Now that I have raised the ire of anyone who has, has survived, or has lost a loved one to cervical cancer, let me delve further into the importance of ending the focus on cervical cancer.
I am certainly not insensitive to the issue of cervical cancer. I myself have dealt with precancerous lesions of the cervix. Neither am I lacking in empathy for those who are survivors, I am a survivor myself – twice!
The fact still remains that cervical cancer is diagnosed in approximately one-half a million women across the globe each year and that half of that number succumb to the disease on an annual basis.
There are significant organizations whose sole focus is the prevention of cervical cancer and they work tirelessly to educate others and raise money for everything from research to the development of educational materials and in some cases even patient assistance.
Cancer is a term which still strikes fear in the hearts and minds of most people diagnosed with it and even those who aren’t, but I don’t think anyone with cervical cancer would align themselves with groups fighting lung cancer, pancreatic cancer or colon cancer. While the commonality which exists because they are also a form of cancer there is a significant difference. That difference is the fact that cervical cancer, unlike the other cancers mentioned, is the result of a virus – human papillomavirus (HPV).
Cervical cancer was the first cancer identified in 1983 as being the result of HPV (HPV16). The connection was only strengthened in 1984 when a second strain of HPV (HPV18) was also identified as the cause of cervical cancer. Between the two strains alone, they combine to account for approximately 70 percent of all cervical cancers. Various other strains of HPV make up the difference bringing the total of all cervical cancers attributed to HPV to 99.9 percent.
Since the approval of the first HPV vaccine (Gardasil) in 2006, its manufacturer, Merck Pharmaceuticals has initiated numerous public education campaigns aimed at driving home the connection between HPV and cervical cancer. The organizations which have cropped up against cervical cancer have consistently done the same. The end result has been that those who are aware of HPV will tell you that it is the virus which causes cervical cancer. If this were a singular cancer, such as lung cancer, I would say that their efforts have been an overwhelming success. The problem is that it isn’t a singular cancer.
In testimony given to the Administrative Committee on Immunization Practices by Maura Gillison, MD and lead author on oropharyngeal research and an oncologist at Ohio State University, at the current rate HPV-induced oropharyngeal cancer will exceed cervical cancer in numbers by the year 2020 (less than a decade). According to the CDC cases of anal cancer are increasing at an annual rate of three percent, which is quite significant and there are more than 5,000 diagnosed cases of anal cancer annually.
In addition to this, the CDC, whose figures are not current but in some cases seven years old, indicate that HPV is also responsible for 65 percent of vaginal cancers, 50 percent of vulvar cancers, 35 percent of penile cancers and 60 percent of oropharyngeal cancers. If these are older figures, one must wonder what they actually are today.
HPV excludes no one. It will infect male or female regardless of age, nationality or ethnicity though some groups have a somewhat higher risk. These cancer statistics from high risk HPV do not even take into account the benign (non-cancerous) conditions resulting from HPV. There are estimated to be approximately 250,000 cases of genital warts annually in U.S. men alone and HPV is also responsible for the majority of cases of recurrent respiratory papillomatosis which affect infants and young children.
If those of us affected by HPV and others whom for whatever the reason advocate against cervical cancer truly want to be heard, then it is time that we align ourselves, combine our voices and our numbers and advocate against the one thing that connects us all – HPV. Not a particular form of cancer caused by HPV but the virus itself.
The focus on cervical cancer has on some level, functioned to lessen the public’s understanding of the true extent of the danger that HPV represents. Focusing on cervical cancer instead of HPV itself functions to exclude the cases of anal, vaginal, vulvar, penile and oropharyngeal cancer diagnosed each year. It also functions to alienate its victims.
Those of us with an HPV-induced cancer not cervical in nature experience the physical and emotional pain and anguish just as those with cervical cancer do. We live with the damage in some form or another and what we go through in terms of treatments/procedures are, in some cases, more severe than cervical cancer.
As a two time survivor of anal cancer resulting from HPV and speaking for those of us with precancerous or cancerous lesions other than cervical, we are no less
significant simply because our numbers may be smaller. In many cases, the focus on cervical cancer to the exclusion of anal cancer has left many an anal cancer patient misdiagnosed and having to endure far more severe treatment because of advanced disease states when the diagnosis is finally made. The lack of education amongst physicians of other specialties such as colorectal and oral surgeons certainly does not benefit the patient. And, while HPV has been identified as causing 90+ percent of anal cancers, there is still no organized screening program as there is with the Pap smear, to pick up the same cellular changes which occur in the cervix. The HPV test is also, regardless of which one since there are now numerous companies offering the test, not advertising or promoted for anal HPV.
Since 1983, HPV has gone from being responsible for one cancer (cervical), to being responsible for six, and there may be more to come. It is long past time to stop creating divisiveness through a myopic focus and to recognize that what is needed, what is desperately needed, is to unify the voices of every individual who suffers from HPV related cancer. Our adversary should not be seen as cervical cancer or anal cancer or any of the other cancers for which HPV is responsible, but HPV itself! I have been aware for over two decades that HPV is responsible for far more than cervical cancer but most are not. I know for myself only because I have been unfortunate as to have experienced it virtually everywhere else in addition to cervical, most have not.
