerous other groups all concerned about HPV and dissemination of information regarding awareness, education and vaccination whose links I have placed on my site and visa versa. We all look to help each other in what is one of our main goals - to educate as many people as we can and provide them with as many reputable sites that may help to facilitate this.

Unfortunately this hasn't been the same with one particular site. I have praised the site for the support connections it has allowed women (and men) to make and the great strides and award winning status it has achieved and I have more integrity than to call them out by name.

However, I have never been happy with the fact that people's posts are, by default sent to "share with the public", an action which places that post and all subsequent responses on the Intenet which can NEVER be removed. One may think that it is no big deal, people have screen names. Simply put many peoples circumstances especially when you are indicated where you're from etc in your profile may divulge just who you are to someone reading your story, screen name or not. Many people are just as concerned about replying to such posts which only lessens the support that individual gets all because they didn't see the box which asked them to make a choice before they hit POST.

I've been told when I informed people of this that it wasn't my place to do so and that if people had chosen their post as public it was probably because that is the way they wanted it. Nonsense! I've spoken to far too many of these people who said they never realized that is what they were doing and thanked me profusely for letting the know.

What this does and what they have acknowledged in their reply (unless they've deleted them) is that having posts go to the Internet makes their site more accessible. This is true because it boosts their site ratings every time a post gets picked up by the search engine spiders (as they're called) as linked back to the site.

My response to that is that there are certainly other means by which to utilize SEO (search engine optimization) to increase market share while still maintaining people's privacy. So, despite my significant following on their site, my account has now been banned with the following explanation:


We have removed your account as we have received notice today that you
are again contacting people via messages to promote your site. We have
repeatedly asked you not to do this as it violates our guidelines.

My profile page has contained my website email address and website and blog info almost from day one so why should this be an issue. This particular reference was the fact that I utilized a "passthrough" link (through my site to another) to get people to the most current HPV related guidelines. What bothers me most is the utter hypocrisy. Dozens if not more members of this same site list their blog links, Facebook links to sites they have created yet they continue unhindered as a member.

Why would someone with such a successful site need to create guidelines that prevent others from listing links (which dozens of people do all the time) yet my own are off limits? I noticed several people leaving blog links so several months ago I did the same and was chastised and had that post deleted while others have continued to post their blog links totally ignored. I've been told they simply "weren't aware" of these other breaches in their guidelines". If you believe that one, I've got a bridge to sell you too.

One must ponder the question, why if getting this information out is the ultimate priority why they would attempt to maintain their members like cloistered nuns unable to make references to the "outside world". My site is certified by HONCode for accurate medical information and certainly SHOULD BE no threat to this wonderful site but that's the way it certainly seems. Self promotion for someones EBay business for example would certainly be inappropriate, but referral to a site with the same intentions?

Just keep in mind when joining any forum or looking at any site to check if they are approved by HONcode (something I don't think this site actually is but I could be wrong). I simply never recall seeing their logo on the site. Is your information valued as well as your privacy or are the most intimate details of your personal life spread about the Internet for the purposes of making a site more accessible. More accessible also means higher rankings and the ability to charge higher rates for advertising and the like. Is this the way you want YOUR private information utilized?

If not, then send a message loud and clear that your personal information is private and should remain that way by default. That obtaining as much accurate information as possible is important to you even if it means visiting other sites to do it and being able to pass along valued links to other members is important to you. In addition you can choose to leave. Don't worry you won't be abandoned as there is a place where you can exchange this same information without fear of it being sent to the Internet and where your privacy comes first!

The HPV Support Network Forums will be active on Friday October 7th and anyone wishing to share their information without fear of disclosure or limitations on what information you are being allowed to have is not an issue here. We value your privacy above our rankings and can find other ways to make our various sites (Website, blog, Facebook and Twitter accounts) accessible without stooping to these tactics.

It is my personal opinion that there is perhaps nothing worse than being used and manipulated at a time when one is so vulnerable.

Tuesday, September 27, 2011

When Vaccines Trump Sex Ed, or Do They?

As a parent myself, I’ve had those often uncomfortable conversations with my children regarding sex. Today, these conversations can become quite complex in an attempt to warn our children against the risks which accompany sexual activity especially with respect to sexually transmitted diseases and infections.

Many parents are not well educated themselves with respect to many of the sexually transmitted diseases and infections which exist thus making the education of their children even more difficult.

As parents, we are certainly not comfortable with the thought of our children engaging in sexual activities in uncommitted relationships and at early ages. However according to Bill Albert, a spokesman for The National Campaign to Prevent Teen and Unplanned Pregnancy. "Teenagers, by and large, have sex episodically, It has much more to do with opportunity than it does with a vaccination, for heaven's sake."

When it comes to the HPV (human papillomavirus) infection however, even celibacy until marriage cannot prevent one from contracting the virus. Recent studies have shown that half of all adult males in the U.S. may be infected with HPV, most unknowingly as it typically has no symptoms and is highly contagious. It is also transmitted through skin-to-skin contact and intercourse is not even necessary to become infected.

HPV is easily transmitted from males to females which his why it is important for not only girls but boys to be vaccinated as well. In addition, recent studies have shown that 75 percent of oropharyngeal cancers are the result of HPV, the majority of these are affecting younger men.

As parents, we do our best to educate our children not only with scientific knowledge but based on our own moral and religious beliefs as well. If we are confident in what we teach our children, a vaccine is not going to change that. If anything, it may very well save their lives.

" Why Teens Have Sex (Hint: It's Not About Vaccines) | Rick Perry & HPV Vaccine Controversy | Sexually Transmitted Infections | LiveScience ." N.p., n.d. Web. 27 Sept. 2011.

" Half of U.S. Men Infected With HPV, Study Reveals." CancerCompass - Empowering cancer patients to make informed decisions. N.p., n.d. Web. 27 Sept. 2011.

"Can HPV Vaccine Stop Throat Cancer?." WebMD Children's Health Center - Kids health and safety information for a healthy child. N.p., n.d. Web. 25 Sept. 2011.

Monday, September 26, 2011

HPV Cancer Survivor and Advocate Calls for Apology from Bachmann

Michele Bachmann, US Representative and GOP presidential candidate has offended not only women, but cancer survivors with comments she made during a political debate earlier this month.

Bachmann’s comments were based on the current vaccine Gardasil which in her words “results in mental retardation”. She continues to stand by her comments despite the fact that this is disputed by experts, including the American Academy of Pediatrics.

Gardasil, approved by the FDA in 2006, reduces the risk of the two highest cancer causing strains of the HPV virus. It has long been know that HPV is responsible not only for cervical cancer but also vaginal, vulvar and anal cancer as well as penile. Recent research now shows its role in 75 percent of oropharyngeal cancers as well.

While she may attempt to sidestep her comments by stating that she is not a doctor or a scientist, she has perhaps done far more damage with her comments than if she had been. Her comment that she “made no conclusions regarding the drug one way or the other” is clearly untrue when she drew the conclusion that it resulted in mental retardation.

