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.

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.

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.

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.

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.

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.

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.