It is essential to expand the public’s knowledge about HPV beyond that of cervical cancer alone. Only once we come together in unity as victims of HPV and not one of its cancers, will our voices truly be heard and the need to recognize this issue on the larger scale that it exists, get the attention it deserves.
"CDC - HPV-Associated Cancers Statistics." Centers for Disease Control and Prevention. N.p., n.d. Web. 26 Feb. 2012. http://www.cdc.gov/cancer/hpv/statistics
"Recommendations on the Use of Quadrivalent Human Papillomavirus Vaccine in Males — Advisory Committee on Immunization Practices (ACIP), 2011." Centers for Disease Control and Prevention. N.p., n.d. Web. 26 Feb. 2012. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6050a3.htm
"CDC - What CDC Is Doing About HPV-Associated Cancers." Centers for Disease Control and Prevention. N.p., n.d. Web. 26 Feb. 2012. http://www.cdc.gov/cancer/hpv/what_cdc_is_doing/
" Oral Sex, Throat Cancer And HPV Vaccines” // Pharmalot 4th, Ed Silverman // October, and Pharma Blog . N.p., n.d. Web. 26 Feb. 2012. http://www.pharmalot.com/2011/10/oral-sex-throat-cancer-and-hpv-vaccines/
"CDC Data & Statistics | Feature: Cervical Cancer Rates by Race and Ethnicity." Centers for Disease Control and Prevention. N.p., n.d. Web. 26 Feb. 2012. http://www.cdc.gov/features/dscervicalcancer
" Human Papillomaviruses and Cancer - National Cancer Institute." Comprehensive Cancer Information - National Cancer Institute. N.p., n.d. Web. 26 Feb. 2012. http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
A site for individuals to share in the conversation regarding life with HPV, concerns about HPV diagnosis and treatment, and to receive support and feedback from others. This site is created in conjunction with The HPV Support Network website which offers a vast array of information for both patients and providers.
Monday, February 27, 2012
Wednesday, February 22, 2012
HPV Victims Need ONE Voice
More often than not when people speak about HPV it is within the context of cervical cancer. HPV is 99.9% responsible for all cancers of the cervix so it is understandable that it would receive a significant amount of attention. It was also the first cancer identified as being caused by HPV in 1983 by Professor Harald zur Hausen, MD.
Subsequently, HPV has been identified as the cause of numerous other cancers as well and most of these have gone ignored both by the medical community and by the media. I have personally dealt with HPV causing high grade precancerous lesions of the cervix, vagina and vulva each requiring a multitude of procedures, surgeries, and even chemotherapy yet none of them were considered an invasive cancer. The two cases of invasive cancer which I survived which was also caused by HPV was anal.
Experts in the field of anal HPV and cancer would say that 100% of anal cancers are caused by HPV. Currently, the CDC lists HPV as responsible for 90% of the anal cancers. There comes a point where hot is hot and whether it is 102 degrees or 103 it's hot. The same goes for HPV related anal cancers, in my opinion. Once you have hit 90% as an identified cause are we really going to quibble over the remaining 10%?
Do those with HPV cancers not involving the cervix deserve any less attention than those with cervical cancer? It cannot be denied that over a quarter of a million women continue to die each year of cervical cancer with approximately half a million being diagnosed. Is the radiation therapy, chemotherapy or surgery that an anal cancer patient goes through any different than what a cervical cancer patient goes through? While I have not had radiation to the cervix, what I can attest to is the fact that radiation for anal cancer results is significant proctitis (inflammation of the bowel) with subsequent episodes of uncontrolled diarrhea. The severe burns to the skin run from the area of the urethra, vagina (often up into the opening of the vagina), the peroneum and surrounding the anus itself. Imagine these burns being continually exposed to episode after episode of diarrhea and the delayed healing and further excoriation that this causes?
Unlike the cervix which (if you've already had your family) is not required for the daily functions of life the anus is, unless of course you opt for a colostomy instead but initially and at least until healing has occurred to determine any sphincter damage this is not something people typically opt to do especially with smaller less invasive cancers.
I specifically remember having to carry around what they call a Peri-bottle which is simply a bottle with a pull-up top allowing you to squeeze, in my case, warm water from the bottle while urinating. The act of urinating itself resulting in such severe pain when the urine came in contact with the radiation burns that the bathroom was simply a nightmare.
Is a woman having to have both sides of her vulva removed any less traumatic than having one's uterus removed? I think only if you haven't had and desire to have kids. If you've done that, then having one's external genitalia mutilated and forever altered is very traumatic. I know, I've had it done!
As an HPV advocate it is very difficult for me when all I hear about is HPV and cervical cancer. It is, for those who advocate against cervical cancer, an outright choice to exclude the other HPV induced cancers and functions to alienate all the other victims of HPV who don't happen to have cervical involvement. Instead, each individual who advocates against cervical cancer should be advocating against not just cervical cancer, but HPV in general and all of the cancers which it causes.