It is just this type of uneducated comment made by Bachmann that has mothers questioning, if not outright refusing the HPV vaccines for their children. Perhaps Congresswoman Bachmann needs a history lesson herself before she attempts to make history as this country’s first woman President.

Cervical cancer affects approximately 12,000 women each year in the US. This figure is down 70% since cervical screening guidelines in addition to the development the HPV test has allowed for early intervention and treatment. However these interventions are not without physical and/or psychological damage, can require mutilating surgery and in some instances result in a woman’s loss of fertility. It continues to be responsible for half a million cancers per year globally with approximately 250,000 deaths.

We now have two vaccines, Gardasil and Cervarix which protect against the major cancer causing strains of HPV which can make things one step better by eliminating the physical and psychological ramifications of the treatment needed to address these precancerous and cancerous lesions.

HPV is responsible for 99.9% of cervical cancer. It is also responsible for 90% of anal cancers and to a lesser extent vaginal and vulvar cancer in women and anal and penile cancer in men. Now 75% of oropharyngeal cancers (mainly in men) are being found to be caused by HPV. Those parents who insist that their child will remain celibate until marriage only further exposes the complete lack of understanding regarding HPV because celibacy will not protect her from getting HPV from her husband when studies show that one out of every two men unknowingly has HPV.

She speaks to exposing our “young girls” to such a vaccine, yet few parents of infants give a second thought to having their child vaccinated with the MMR (prevention for measles, mumps, rubella) or dTAP (prevention for diphtheria, tetanus and pertussis also known as whooping cough) or polio. It is well known that the best time for any child to be vaccinated is before they are exposed to these viruses.

There are always going to be those with unforeseen allergies or other medical conditions resulting in untoward effects whether it be to a vaccine, or peanuts, sesame seeds or antibiotics. Shall we ban Penicillin because of the large number of individuals allergic to it. Birth control pills are long known to cause blood clots which can result in death yet that hasn’t resulted in the type of backlash that these vaccines have and that is more directly connected to sexual activity than the receipt of any vaccine.

As the mother of a 20-year-old daughter, I didn’t think twice about having her vaccinated when Gardasil was released. Why? Because I have lived with the severe ramifications of what this virus can do. I am the survivor of two invasive HPV-induced cancers having endured the mutilating surgeries, chemotherapy and radiation as well as the unfortunate complications and side effects of those treatments. I cannot conceive of my daughter having to go through even a small portion of what I did because I chose not to get her vaccinated. I wonder how many other parents could watch their child suffer the ravages of this virus knowing it was a result of their decision not to have them vaccinated.

Now, women having survived a variety of these HPV-induced cancers, those with precancerous lesions and even those diagnosed with HPV are outraged. At a time when they are desperately trying to spread the word about HPV and the importance of vaccination, Bachmann’s comments are simply untenable.

As President of The HPV Support Network Inc, a non-profit organization which advocates for awareness and education of both physicians and patients, I personally call for an apology from Representative Bachmann. She has done a tremendous disservice to all of us not to mention future generations of women (and men)who may remain unvaccinated and suffer HPV related disease. It is particularly painful to those of us who are HPV cancer survivors.

Hopefully when she begins to hear the voices of these women, she will comprehend just how devastating HPV is to their lives, how important vaccination is for future generations, and that inaccurate statements regarding this most valuable vaccine, used for the purposes of a political ploy, will not be tolerated.

Complaints can be made to:

Hughes, Sarah Anne. "Michele Bachmann’s HPV claims just latest in Gardasil debate - BlogPost - The Washington Post." The Washington Post: National, World & D.C. Area News and Headlines - The Washington Post. N.p., n.d. Web. 25 Sept. 2011.

"The HPV Support Network: Jul 26, 2011." The HPV Support Network. N.p., n.d. Web. 25 Sept. 2011. http://thehpvsupportnetwork.blogspot

"Can HPV Vaccine Stop Throat Cancer?." WebMD Children's Health Center - Kids health and safety information for a healthy child. N.p., n.d. Web. 25 Sept. 2011.

"Gardasil." U S Food and Drug Administration Home Page. N.p., n.d. Web. 26 Sept. 2011.

"Pediatricians Fact-Check Bachmann's Bashing Of HPV Vaccine : Shots - Health Blog : NPR." NPR : National Public Radio : News & Analysis, World, US, Music & Arts : NPR. N.p., n.d. Web. 26 Sept. 2011.

Wednesday, September 14, 2011

HPV - Beyond Cervical Cancer

HPV was first identified as the cause of cervical cancer in 1983 when Professor Harald zur Hausen, MD discovered HPV16. In 1984, he discovered HPV18 which, between the two strains were shown to be responsible for approximately 70% of cervical cancers.

In 2006, the first vaccine to prevent cervical cancer as a result of these two strains, Gardasil, was approved by the FDA. The vaccine protects against two high risk strains, those known to potentially cause cancer, and two low risk strains that typically result in genital warts.

Since that time, the usefulness of the vaccine has expanded. The vaccine which initially was approved as useful only with respect to cervical cancer was approved by the FDA for the prevention of vaginal, vulvar and most recently anal precancerous and cancerous lesions resulting from these two strains of the virus.

Because Gardasil was initially approved for use only in preventing cervical cancer, its manufacturers, Merck Pharmaceuticals, was initially forced to limit its advertising to cervical cancer prevention and genital warts only to avoid any compliance and regulatory issues. As a result, the majority of individuals who have even heard of HPV typically make the connection to cervical cancer. It is almost as if the two have become synonymous.

What is unfortunate, is that despite the FDA expanding its use for prevention of three additional cancers, Merck has not developed any new advertising campaigns to update the public regarding the increased risk from HPV. Even its website fails to provide any more than a single line of information and even this fails to include anal cancer.

More recently, a second vaccine, Cervarix was developed by Glaxo Smith Kline also for the prevention of cervical cancer but not protecting against genital warts. Its use has not been expanded to include any other cancers nor has it been approved for use in males as Gardasil was in 2009.

With over 20 million Americans infected with HPV at any one time, according to the CDC, and over six million new cases per year, one would think that there would be far more information distributed to the public.

With more recent studies identifying HPV as the cause of oral cancer as well, it probably will not be long until Merck applies to the FDA to expand once again the usefulness of Gardasil to include oral cancers as well.
The CDC however recently reported a decline in the number of those eligible for the vaccine and who are choosing to take advantage of it. The rate of vaccination from 2009 to 2010 rose only 5.2%. This brought the total overall vaccination rate, considered to be an individual receiving all three of the shots required to complete the series, to an abysmal 32%. The CDC is concerned, and rightly so, that unless it can turn its vaccination campaign around, there will be another entire generation of women having to deal with the ravages of dysplasia and cervical cancer.

The CDC has a right to be concerned. However, until the government as well as the medical community and the vaccine manufacturers alike begin an all out effort to educate the public regarding the extensive cancer causing potential for HPV, it is unlikely that much will change.

CDC Media Relations - Press Release: August 25, 2011." Centers for Disease Control and Prevention. N.p., n.d. Web. 12 Sept. 2011. Web September 12, 2011

Thursday, September 8, 2011

Is Your Risk for HPV Greater Than You Think?

