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.