There should be no sense of disrespect for those whose HPV has caused a cancer other than cervical, no less-than status. At the same time while holding no disrespect for anyone having to go through cervical cancer - I can live without my uterus and I can live without my cervix but I can't live normally without my anus! It's that simple.
We ALL need to come together as one voice
Subsequently, HPV has been identified as the cause of numerous other cancers as well and most of these have gone ignored both by the medical community and by the media. I have personally dealt with HPV causing high grade precancerous lesions of the cervix, vagina and vulva each requiring a multitude of procedures, surgeries, and even chemotherapy yet none of them were considered an invasive cancer. The two cases of invasive cancer which I survived which was also caused by HPV was anal.
Experts in the field of anal HPV and cancer would say that 100% of anal cancers are caused by HPV. Currently, the CDC lists HPV as responsible for 90% of the anal cancers. There comes a point where hot is hot and whether it is 102 degrees or 103 it's hot. The same goes for HPV related anal cancers, in my opinion. Once you have hit 90% as an identified cause are we really going to quibble over the remaining 10%?
Do those with HPV cancers not involving the cervix deserve any less attention than those with cervical cancer? It cannot be denied that over a quarter of a million women continue to die each year of cervical cancer with approximately half a million being diagnosed. Is the radiation therapy, chemotherapy or surgery that an anal cancer patient goes through any different than what a cervical cancer patient goes through? While I have not had radiation to the cervix, what I can attest to is the fact that radiation for anal cancer results is significant proctitis (inflammation of the bowel) with subsequent episodes of uncontrolled diarrhea. The severe burns to the skin run from the area of the urethra, vagina (often up into the opening of the vagina), the peroneum and surrounding the anus itself. Imagine these burns being continually exposed to episode after episode of diarrhea and the delayed healing and further excoriation that this causes?
Unlike the cervix which (if you've already had your family) is not required for the daily functions of life the anus is, unless of course you opt for a colostomy instead but initially and at least until healing has occurred to determine any sphincter damage this is not something people typically opt to do especially with smaller less invasive cancers.
I specifically remember having to carry around what they call a Peri-bottle which is simply a bottle with a pull-up top allowing you to squeeze, in my case, warm water from the bottle while urinating. The act of urinating itself resulting in such severe pain when the urine came in contact with the radiation burns that the bathroom was simply a nightmare.
Is a woman having to have both sides of her vulva removed any less traumatic than having one's uterus removed? I think only if you haven't had and desire to have kids. If you've done that, then having one's external genitalia mutilated and forever altered is very traumatic. I know, I've had it done!
As an HPV advocate it is very difficult for me when all I hear about is HPV and cervical cancer. It is, for those who advocate against cervical cancer, an outright choice to exclude the other HPV induced cancers and functions to alienate all the other victims of HPV who don't happen to have cervical involvement. Instead, each individual who advocates against cervical cancer should be advocating against not just cervical cancer, but HPV in general and all of the cancers which it causes.
There should be no sense of disrespect for those whose HPV has caused a cancer other than cervical, no less-than status. At the same time while holding no disrespect for anyone having to go through cervical cancer - I can live without my uterus and I can live without my cervix but I can't live normally without my anus! It's that simple.
We ALL need to come together as one voice
Friday, February 17, 2012
Can HPV Go Away on Its Own - Part 2
In Part One of this article, I talked about the controversial question - Can HPV Go Away on Its Own? The answer you receive may be yes, but this is not actually the case. It is being given in a certain context (which of course is NOT explained) and leads to much confusion.
The context essentially is that it typically takes up to 24 months for the body’s immune system to render the virus dormant. The answer yes is because of a lack of understanding; because of a lack of education when it comes to the medical aspects of the virus, HPV leads to confusion of our educators and confusion for the patients.
Our educators, i.e. our doctors, nurses, nurse practitioners and other medial professionals fail to understand that a simple word like “clear” can create such confusion for patients and lead to the belief that the virus is literally gone because it does not show as positive on an HPV test. Worse yet, women equate a negative Pap test with not having HPV. Why? Because they have never been told otherwise and mainly because the emphasis has been placed on HPV as it relates to cervical dysplasia (cell abnormality) and cervical cancer and not much else.
When those responsible for explaining HPV to us understand for themselves that HPV can become dormant for weeks, months, years and even decades; when they understand that the HPV DNA remains within our cells; when they understand that HPV is responsible for far more than cervical cancer, only then can they accurately and adequately educate us regarding the true answer to this question.
Cervical cancer was the first cancer connected with HPV. Since that time, HPV has been connected with vaginal, vulvar, anal and oropharyngeal cancers as well as penile cancer.
Unlike bacteria, a virus requires access of its DNA into our own cells to replicate. If our immune system keeps these levels dormant or at lower levels than are detectable during testing, this does not mean that the HPV DNA has disassociated with our cells, it is merely undetectable but not that it isn’t there, and under certain circumstances can become active once again. When HPVs own proteins, E6 and E7, allow for the literal shut-down of our body’s tumor suppressor proteins it is then that HPV can “take hold” and lead to the unregulated growth of cells. Typically, when a cell is or becomes abnormal, our proteins instruct those cells, in essence, to self-destruct. But when those proteins have been compromised these now mutated cells do not self-destruct but continue to reproduce mutations and all.