It has long been reported that the risk of HPV progressing to a significant level of precancerous and subsequently cancerous lesion are very low. I have long been concerned regarding just how accurate this information may be.

The rates of cervical cancer over the past half a century have dropped dramatically as a result of cervical screening programs which can identify abnormalities in advance of their becoming cancerous. As a direct result of these programs, high-grade lesions (CIN2, CIN3 and CIS also known as carcinoma in situ) are routinely treated and removed in an attempt to eliminate the potential for cancer.

HPV however, like many other contagious conditions, is not a reportable infection like Chlamydia or Hepatitis. There is the potential for far more of these lesions to exist because there also is no repository from which to study and track the numbers of these high-grade lesions.

However HPV is known to cause multiple other cancers aside from cervical. One of the most significant is anal cancer. While this cancer has an extremely high cure rate if identified and treated early in its course, all too often it is misdiagnosed as bleeding hemorrhoids thus delaying a true diagnosis for months or even years.

Just like cervical HPV, anal HPV progresses from small changes within the cells and over time increasingly abnormal changes which eventually will result in cancer.

For the most part, HPV and the associated conditions has long been a “woman’s disease” while recent studies in both North and South America have shown that 50 percent of men have HPV. Obviously this information is something which the public needs to know and for which men need to take responsibility since they can transmit the virus to women.

In recent studies referenced by Dr. Joel Palefsky, one of the leading HPV researchers and infectious disease specialists in the United States, anal HPV infection was shown to be present in 60 percent of normal healthy women while only 50 percent were shown to have cervical HPV infections. This indicates that anal HPV infection is more prevalent than previously thought.

Dr. Palefsky intends to initiate a study which would also create a repository for specimens relating to anal HPV. This could be used to study for an early signs of transition to higher grade lesions and cancer which may be useful in the future in determining those most in need of treatment. Dr. Palefsky will be presenting this proposal to the National Institutes of Health early this month.
What has long been needed is such a repository to adequately determine the risk for high-grade cervical lesions as well. Hopefully someone will follow Dr. Palefsky’s innovative and forward thinking in creating just such a repository.

Webcasts | Joel Palefsky, MD — ." Sexuality, Reproduction & Menopause. N.P., n.d. Web. 7 Sept. 2011.

"Anal Cancer: Statistics | Cancer.Net." Doctor-approved cancer information from ASCO | Cancer.Net. N.P., n.d. Web. 7 Sept. 2011.

"Cervical Cancer Prevention." THE MEDICAL NEWS | from News-Medical.Net - Latest Medical News and Research from Around the World. N.P., n.d. Web. 7 Sept. 2011.

Tuesday, September 6, 2011

Why There is No HPV Test for Men

There has long been a frustration, upsetment and for some a feeling of discrimination because there is currently no available HPV test for boys and men.

We are the ones burdened with the diagnoses, having to inform partners, shouldering feelings of shame and guilt and ultimately if persistent and progressive having to deal with all the physical and emotional ramifications of treatment.

The medical community has not been falling over itself in a race to make available a test for men and so the predominant question becomes - why not?

To begin with the current HC2 technology used in testing for HPV does not discriminate. It knows not whether the specimen is from a male or a female. PCR, or polymerase chain reaction, is a test which has been used long before the digene HPV test and most currently used was approved by the FDA. This is also true of the tests available through Hologic and Roche's new cobas test.

It is often heard that there is no consistently reliable test for men, yet PCR is typically used in the majority of research studies, including those on men. If it were so unreliable, then the research study results should also be in question but they're not. These same results are used to develop policies and guidelines relative to things like screening, so obviously it isn't because the test is unreliable.

According to Joel Palefsky, MD, of the University of California San Francisco, who deals with infectious disease and HPV related anal cancers, the unfortunate fact is, that it doesn't serve a purpose. Unless a man has some type of lesions which can be further tested simply knowing that he has HPV is not going to change anything. He states that most individuals are not tested in advance of sexual involvement with a partner but typically are dragged in by a partner who has been diagnosed with HPV. By that time, it is too late to undue transmission for any strain of virus which may have been acquired.

I know many are now adamantly disagreeing with this. It's unfair that women cannot have their partners tested in advance, it is unfair to put the burden on women and essentially result in women taking the blame for HPV transmission and a host of other reasons women typically consider.

Many may be surprised to know that the current test is only approved by the FDA for use with cervical specimens despite the fact that HPV can also be found in vaginal, vulvar and anogenital tissue. Once again, the test cannot distinguish from where the sample originates and would work just fine on any of these other areas.

Many of you may have heard of the anal pap. This is usually performed more on men than on women so of course one would wonder how this would work. Simple really, the origin of the specimen would simply be changed prior to submission to the lab for analysis. While this can be highly dangerous if it were done with a biopsy, for the HPV test which is simply looking to detect HPV DNA the sample area isn't significant. Either the DNA is present or it's not.

So why is it considered of no use in men? Well because while a urethral swab could be taken and perhaps a penile swab there is nothing that can be done for the patient if it were to reveal him to be HPV positive. Just as with women there would have to be some type of lesion which could be biopsied to check for dysplasia and/or cancer and penile cancer is very rare and there are rarely if ever visible penile lesions (unless of course they are genital warts which are the low risk type of HPV and not what we're talking about here). You don't need a test to tell you that genital warts are present, they're pretty obvious. It's the high risk oncogenic strains we're talking about here.

Tests are not typically performed by a physician unless there is the ability to then DO something based upon those results. There isn't anything that can be done for a man who is diagnosed as HPV positive other than to provide the standard precautions regarding the spread of the virus and using condoms and this information can be given even without an HPV result.

Even with condoms, HPV is so contagious and often exists in the tissue around the penis, testicles and perianal area that transmission is highly likely even with condoms and the only thing that will really make a difference would be if the man were to become a cloistered monk.

So its not that there isn't a test able to detect HPV in men, it's just viewed as pointless in testing for it. When it comes to the blame and shame which falls almost exclusively on women, what will make a difference is the FDA changing their current position regarding male vaccination against HPV. Right now vaccination is only recommended for women. It is approved for boys and men but not recommended. That recommendation carries all the difference, it says that protecting against HPV is just as important for men as women and levels the field when it comes to people's perception that women are to blame. Having the FDA make it a recommendation says that men are equally involved and accountable when it comes to the transmission of the virus and helps to lift the burden currently placed solely on women.

So in summary, it isn't that a test doesn't exist because it does. It is just not embraced for use by the medical community because knowing if they are positive is not going to really change anything and if their HPV is dormant at the time resulting in a negative test it would only be misleading. anyway.

The reason other vaccines have such a high compliance rate compared to HPV is because they are mandatory, typically required if a child is going to be allowed into school. Being "recommended" as HPV currently is certainly doesn't prompt compliance and since most doctors do not discuss HPV with patients they typically only learn about it as part of their positive diagnosis.

Since there are so many other means of transmission now being discovered and even kissing being suggested by those at Johns Hopkins doing research on HPV oral cancers then what is to prevent a child from transmitting it to another child by sharing a drink in the cafeteria. This is how Hepatitis B is transmitted very often and that results in cancer as well. Those against mandatory vaccination say that since it is an STI and younger children are not engaging in sex it isn't necessary, but if indeed it is as simple as sharing a drink or kissing (HPV has been identified in saliva) then it can easily be transmitted even without the sexual component in that age group.

Given the fact that male oral cancers from HPV have doubled from 1973 to 2004 is all the more reason for the FDA to make vaccination recommended in boys and men. Perhaps then this will lessen the stigma so often placed upon women and educate others to the fact that men are just as responsible for HPV transmission as women.
HPV Oral Cancers on Rise as Oral Sex Becomes More Popular, May Spread Human Papilloma Virus - ABC News." Daily News, Breaking News and Video Broadcasts - ABC News. N.p., n.d. Web. 5 Sept. 2011.

Joel M. Palefsky, MD - UCSF Helen Diller Family Comprehensive Cancer Center." UCSF Helen Diller Family Comprehensive Cancer Center. N.p., n.d. Web. 5 Sept. 2011.

HPV and Anal PAP Testing, Health Facts For You, UW Health, University of Wisconsin Hospital, Madison ." UW Health, University of Wisconsin Hospital, Madison . N.p., n.d. Web. 5 Sept. 2011.

Thursday, September 1, 2011

FDA Approves New Cobas High Risk HPV Test

On April 20, 2011, Roche Diagnostics announced that the FDA has approved its new HPV test, cobas. This new test detects the presence of DNA for fourteen high risk strains of the virus. There are a few differences between the Roche test and the current digene HPV test. Roche’s test will check for fourteen of the high risk HPV strains while the digene test checks for thirteen. Once this is completed, the Roche test will then concurrently genotype the specimen for types 16 and 18. These two HPV strains re shown to cause approximately 70 percent of all cervical cancers.

Roche representatives, Christoph Majewski , Head of HPV molecular science and Dr. Catherine Behrens, Director of Medical Affairs of the women involved in the ATHENA study with a Pap result of ASCUS (atypical squamous cells of undetermined significance) 90 percent were shown on biopsy to have CIN2/3 lesions. Of those, 46 percent were CIN3.

The National Cancer Institute indicates that 10 percent of women who are positive for HPV types 16 and 18 have been shown to develop CIN3 (cervical intraepithelial neoplasia grade 3) within three years. CIN3/CIS (carcinoma in situ) is the most severe type of abnormality prior to the lesion becoming an invasive cancer.

The ATHENA study was utilized to determine the effectiveness of this new test, cobas. The study was conducted throughout the United States and involved a total of 47,000 women. It showed that one in ten women who tested positive for types 16 and 18 genotyping had precancerous lesions despite having a negative result on their Pap smears.

The current digene HPV test in existence for over ten years does not, at this point, genotype within its 13 panel assay. It has however since its inception performed over forty million tests and had over three-hundred pier review articles with respect to its methods.

Cervista*, the HPV test from Hologic, approved by the FDA, like Roche, tests for fourteen high risk strains. While Cervista* HR does not concurrently genotype for 16 and 18 as cobas does, they do offer a separate test to genotype for both 16 and 18.

It may seem more convenient to have all testing done relatively simultaneously in one HPV test. However, since much of the cost of testing is ultimately determined by the laboratories performing them, it will be interesting to see just which test will take the lead.

*This blog has been changed (with our apologies) to correctly reflect the name of the Hologic HPV test which is Cervista and not Cervarix as previously mentioned. Cervarix, along with Gardasil is one of the two FDA approved HPV vaccines.

Monday, August 29, 2011

Is Cancer Contagious? The ACS Says No, but is This the Truth?

In an article by the American Cancer Society titled “Is Cancer Contagious”, the comment is emphatically made that it is not. It goes on to say,

“If cancer were contagious, we would have cancer epidemics just as we have flu epidemics -- cancer would spread like measles, polio, or the common cold. We would expect a high rate of cancer among the families and friends of cancer patients and among health professionals to reflect their exposure to the disease. This is not the case.”

In the case of the human papillomavirus I would have to disagree. HPV is known to cause numerous cancers including cervical, vaginal, vulvar, anal and oral, as well as penile. Its main method of transmission is through intimate skin-to-skin contact. It does not require intercourse however this only increased the chances of contracting the virus especially for women through small tears or abrasions in the vagina during intercourse.

Family members don’t have intimate relations with each other and they don’t typically have them with their friends either. And it’s obvious that they aren’t having intimate relations with their physicians. So the theory as related in this article borders on nothing but the absurd.

While HPV does not transmit cancer in the literal sense of the word, it does introduce the precursors known, under the right conditions, to cause cancer. We know that HPV is a sexually transmitted disease and can also be transmitted through oral sex and some have indicated that kissing is not beyond the realm of possibilities as well as through foamites (inanimate objects, fingers, sex toys etc).
The article goes on to state:

“There is no evidence that close contact or things like sex, kissing, touching …… can spread cancer from one person to another.” On the contrary, more and more research is confirming that transmission of HPV is far more complex and involves multiple modes of transmission and one is certainly more likely to develop one of these cancers if they have been exposed to HPV than not.

Today, 99.9% of cervical cancers are the result of HPV and over 90% of anal cancers. Oral cancers continue to rise, particularly in younger men, at a staggering rate which has already exceeded the number of cervical cancers on an annual basis.
As with other HPV related cancers, it is not a difficulty in diagnosing these cancers that are the problem, but a lack of education on the part of physicians and the lack of public awareness and early screening opportunities.

Cancer in the broader sense of the conversation, or shall I say the potential for cancer, has shown to be very much contagious as it relates to HPV. The Hepatitis viruses have long been known to result in liver and pancreatic cancers. Perhaps we may ultimately find that all cancers are the result of various viruses, but until then, perhaps the ACS should take a bit more pragmatic view on its current position.

" Is Cancer Contagious? ." American Cancer Society :: Information and Resources for Cancer: Breast, Colon, Prostate, Lung and Other Forms. N.p., n.d. Web. 28 Aug. 2011.

"Hepatitis B Foundation: Hepatitis B and Primary Liver Cancer." Hepatitis B Foundation. N.p., n.d. Web. 28 Aug. 2011.

The Oral Cancer Foundation. Web.28 Aug. 2011.

Sunday, August 21, 2011

International Conference Update

The schedule for this year's International Papillomavirus Conference in Berlin Germany has been finalized. My presentation, HPV - The Patient Experience is the first in the experience of the conference given by a patient and I commend the organizers of this conference in recognizing the need to include the voice of those most affected by HPV - the patients.

It is my hope that this will set a new standard by which future conferences will continue to include the voice of the patient. There is much that can be learned from the patient's input however for too long the medical community has not appreciated that they could learn anything useful from them aside from the results provided regarding physical research. But HPV is not solely a physical condition but a psychological one as well.

In finalizing my presentation I realize just how much of the psychological aspects of an HPV diagnosis is relevant to the development of guidelines currently only focused on scientific physical evidence. While this is certainly a significant factor, the psychological aspect simply cannot be ignored if the patient is going to be treated as a whole.