For some women, they may have but a single HPV infection in their lives. Their immune system keeps the virus dormant and they never experience any further issues Again, this does not mean the HPV no longer exists but that your immune system is doing a wonderful job. This is what happens the majority of the time however that knowledge should not give you a false sense of security either. Obviously someone makes up the statistics of the minority and it could just as easily be you.
For other women not only do they experience repeated episodes of HPV lesion development (precancerous, cancerous or both) but can also experience multi-focal (more than one area) disease. It can affect both the cervix and vulva or cervix and anus or in cases such as mine, the cervix, vulva, vagina and anus.
Women can get very excited when they receive their Pap smear results and they are negative. While this can be great news, women need to understand that HPV affects more than the cervix so while the cervical cells may not show evidence of HPV, other cells may such as vagina, vulva or anus. It is important for women to know enough to ask that their doctor examine these other areas when performing a Pap smear. It is also important to know that prior cervical involvement brings with it an increased risk of anal involvement. If necessary, you may need to consult a colorectal surgeon for an anal Pap. Currently Dr. Joel Palefsky, leading infectious disease specialist specializing in HPV is working with the NIH (National Institute of Health) to develop a screening protocol specifically for anal cancer as currently exists for cervical cancer. While this will take years to develop, performing the exam in the interim can still be done. Finding a physician capable of doing one may be another story.
Most women I have spoken to who have HPV to some degree or another have expressed an absence of the virus with a recurrence occurring subsequent to a stressful or number of stressful incidents which have occurred in their lives. For others, (including myself) many women never had any issues with HPV until after they became pregnant, a condition which does tax the immune system. Some women who have had precancerous lesions diagnosed prior to becoming pregnant were found to have the lesions progress in severity during their pregnancy. This particular situation has also happened to me as well.
In closing, let me say that ultimately people will choose to believe what they will regardless of any factual information presented to them. Having lived with HPV, off and on, since my initial diagnosis in 1987 constitutes a significant length of time. This has allowed me to experience, first hand, the developments and achievements in the field of HPV research in addition to the
The context essentially is that it typically takes up to 24 months for the body’s immune system to render the virus dormant. The answer yes is because of a lack of understanding; because of a lack of education when it comes to the medical aspects of the virus, HPV leads to confusion of our educators and confusion for the patients.
Our educators, i.e. our doctors, nurses, nurse practitioners and other medial professionals fail to understand that a simple word like “clear” can create such confusion for patients and lead to the belief that the virus is literally gone because it does not show as positive on an HPV test. Worse yet, women equate a negative Pap test with not having HPV. Why? Because they have never been told otherwise and mainly because the emphasis has been placed on HPV as it relates to cervical dysplasia (cell abnormality) and cervical cancer and not much else.
When those responsible for explaining HPV to us understand for themselves that HPV can become dormant for weeks, months, years and even decades; when they understand that the HPV DNA remains within our cells; when they understand that HPV is responsible for far more than cervical cancer, only then can they accurately and adequately educate us regarding the true answer to this question.
Cervical cancer was the first cancer connected with HPV. Since that time, HPV has been connected with vaginal, vulvar, anal and oropharyngeal cancers as well as penile cancer.
Unlike bacteria, a virus requires access of its DNA into our own cells to replicate. If our immune system keeps these levels dormant or at lower levels than are detectable during testing, this does not mean that the HPV DNA has disassociated with our cells, it is merely undetectable but not that it isn’t there, and under certain circumstances can become active once again. When HPVs own proteins, E6 and E7, allow for the literal shut-down of our body’s tumor suppressor proteins it is then that HPV can “take hold” and lead to the unregulated growth of cells. Typically, when a cell is or becomes abnormal, our proteins instruct those cells, in essence, to self-destruct. But when those proteins have been compromised these now mutated cells do not self-destruct but continue to reproduce mutations and all.
For some women, they may have but a single HPV infection in their lives. Their immune system keeps the virus dormant and they never experience any further issues Again, this does not mean the HPV no longer exists but that your immune system is doing a wonderful job. This is what happens the majority of the time however that knowledge should not give you a false sense of security either. Obviously someone makes up the statistics of the minority and it could just as easily be you.
For other women not only do they experience repeated episodes of HPV lesion development (precancerous, cancerous or both) but can also experience multi-focal (more than one area) disease. It can affect both the cervix and vulva or cervix and anus or in cases such as mine, the cervix, vulva, vagina and anus.
Women can get very excited when they receive their Pap smear results and they are negative. While this can be great news, women need to understand that HPV affects more than the cervix so while the cervical cells may not show evidence of HPV, other cells may such as vagina, vulva or anus. It is important for women to know enough to ask that their doctor examine these other areas when performing a Pap smear. It is also important to know that prior cervical involvement brings with it an increased risk of anal involvement. If necessary, you may need to consult a colorectal surgeon for an anal Pap. Currently Dr. Joel Palefsky, leading infectious disease specialist specializing in HPV is working with the NIH (National Institute of Health) to develop a screening protocol specifically for anal cancer as currently exists for cervical cancer. While this will take years to develop, performing the exam in the interim can still be done. Finding a physician capable of doing one may be another story.