We are not just physical nor just psychological beings but a delicate combination of both. It is important for me to dispel the myth that providing the patient with information will only result in hysteria and upset. In my experience it is exactly the opposite. It is that lack of education of the patient which results in psychological distress. The feelings of not only the unknown but the loss of control over their bodies as well The loss of control is especially true in the case of persistent disease in which the patient cannot in many instances effectuate a change in the progression of precancerous lesions. Younger individuals, once feeling invincible with the world ahead of them are now fearful and concerned about the potential for loss of future fertility and possibly death - something which, because of their age they typically would never have had to face if not for HPV.

It is also important that women not continue to have to bear the burden of HPV diagnosis themselves and a test for men must be developed. In addition the development of a therapeutic vaccine for those already infected with the virus is paramount. The percentage of individuals who actually complete the three doses of the current vaccine in the US is only 30% and without a widespread public education campaign far more individuals will become infected than those protected.

This will certainly prove to be a precedent setting conference.

Thursday, August 4, 2011

Comparisons Between AIDS and HPV

Both HIV/AIDS and HPV are viruses. Just as with HPV (Human Papillomavirus) which has been in existence for centuries, HIV/AIDS (Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome) has also existed as an unidentified condition decades before it’s identity as a retrovirus was discovered in the early 1980s. This is the same time frame during which HPV was identified as being responsible for cervical cancer. Actually the retroviruses responsible for AIDS were discovered in the very same year, 1984, as was the connection between HPV and cervical cancer.

According to information from those who researched AIDS in the earliest years, the time of onset of symptoms could be ten years or more. Similarly, while the incubation period for HPV is usually three months, symptoms are usually absent and actual progression to an invasive cancer takes a similar amount of time, approximately ten years.

Dr. Robert Yarchoan of the National Institute of Health, made the following comment regarding the early days of AIDS diagnoses, “I remember doing a rough mental calculation of the number of gays in the country and the percentage who were likely to be HIV-infected, and estimating that there were half a million to a million people infected with this lethal virus who did not know it.” With HPV estimated to affect over twenty million Americans and more than six million more acquiring the virus each year, still few people are even aware of what HPV stands for.

By the mid-eighties however, far more extensive research was being conducted with respect to pharmaceuticals and vaccines and more so after the United States Congress allocated additional funding in 1986. Within ten years of the identification of the AIDS virus there existed medications which could control the disease, yet it took another two decades for the first vaccine to become available for HPV in 2006. Even this vaccine is limited and does not cover all cancer-causing strains of HPV.

While the Pap smear and subsequent HPV test has resulted in a dramatic reduction in the number of cervical cancers this is the result of early identification, the treatment for which is typically some form of invasive tissue removing procedure, but certainly not a medication which would be far less traumatic and result in fewer consequnces (physical and psychological) for women, including potential infertility.

So why is AIDS so familiar to the majority while HPV remains relatively unknown? It would appear that the governments direct involvement as well as its massive funding for AIDS research may be the answer. The media also played more of a role in educating the public than they do today with HPV. Yet, high risk HPV has now been identified as being necessary for the progression to a minimum of five different cancers; cervical, vaginal, vulvar, anal and oral, with other conditions resulting from low risk strains.

While HPV may not be fatal within a short period of time as AIDS was, it is ultimately still responsible for millions of deaths throughout the world each year. The question remains, just how many cancers will need to be attributed to HPV before the government decides to involve itself both in education and funding? Despite all the similarities, the difference in how each has played out since discovery appear quite disturbing.

Tuesday, July 26, 2011

Changes in Immunization Practices May Reduce Oral Cancer

Until now, the ACIP (Advisory Committee for Immunization Practices) has only approved the HPV vaccine for girls and young women through age 26. This despite the fact that the FDA (Food and Drug Administration) itself approved the vaccine for use in boys and young men almost two years ago in 2009.

Since its approval in 2006, the Gardasil vaccine, originally approved only to prevent certain strains of HPV known to cause cervical cancer and their precancerous lesions has been expanded to include vaginal and vulvar cancers and their precancerous lesions as well. Last year, they extended this to include anal cancer.

Until now, including boys and young men would not be cost effective given the low percentage of women who actually go on to complete the three shot series.
Now however there has been an explosion with respect to the number of oral cancers which are predominantly affecting males and which has overall exceeded the number of cervical cancers annually. Previously, smoking and alcohol were considered to be the major causes of oral cancers.

In the time period from 1984 to 1989, 16 percent of oral cancers were attributed to HPV. In comparison, in the time period of 2000 to 2004 the percentage of oral cancers related to HPV had increased to 75 percent and, it is known that the risk of oral cancer increases related to an increase in oral sex and kissing.

During the ACIP meeting of June 22, 2011, testimony was heard from Aimee Kreimer, PhD of the National Cancer Institute. She stated, "At some point ... it is projected that there will be the same incidence of OP cancer in men as cervical cancer in women, If current trends continue, OP cancer in men will pass cervical cancer in 2025."

Many abstinence groups are opposed to the vaccine claiming, like the distribution of condoms in the past, that it was the equivalent of approval to engage in sexual activities. That argument is becoming weaker when simply the act of kissing is considered a risk factor for oral HPV related cancers.

Dr. Dong Moon Shin of Emory University’s Winship Cancer Center stated, “The time is now. For the HPV vaccine, cost is the only issue as side effects are minimal. Routine HPV vaccination has to be implemented very soon, for both boys and girls."

Given the information to date, it is apparent that the sooner the ACIP includes in their recommendations that boys as well as girls receive the vaccine, the greater the impact on all HPV related cancers will be.

Friday, July 15, 2011

Tips for a More Accurate Pap Test Result

Most women have undergone a mammography, perhaps more than once. I myself have never made an appointment without being given specific instructions on what not to do the day of the exam. Don’t use any perfume, powder or deodorant is what someone planning a mammography is typically told.

Most women however are not provided with some also simple instructions when it comes to getting a Pap smear. Whether or not you comply with these recommendations can make a difference in the outcome of your results. In fact, they can interfere with accurate results. Although there has been a 75% reduction in cervical cancer over the past decades, the majority of that decrease today is the result of early treatment for precancerous lesions thus preventing them from progressing to cancer. So following these instructions continues to be important when it comes to your health and obtaining the most accurate results possible.

According to Women’s Health, the following are instructions which all women should be provided when scheduling a visit which will include a Pap test:

1. Vaginal douches are not recommended for the three days prior to the
Pap test.
2. Do not have sexual intercourse two days before your Pap test.
3. Take showers instead of tub baths two days prior to the exam.
4. Tampons, vaginal creams or medications, contraceptive foams and
Jellies are not advised I the 48 hours preceding the Pap.
5. Schedule your Pap one to two weeks after your period.

I’ve been having Pap tests for decades and cannot ever remember being given this information. The recommendations make perfect sense when considering the purpose of the Pap and just what is removed during the test. Any unusual substances such as contraceptive products and those contained in douches can effect the environment surrounding the cervix itself thus preventing removal of the cells necessary to provide a more accurate result. This is true of any outside substance which would include seminal fluid which his why sexual intercourse is discouraged as well.

I hope that you have been provided with this information when you have scheduled your Pap test. If not, you now have the tips which will help you to receive the most accurate results possible, and when it comes to an exam used to detect cervical cancer, we of course want the most accurate results possible.

Sunday, June 26, 2011

What Really Killed Farrah Fawcett?

Recently Ryan O'Neal sat down for an interview with CNN's Piers Morgan. When I first heard that he was claiming to have potentially been the cause of the late actresses death I was intrigued to see if he was going to comment about HPV (Human Papillomavirus).

It was truly disappointing not only to have no mention of HPV, but to blame it on of all things, his daughter? Unfortunately Ryan O'Neal has had a long history of anger, threats, and drug problems. Now we can obviously add denial to that list. How repulsive for any parent to refuse accountability and responsibility for his own actions and life decisions than to blame it on your child.

He stated in his interview that "we really don't know what causes cancer". Well Mr. O'Neal, in the case of anal cancer, which ultimately took Farrah's life in 2009, we DO know that more than 90% of them are the result of HPV.

While most people relate HPV to cervical cancer, they are blissfully unaware of the myriad of other cancers resulting from this virus nor that there is a vaccine available to help protect against two of the most high risk strains of the virus known to cause most cancers.

Knowing that HPV causes 99.9% of cervical cancers, and since instituting screening programs decades ago the incidence of cervical cancer in the US has dropped 75%. Anal cancers however have been on the rise. A research study conductd by the Fred Hutchinson Cancer Research Center in Seattle Washington shows that over the past thirty years anal cancer in women has increased by 78% while in men, it has increased a staggering 160%. That study was conducted in 2004. Who knows how much higher those statistics have risen in the intervening seven years.

While HPV was never mentioned in Farrah's documentary, statistics would suggest that HPV was involved (though there is a small likelihood that it was not). In trying to overcome the stigma of anal cancer, Farrah created her documentary to educate others regarding this little talked about cancer. Unfortuately, and especially in the opinion of those having HPV, she failed miserably in not providing any type of public service announcement letting people know about anal HPV and more importantly about the vaccine.

The HPV forums were raging for weeks after the documentary, which garnered millions of viewers, aired. Such a lost opportunity for someone of such celebrity not to have gone further and provided information which, since it aired, could have saved countless lives. It definitely has cost some.

I also wish that Piers Morgan, as a journalist, were more educated as to have posed a question regarding HPV in response to O'Neal's comment. It is far more likely if O'Neal had stated he knew he had HPV that perhaps yes, he possibly could have caused Farrah's cancer. Could the stress he attributes to his family life have affected Farrah's immune system making it more difficult for her body to control the HPV? This is certainly a more realistic conclusion.

Whether her cancer was the result of HPV or not, the statistics alone certainly warranted mention in her documentary. Will people remember the documentary? I'm sure they will. Would more people be asking their doctors about anal cancer, HPV and the available vaccine, which has been available since 2006, had it been mentiond? I'm sure they would.

Sunday, June 19, 2011

The New Side Effect of Cancer - Bankruptcy

There have previously been studies regarding the link to bankruptcy and cancer. For the most part this information has been obtained from those willing to divulge their bankruptcy filing. However, now for the first time research has been done utilizing the government’s public records regarding bankruptcy filings and the tumor registry recordings of cancer.

According to Scott Ramsey, MD and PhD who lead the study, “The risk of bankruptcy for cancer patients is not well known, and previous studies have relied on individual self-reports about medically related reasons for bankruptcy filing. By linking two irrefutable government records of cancer and bankruptcy, we are able to determine how financial insolvency risk varies by cancer type, treatment and other factors.”

Ramsey is a healthcare economist and an internist at the Fred Hutchinson Cancer Research Center. He is also a member of the Hutchinson Center’s Public Health Sciences Division which conducted the study linking the federal governments’ court bankruptcy records in 13 counties in western Washington with the state’s cancer registry data.

The results show that bankruptcy increases an astounding four-fold within the first five years after diagnosis. It is shown to double within the first two years. While medical debt is typically not something an individual enters into voluntarily, credit reporting agencies such as Experian, Equifax and Transunion, (the top 3 credit reporting agencies) continue to include this debt on the patient’s personal credit report.

These results were just presented at the annual meeting of the American Society of Clinical Oncology in Chicago. The study was conducted utilizing information from 232,000 adult cancer patients over a period of fourteen years and found that the length of survival correlated to the risk for insolvency.

Interestingly enough, those people on Medicare were less likely to be affected than younger individuals (also presumably with private or no insurance).

Other research has shown that the cost of cancer treatment in the United States has doubled over the past two decades. Many may presume that this is the result of the high cost of new chemotherapy drugs or innovative new treatments. The study concluded however that the actual cause of the dramatic rise in cost was the increase in the number of cancer patients themselves.

With FICO credit scores being utilized for just about everything these days, from obtaining a credit card to obtaining a job, Congress needs to look into modifying the current bankruptcy laws taking into account this new information. The longer a cancer patient survives, the more likely they are to become insolvent. Is what a cancer patient must endure to survive not enough of a punishment? Should a federal law designed to provide an individual with a fresh start be allowed to be utilized in such a way as to totally subjugate that purpose?

If one has a perfect driving record, why should their auto insurance rates go through the roof because they now have a low FICO score resulting from trying to survive cancer? It shouldn't. The road a cancer patient must travel in order to survive is difficult enough. Should they continue to be penalized by the existing bankruptcy laws as the price for having survived?

Perhaps when doctors are explaining to patients the potential side effects of their cancer treatment, filing bankruptcy should now be included in that list.

Sunday, May 29, 2011

Input Requested for International HPV Conference

I have been honored with a request to present a lecture at this years International Papillomavirus Conference in Berlin Germany. This is the first time that a patient has ever presented at such a conference and this is truly both an honor as well as an enormous opportunity to speak on behalf of those with HPV.

I would appreciate hearing your concerns, issues and other information you feel is relevant to today's testing, treatment and vaccine issues to name a few. Your input is valuable in presenting the most impactful lecture to 1400 members of the HPV community (researchers, clinicians etc).

Thank you in advance for your contributions.

Wednesday, May 18, 2011

Tips to Protect Yourself Against HPV

With HPV (human papillomavirus) being the number one sexually transmitted infection, there are good reasons to take advantage of ways in which you can reduce your risks.

The Center for Disease Control (CDC) estimates that there are over 20 million Americans with HPV, and an additional 6.2 million cases diagnosed each year. Since this virus was first identified as being responsible for cervical cancer through the research of Professor Harald zur Hausen, MD in 1984, numerous other cancers have now been identified as the result of HPV.

HPV can cause cervical, vulvar, and vaginal cancers in women; anal cancer in both women and men and penile cancer in men. It has recently been shown to cause head/neck cancers which typically manifest in the tonsils and the base of the tongue. These types of cancers are more typical in males than in females. While it is believed that oral HPV cancers are the result of oral sex, 40 percent of those in a recent John’s Hopkins study had never engaged in oral sex.