Most women I have spoken to who have HPV to some degree or another have expressed an absence of the virus with a recurrence occurring subsequent to a stressful or number of stressful incidents which have occurred in their lives. For others, (including myself) many women never had any issues with HPV until after they became pregnant, a condition which does tax the immune system. Some women who have had precancerous lesions diagnosed prior to becoming pregnant were found to have the lesions progress in severity during their pregnancy. This particular situation has also happened to me as well.
In closing, let me say that ultimately people will choose to believe what they will regardless of any factual information presented to them. Having lived with HPV, off and on, since my initial diagnosis in 1987 constitutes a significant length of time. This has allowed me to experience, first hand, the developments and achievements in the field of HPV research in addition to the
Wednesday, February 15, 2012
Does HPV Go Away on Its Own? Part 1
The Ultimate Controvery - Does HPV Go Away on Its Own? Part 1
One of the reasons that the question still persists regarding whether or not HPV goes away on its own is because the answer is both yes, and no. Each of these answers depends upon numerous factors including some understanding of the medical aspects of virus.
The body is truly incredible when one stops to think of all the functions it carries out at any given moment, all acting in conjunction with one another. It would be wrong, as many doctors and nurses do (usually the result of misunderstanding the virus themselves), to simply state that in the majority of cases the body’s immune system will rid itself of the virus. It would actually be more correct to say that the virus never truly leaves. This is especially true when it comes to the immune system and the general lack of peoples knowledge regarding the body’s tumor suppressors proteins of its own.
HPV, which is short for Human Papillomavirus, was actually discovered as the cause of cervical cancer in 1983 by Professor Harald zur Hausen, MD Dr. zur Hausen had been studying HPV, which is named in sequence of its finding (come to be known as strain) and took quite a number of years before he discovered the first HPV strains associated with cancer.
It was during 1983 that his research lead to the discovery of HPV16, which was found to be present in 50 percent of the cervical cancer cells which he was studying . A year later, he discovered HPV18 which was shown to exist within yet another 20 percent of these cancer specimens. Today, these two HPV strains alone, 16 and 18, are known to be responsible for a total of 80 percent of all cervical cancers. HPV16 and HPV18 are also known to be responsible for 90+ percent of anal cancers.
It now becomes important to understand how the body responds when introduced to the HPV virus. The tumor suppressor proteins contained by the body are referred to as p53 and pRb. p53 is the most commonly mutated tumor suppressor protein involved in cancer. Such is the case with cancers involving HPV as well. These tumor suppressor proteins were only discovered in the late 1970’s, a few short years before the discovery of HPV16.
It is important for the purposes of this article to make the distinction between low risk and high risk HPV. Low risk strains of HPV (like 6 and 11) cause genital warts, and other low risk strains of HPV cause the warts typically found on the hands. These are not the strains of HPV we are discussing here. It is the high risk strains of HPV which can go on to result in precancerous and cancerous lesions and these are the ones which we speak of here. There are approximately fourteen high risk strains of HPV known to potentially result in cancer with HPV16 and HPV18 being the most common.
Research has shown that the majority of individuals positive for high risk HPV infection will not remain so at twenty-four months. However, this would depend largely on the degree of abnormality present within the cells. In the case of low risk infection, these are the ones which typically will become dormant within twenty-for months. It is for this reason that many physicians will choose the wait and watch method before performing any more invasive types of procedures.
It is important for women to understand that there two different tests of importance here, the Pap test, and the HPV test. In more cases than not, women will need to ask for the HPV test as many physicians will not perform the HPV test unless the Pap is positive. Research has shown that a Pap test can be negative yet the patient still be positive for HPV. So, despite current FDA rulings which do not allow HPV tests until 30 years of age and older, ask your doctor to perform the test anyway. It could save your life.
The Pap test reveals abnormalities within the cells themselves, while the HPV test actually looks for the HPV DNA itself within your cells. Less abnormal cells (serious) which will be determined based on the results of the Pap smear and histology and more likely to become dormant may often be treated immediately to prevent further progression to a more abnormal (serious) condition such as invasive cancer. This is why it is important for women to follow-up when it comes to their Pap tests and now, HPV testing as well.
If you are one of these individuals whose infection has resolved after twenty-four months, it has done just that - resolved. It has not vanished, disappeared or otherwise been stricken permanently from your body, as it has already been incorporated into your own cell DNA.
HPV contains tumor suppressors within its own arsenal referred to as E6 and E7. These function to deactivate p53 and disable pRB. It is E6 and E7 which enables the virus to enter your own cells, utilize them to replicate (duplicate themselves) indefinitely, which is essentially the definition of cancer - the uncontrolled replication of cells.
In Part 2, we will discuss the uncontrolled replication of HPV, in addition to various risk factors and ones own immune system as they contribute to recurrent HPV infections.
One of the reasons that the question still persists regarding whether or not HPV goes away on its own is because the answer is both yes, and no. Each of these answers depends upon numerous factors including some understanding of the medical aspects of virus.
The body is truly incredible when one stops to think of all the functions it carries out at any given moment, all acting in conjunction with one another. It would be wrong, as many doctors and nurses do (usually the result of misunderstanding the virus themselves), to simply state that in the majority of cases the body’s immune system will rid itself of the virus. It would actually be more correct to say that the virus never truly leaves. This is especially true when it comes to the immune system and the general lack of peoples knowledge regarding the body’s tumor suppressors proteins of its own.
HPV, which is short for Human Papillomavirus, was actually discovered as the cause of cervical cancer in 1983 by Professor Harald zur Hausen, MD Dr. zur Hausen had been studying HPV, which is named in sequence of its finding (come to be known as strain) and took quite a number of years before he discovered the first HPV strains associated with cancer.
It was during 1983 that his research lead to the discovery of HPV16, which was found to be present in 50 percent of the cervical cancer cells which he was studying . A year later, he discovered HPV18 which was shown to exist within yet another 20 percent of these cancer specimens. Today, these two HPV strains alone, 16 and 18, are known to be responsible for a total of 80 percent of all cervical cancers. HPV16 and HPV18 are also known to be responsible for 90+ percent of anal cancers.
It now becomes important to understand how the body responds when introduced to the HPV virus. The tumor suppressor proteins contained by the body are referred to as p53 and pRb. p53 is the most commonly mutated tumor suppressor protein involved in cancer. Such is the case with cancers involving HPV as well. These tumor suppressor proteins were only discovered in the late 1970’s, a few short years before the discovery of HPV16.
It is important for the purposes of this article to make the distinction between low risk and high risk HPV. Low risk strains of HPV (like 6 and 11) cause genital warts, and other low risk strains of HPV cause the warts typically found on the hands. These are not the strains of HPV we are discussing here. It is the high risk strains of HPV which can go on to result in precancerous and cancerous lesions and these are the ones which we speak of here. There are approximately fourteen high risk strains of HPV known to potentially result in cancer with HPV16 and HPV18 being the most common.
Research has shown that the majority of individuals positive for high risk HPV infection will not remain so at twenty-four months. However, this would depend largely on the degree of abnormality present within the cells. In the case of low risk infection, these are the ones which typically will become dormant within twenty-for months. It is for this reason that many physicians will choose the wait and watch method before performing any more invasive types of procedures.
It is important for women to understand that there two different tests of importance here, the Pap test, and the HPV test. In more cases than not, women will need to ask for the HPV test as many physicians will not perform the HPV test unless the Pap is positive. Research has shown that a Pap test can be negative yet the patient still be positive for HPV. So, despite current FDA rulings which do not allow HPV tests until 30 years of age and older, ask your doctor to perform the test anyway. It could save your life.
The Pap test reveals abnormalities within the cells themselves, while the HPV test actually looks for the HPV DNA itself within your cells. Less abnormal cells (serious) which will be determined based on the results of the Pap smear and histology and more likely to become dormant may often be treated immediately to prevent further progression to a more abnormal (serious) condition such as invasive cancer. This is why it is important for women to follow-up when it comes to their Pap tests and now, HPV testing as well.
If you are one of these individuals whose infection has resolved after twenty-four months, it has done just that - resolved. It has not vanished, disappeared or otherwise been stricken permanently from your body, as it has already been incorporated into your own cell DNA.
HPV contains tumor suppressors within its own arsenal referred to as E6 and E7. These function to deactivate p53 and disable pRB. It is E6 and E7 which enables the virus to enter your own cells, utilize them to replicate (duplicate themselves) indefinitely, which is essentially the definition of cancer - the uncontrolled replication of cells.
In Part 2, we will discuss the uncontrolled replication of HPV, in addition to various risk factors and ones own immune system as they contribute to recurrent HPV infections.
Sunday, January 15, 2012
How Surviving Cancer can be a Curse
Fifty some-odd years ago a woman and her friend both of whom has survived breast cancer got to talking about how important a support group would be to others like themselves.
They decided to take out a half-page ad in the New York Times. Upon calling, it was explained to the woman at the NY Times that the add should read that a meeting was being held for all of those pateints having survival breast cancer, and went on to give the address and time of the meeting.
The caller was politely told that not only were they not allowed to use the word cancer, they certainly could not use the word breast either. Outraged and I would think much like I feel a good portion of the time, she was told that she could rephrase the announcement to state that a meeting was being held for all those who has survived diseases of the chest wall.
The organization which these two woman created was called "Reach to Recovery" and was later taken over and is now run by the American Cancer Society. Over fifty years later people are still having issues with names of body parts as in anal cancer for example.
While breast cancer has certainly developed a significant following, such a following needs to be developed regarding HPV especially when it is responsible for so many known cancers. How can you make a difference? Get your child vaccinated and talk to other parents (if you are a parent with a child of age to be vaccinated) or your friends about the need to get vaccinated early to avoid this cancer causing virus.