So what can you do to reduce your chances of contracting HPV and/or minimizing any potentially negative ramifications of the virus? While it only takes an encounter with one partner to contract HPV, studies have shown that the risks of HPV of greater when someone has a increased number of partners. Give careful consideration to whom you choose to be intimate with. Transmission occurs with intimate skin to skin contact and sexual intercourse in any form is not a prerequisite for acquiring HPV.

Studies have also shown that there is a direct link between smoking and an increased likelihood of persistent disease once HPV is contracted. Smoking is also know to effect the body in numerous ways including its effects on lowering the immune system. So, if you can, quite smoking. I know it’s difficult but consult your doctor for assistance if need be.

Using condoms can help to reduce but does not totally eliminate the possibility for contracting HPV. Since transmission occurs when one comes into contact with an infected area, and since a condom can only cover the penis it is still better than choosing to have unprotected sexual interactions.

Another risk factor for contracting HPV is beginning sexual interactions at an early age. This may be in part due to the fact that more partners may become a factor when beginning at an earlier age. Either consider postponing any sexual encounters yourself, or if you are the parent of a young daughter in particular, talk to her about HPV. No parent ever wants to believe their daughter is having sexual relations as early as many of them are and waiting until she is 15 or 16 may be too late.

One of the most important things that can be done to protect yourself or your child (male or female) against the two most aggressive forms of HPV and those which are responsible for the majority of precancerous and eventually cancerous lesions, is to get vaccinated against HPV. A side benefit to the vaccine is that it also protects against two low risk strains of HPV (types 6 and 11) which cause genital warts.

Talk to your doctor about HPV and ask about receiving the vaccine. While unfortunate, some physicians are not comfortable discussing these topics (unless of course it is a gynecologist but sometimes even then) and may worry about making the patient uncomfortable by initiating the discussion. The best advice is to advocate for yourself.

Monday, May 9, 2011

HPV Shown to Cause Head/Neck Cancers

Since the discovery in 1984 that HPV (Human Papillomavirus) was responsible for cervical cancer, research has continued to prove the connection between HPV and cancers in other areas of the body.

It has been known for quite some time now that HPV is also responsible for dysplasias (abnormal cells) and cancer of the vulva, vagina, and the penis in men. In the last decade, the connection has also been made between HPV and anal cancer. More recent research has pointed to HPV as being the cause of a high percentage of oral and throat cancers.

In a study performed at the John’s Hopkins Oncology Center, twenty-five percent of the 253 patients included in the study and having been diagnosed with head and neck cancers were positive for HPV. Of those, HPV16 (considered to be one of the most aggressive strains of the virus) accounted for ninety percent of the cases. These results were published in the New England Journal of Medicine, May 2008. According to Dr. Maura Gillison of John’s Hopkins, HPV16 accounted for a thirty-two fold increase in risk for oropharyngeal squamous cell cancers. Subsequent studies have shown the percentage of HPV related tumors to be as high as sixty-four percent.

In a paper presented to the American Society of Clinical Oncology in 2009, patients have a better chance of survival, by more than fifty percent, if their tumors contain HPV than if they don’t. The differences between those oropharyngeal cancers caused by HPV and those caused by other factors such as prolonged cigarette smoking, alcohol consumption and the chewing of tobacco are so marked, it is suggested that they be treated as two different types of cancer.

Researcher at the Roswell Park Cancer Institute in Buffalo New York indicates that since 1989 they have had a three-fold increase in the number of throat cancers they treat. This according to Dr. Thom Loree, Chair of the Department of Head and Neck Surgery. They also advocate a national discussion regarding providing the HPV vaccine to both young men and women in an effort to prevent these head and neck cancers. Their data shows that those patients whose cancers were HPV related were about fifty to sixty percent.

Since its approval by the FDA (Food and Drug Administration) in 2006, the Gardasil vaccine’s indication for use has changed numerous times to allow for the inclusion of the prevention of various other cancers. It appears that the vaccine may well prevent oropharyngeal cancers as well. Currently, the number of individuals who actually go on to complete the three shot series for the vaccine is a meager thirty percent in the United States. It will be interesting to see if these numbers increase when the focus shifts away from a sexually transmitted infection to a head or neck cancer.

Tuesday, May 3, 2011

New HPV Test to Detect Greater Cancer Risk

On April 20, 2011 Roche Diagnostics announced the FDA’s approved of its new HPV test, cobas. This new test detects the presence of DNA for fourteen high risk strains of the virus. There are a few differences however between cobas and the other HPV tests currently on the market.Roche’s test will check for fourteen of the high risk HPV strains. The Hologic test, Cervista, also tests for these same fourteen strains, while the digene test checks for thirteen.

Once this is completed, the Roche test will then concurrently genotype the specimen for HPV types 16 and 18. These two HPV strains are shown to cause approximately 70 percent of all cervical cancers.

The ATHENA study was utilized to determine the effectiveness of this new test, cobas. The study was conducted throughout the United States and involved a total of 47,000 women. It showed that one in ten women who tested positive for types 16 and 18genotyping had precancerous lesions despite having a negative result on their Pap smears.

Roche representatives, Christoph Majewski , Head of HPV molecular science and Dr. Catherine Behrens, Director of Medical Affairs, state that of the women involved in the ATHENA study with a Pap result of ASCUS (atypical squamous cells of undetermined significance) 90 percent were shown on biopsy to have CIN2/3 lesions. Of those, 46 percent were CIN3.

The National Cancer Institute indicates that 10 percent of women who are positive for HPV types 16 and 18 have been shown to develop CIN3 (cervical intraepithelial neoplasia grade 3) within three years. CIN3/CIS (carcinoma in situ) is the most severe type of abnormality prior to the lesion becoming an invasive cancer.
The current digene HPV test in existence for over ten years does not, at this point, genotype within its 13 panel assay. It has however since its inception performed over forty million tests and had over three-hundred peer review articles with respect to its methods. Both Hologic and Roche have a bit of catching up to do in that respect.

Cervista (the HPV test from Hologic and also approved by the FDA) like cobas, also tests for fourteen high risk strains. While Cervista does not concurrently genotype for 16 and 18 like cobas, they do offer a separate test to genotype for both 16 and 18.

It may seem more convenient to have all testing done relatively simultaneously in one HPV test. However, since much of the cost of testing is ultimately determined by the laboratories performing them, it will be interesting to see just which test will take the lead.