They decided to take out a half-page ad in the New York Times. Upon calling, it was explained to the woman at the NY Times that the add should read that a meeting was being held for all of those pateints having survival breast cancer, and went on to give the address and time of the meeting.
The caller was politely told that not only were they not allowed to use the word cancer, they certainly could not use the word breast either. Outraged and I would think much like I feel a good portion of the time, she was told that she could rephrase the announcement to state that a meeting was being held for all those who has survived diseases of the chest wall.
The organization which these two woman created was called "Reach to Recovery" and was later taken over and is now run by the American Cancer Society. Over fifty years later people are still having issues with names of body parts as in anal cancer for example.
While breast cancer has certainly developed a significant following, such a following needs to be developed regarding HPV especially when it is responsible for so many known cancers. How can you make a difference? Get your child vaccinated and talk to other parents (if you are a parent with a child of age to be vaccinated) or your friends about the need to get vaccinated early to avoid this cancer causing virus.
How Regulations Penalize Cancer Survivors
Recent research which took place over a period of 14 years and utilized two irrefutable government sources for its statistical information was presented at the 2011 annual meeting of The American Society of Clinical Oncology.
This research used both the cancer registry statistics as well as the U.S. bankruptcy court records and involved nearly a quarter of a million cancer survivors. The results, that bankruptcy rates among cancer survivors at one year after diagnosis was nearly twice as high as that of the general population. On average, bankruptcy rates increased four-fold within the five year period after diagnosis
The U.S. bankruptcy laws changed dramatically in 2005 making it more difficult for an individual to file bankruptcy. The filing of a bankruptcy was an action which was intended to give an individual a “clean slate” however when it comes to cancer survivors it is anything but.
Based upon this research, cancer patients who have struggled through horrific treatments in order to survive now face yet more stress and hardship from a financial standpoint. Is it reasonable to penalize cancer survivors simply for having survived? Yet this is exactly what happens when a cancer survivor must file bankruptcy.
Federal and State programs (First Time Homebuyer Assistance) which exist to assist lower income families in obtaining a home by providing funds for down payments as well as closing costs stipulates that a bankruptcy must have been discharged (finalized by the bankruptcy court and all debts absolved) a full two years before an individual can even submit an application for assistance.
There are many financial hardships which cancer patients/survivors endure one of which may be the loss of their jobs and their homes. The First Time Homebuyer Assistance Program mentioned above will provide assistance to first time home buyers which also includes those who have not owned a home in three years. A cancer survivor who has lost their home resulting from their medical expenses three or more years ago would also be eligible. However, it is more than likely that they also may have had to file bankruptcy and therefore simply cannot catch a break. The approval guidelines require that they cannot file an application until two years after their bankruptcy discharge date. Since every application is taken in order of submission, people are placed on a waiting list until their application is approved. Based on these requirements, they would not even be allowed to submit their applications and allow their time on the waiting list to be applied to the necessary two year period. They must wait two years to submit their applications and then wait yet again on a waiting list. Funds are limited and depending upon how many applications are received their application may extend into the following fiscal year.
Being a two-time survivor of cancer I can say that while it isn’t something which occupies my thoughts on any regular basis, there always exists in the back of my mind the possibility of a recurrence. I think it is safe to say that this is true for most cancer survivors on some level.
The longer a cancer patient survives after treatment the greater the likelihood that they will end up having to file bankruptcy. Out-of-pocket expenses associated with follow-up testing, follow-up doctor visits and prescriptions amongst other things continue to place a financial burden on survivors.
If there was ever a need for a true “clean slate” it is for the cancer survivor, and given this recent research bankruptcy laws should be amended for those having to file as a result of cancer. Bankruptcy filings resulting from cancer should not be allowed to be included on the individual’s credit report and all associated discharged accounts should be removed as well. This would truly provide the cancer survivor with a “clean slate” from which to live out their remaining lives. Congress needs to amend the bankruptcy laws to provide such protection for cancer survivors.
As for the First Time Homebuyer Assistance Program referred to earlier, these survivors would no longer be penalized when it comes to receiving funds for a home. Losing one’s home is a devastating event for anyone but even more so for a cancer survivor who has often lost their job as well and in some cases are unable to return to work as a result of complications of their treatment. This often leaves them having to rely on Social Security Disability. They may still be able to afford a small mortgage payment but the existence of a bankruptcy will prevent them from qualifying for one, especially in the current banking climate when even those with good credit have difficulty.
Even the thought of a cancer diagnosis is something which strikes fear in the hearts of most people. For those who have lived it, the diagnosis is nothing compared to what they must endure in their struggle to survive. This research makes clear for the first time the severity of the financial fall-out for cancer survivors compared to the general population as it relates to bankruptcy. It also speaks to the need for change in our bankruptcy laws which respect what these individuals have had to endure to survive and compassion to allow them to continue the lives they struggled to keep without further discrimination and hardship.