Monday, April 11, 2011

Some Things Never Change

"We believe that medical attitudes serve to create a climate of emotional and physical estrangement, to reinforce the attitudes of acceptance and self-blame for the situations we find ourselves in. This makes it impossible to ask questions or challenge what is happening around our own health and increases the feelings of despair and feeling of not being in control. What happens in hospitals can have damaging and permanent physical and emotional effects on women's lives and basically, what we ask is to retain our dignity."
I'm sure most would agree that this is a reflection of how we women feel today with respect to the treatment we receive. The interesting thing however is, that this comment was made by a member of The Women's Health Cooperative at hearings regarding activities at National Women's Hospital in New Zealand and, that it was made in 1989. Some things never change as evidenced by the twenty-two year interval since this comment was made.
When it comes to the subject of HPV, the most common sexually transmitted infection, a virus known to cause at least a half-dozen invasive cancers, these comments are even more significant. The ways in which women are treated when it comes to a cervical or anal cancer almost 100% of which are caused by HPV, this is much different than how a woman is treated who has a diagnosis of breast cancer. The former being viewed as something for which the patient is "to blame". No one can "blame" a woman for having breast cancer.
We are heading down a very slippery slope if members of the medical community begin determining the treatment a patient will receive based upon whether or not they can be "blamed" for their condition, cancer or otherwise. It is interesting because even patients with lung cancer which has long been associated with smoking and for which the patient could be blamed because it was after all, their behavior which brought about the disease, we have not seen this type of disparaging treatment.
When one's behavior becomes part of the criteria for treatment of disease then we are all in trouble. What of the patient whose heart attack was caused by their obesity and high cholesterol?
Until now, with research showing an ever enlarging group of cancers resulting from the human papillomavirus, we have not seen such bigoted perspectives by members of the medical community. Obviously when reading these initial comments it is evident that these bigoted perspectives have been long held when it comes to sexually transmitted infections and the gynecologic conditions they cause.
Hopefully with more women advocating against just this sort of behavior and for the education of women regarding their health, these attitudes will not continue for another two decades.

Sunday, February 27, 2011

The World's New "Natural Disaster"

I don't know about the rest of you but it becomes very frustrating when our own country cannot balance it's budget, spends money like drunken sailors and places the ramifications on the backs of hard woring Americans.

Then come the natural disasters, earthquakes, floods, tsunammi's. I don't have an exact number on just how much the US provides to other countries but I know it's quite an extraordinary figure. On top of that, we see fundraisers for the victims of this tragedies to which celebrities in particular (but others as well) contribute literally millions of dollars. Does anyone who has contributed to Haiti actualy think any of that money will ever get to the people? Pleeease!

Meantime, there is a growing natural disaster in this country to which most are oblivious except of course those living it. It's called CANCER and it can turn a person's life upside down just as fast as an earthquake or a flood. It's ramfications can leave you homeless, jobless, having to make choices between eating and obtaining often vital medications, many to alleviate agonizing pain.

If course I see fundraisers for various cancer "research", but what about fundraisers to actually help the patients? To help them to rebuild their lives, alleviate the near constant daily stress which only causes further deterioration of their condition because we all know what stress does to the body and the immune system.

I'm glad Sean Penn and others think that Haiti has the potential for such vast improvements. Potential perhaps, likelihood not so much. The American Cancer Society doesn' t provide financial assistance either, much to the surprise of most people, instead they just give you a list of phone numbers which you can call and repeat your story to over and over again trying to receive assistance, as if that isn't traumatic.

Far too many cancer organizations think that the patient's need ends when treatment ends. This couldn't be further from the truth and actually is just the beginning for most of these folks. They've previously been caught up in their treatment schedule, doctors appointments, appointments for CT scans and PET scans, chemotherapy etc and have no time to even focus on "daily life" because this has become their daily life. But when treatments ends, daily life is never the same and too many patients find themselves financially destitute, lacking emotional support as well, needing help because side effects complicate what were once simple everyday chores. These are the forgotten. I think survivor is an incorrect classification because often they are not even surviving they're barely existing. And, while it's nice that the ACS provides a beauty sessoin with free make-up to help women feel better about themselves, personally I'd rather have a check to pay my electric bill or put food on the table.

Perhpas it's long past the time when we should be looking within our own countries to those who have been just as ravaged and just as emotionally and financially devastated as the others they so quickly rush to support. Perhaps it is time for these same people to contribute to a fund which will provide houses to cancer victims who have lost theirs, or funds to pay their electric bills, medical bills, be able to obtain their much needed medications and even buy food.

I think I speak for many victims of cancer, especially those whose cancer is HPV related. A virus which 80% of us will be affected by, but far few that have even heard of. Bring the compassion home to care for those Americans who are struggling every day but for whom nobody is putting on a fundraiser to assist their needs. Charity begins at home and far too many have forgotten that very simple slogan.

Wednesday, January 26, 2011

Negotiating Medical Bills

Cancer cannot only devastate the body , it can devastate the pocketbook as well. I know from personal experience. So in this entry I would like to educate people on something few know about but certainly anyone with cancer should regardless of its origin.

There is a federal law referred to as Hill-Burton. Within this law, hospitals are allowed to maintain tax-exempt status in return for providing a certain amount of services to patients who could otherwise not afford them.

Virtually every hospital has a Financial Services Department. This is the department you should be communicating with, not the billing or collections or any other department!

Request financial aid/charity forms and let them know about your situation. There are guidelines and unfortunately, there are maximum incomes as with most programs but for many, this could be a Godsend. Many hospitals, once approved, will then waive any co-pays, deductibles and co-insurances beyond what your insurance will pay. This is one way to keep more of the money that YOU desperately need. You will need to get past any ego issues about asking for charity but most people in this situation are far beyond that anyway.

You will need to provide documentation but it isn't really all that complex and certainly nothing compared to what you need to provide to file a bankruptcy.

In the coming weeks a number of other financial topics will be discussed here, including negotiating COBRA payments with your hospital, ways to obtain medications at no cost, and yes that dreaded subject - bankruptcy. I hope you will join and contribute any programs or organizations so I can compile them within the website It certainly would be much easier to do a "one stop shopping"now wouldn't it?

Wednesday, January 19, 2011

FDA Approves Gardasil to Prevent Anal Cancer!

When Merck released the Gardasil vaccine it was initially touted as the preventative for cervical cancer. Unfortunately all these years later this is all that most people associated both the vaccine, and the virus (HPV), with.

What most people don't know, is that in the interim, the FDA approved the revision of the insert provided along with the vaccine to include protection/prevention of VIN (vulvar intraepithelial neoplasia) and VaIN (vaginal intraepithelial neoplasia). It has been a struggle to get the FDA to recommend revision yet again to include AIN/anal cancer. The FDA wanted four years of data before making such a decision something which only became available last year.

In November of last year, the FDA held hearings to determine whether or not to include anal cancer along with it's prior revisions. Luckily and thankfully, they made the right decision. Having gone through two cases of invasive anal cancer caused by HPV I have long known that if the virus strains which caused the other dysplasias/cancers could be thwarted by this vaccine that so should anal cancer. I didn't need four years of data to know that. But, the FDA being what it is seems to rush some things to market too quickly and linger too long with others. This should have been a slam dunk years ago and I seriously must question the thinking of those overseeing these decisions. They also approved Gardasil for use in boys which was another good sign.

Now, the final hurdle which remains is getting them to extend the age for which both women and men can obtain the vaccine which now tops out at 27. Many individuals married for decades may find themselves divorced and back on the dating scene. Why should they not be offered this same protection? While the decision has not been denied, it has been pushed back and is expected this summer. Let's hope they remain consistent with these prior two decisions and extend the age, which in my opinion should be open-ended and not just 45. Only time will tell.