"Bankruptcy Rates Higher Among Cancer Survivors." ConsumerAffairs.com: Knowledge is Power! Consumer news, reviews, complaints, resources, safety recalls. N.p., n.d. Web. 2 Jan. 2012. http://www.consumeraffairs.com/news04/2011/06/bankruptcy-rates-higher-among-cancer-survivors.html
This research used both the cancer registry statistics as well as the U.S. bankruptcy court records and involved nearly a quarter of a million cancer survivors. The results, that bankruptcy rates among cancer survivors at one year after diagnosis was nearly twice as high as that of the general population. On average, bankruptcy rates increased four-fold within the five year period after diagnosis
The U.S. bankruptcy laws changed dramatically in 2005 making it more difficult for an individual to file bankruptcy. The filing of a bankruptcy was an action which was intended to give an individual a “clean slate” however when it comes to cancer survivors it is anything but.
Based upon this research, cancer patients who have struggled through horrific treatments in order to survive now face yet more stress and hardship from a financial standpoint. Is it reasonable to penalize cancer survivors simply for having survived? Yet this is exactly what happens when a cancer survivor must file bankruptcy.
Federal and State programs (First Time Homebuyer Assistance) which exist to assist lower income families in obtaining a home by providing funds for down payments as well as closing costs stipulates that a bankruptcy must have been discharged (finalized by the bankruptcy court and all debts absolved) a full two years before an individual can even submit an application for assistance.
There are many financial hardships which cancer patients/survivors endure one of which may be the loss of their jobs and their homes. The First Time Homebuyer Assistance Program mentioned above will provide assistance to first time home buyers which also includes those who have not owned a home in three years. A cancer survivor who has lost their home resulting from their medical expenses three or more years ago would also be eligible. However, it is more than likely that they also may have had to file bankruptcy and therefore simply cannot catch a break. The approval guidelines require that they cannot file an application until two years after their bankruptcy discharge date. Since every application is taken in order of submission, people are placed on a waiting list until their application is approved. Based on these requirements, they would not even be allowed to submit their applications and allow their time on the waiting list to be applied to the necessary two year period. They must wait two years to submit their applications and then wait yet again on a waiting list. Funds are limited and depending upon how many applications are received their application may extend into the following fiscal year.
Being a two-time survivor of cancer I can say that while it isn’t something which occupies my thoughts on any regular basis, there always exists in the back of my mind the possibility of a recurrence. I think it is safe to say that this is true for most cancer survivors on some level.
The longer a cancer patient survives after treatment the greater the likelihood that they will end up having to file bankruptcy. Out-of-pocket expenses associated with follow-up testing, follow-up doctor visits and prescriptions amongst other things continue to place a financial burden on survivors.
If there was ever a need for a true “clean slate” it is for the cancer survivor, and given this recent research bankruptcy laws should be amended for those having to file as a result of cancer. Bankruptcy filings resulting from cancer should not be allowed to be included on the individual’s credit report and all associated discharged accounts should be removed as well. This would truly provide the cancer survivor with a “clean slate” from which to live out their remaining lives. Congress needs to amend the bankruptcy laws to provide such protection for cancer survivors.
As for the First Time Homebuyer Assistance Program referred to earlier, these survivors would no longer be penalized when it comes to receiving funds for a home. Losing one’s home is a devastating event for anyone but even more so for a cancer survivor who has often lost their job as well and in some cases are unable to return to work as a result of complications of their treatment. This often leaves them having to rely on Social Security Disability. They may still be able to afford a small mortgage payment but the existence of a bankruptcy will prevent them from qualifying for one, especially in the current banking climate when even those with good credit have difficulty.
Even the thought of a cancer diagnosis is something which strikes fear in the hearts of most people. For those who have lived it, the diagnosis is nothing compared to what they must endure in their struggle to survive. This research makes clear for the first time the severity of the financial fall-out for cancer survivors compared to the general population as it relates to bankruptcy. It also speaks to the need for change in our bankruptcy laws which respect what these individuals have had to endure to survive and compassion to allow them to continue the lives they struggled to keep without further discrimination and hardship.
"Bankruptcy Rates Higher Among Cancer Survivors." ConsumerAffairs.com: Knowledge is Power! Consumer news, reviews, complaints, resources, safety recalls. N.p., n.d. Web. 2 Jan. 2012. http://www.consumeraffairs.com/news04/2011/06/bankruptcy-rates-higher-among-cancer-survivors.html
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:
http://www.medscape.com/viewarticle/752193
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:
http://www.medscape.com/viewarticle/752193
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:
http://www.uspreventiveservicestaskforce.org/draftrec4.htm
Please provide your comments before November 15th at the following link:
http://www.uspreventiveservicestaskforce.org/uspstf_form4/
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.
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:
http://www.uspreventiveservicestaskforce.org/draftrec4.htm
Please provide your comments before November 15th at the following link:
http://www.uspreventiveservicestaskforce.org/uspstf_form4/
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:
http://www.thehpvsupportnetwork.org/
We look forward to seeing you there!
http://www.thehpvsupportnetwork.org/
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.
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:
Hello,
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.
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:
Hello,
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. http://www.livescience.com/16061-hpv-vaccine-controversy.html
" 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. http://www.cancercompass.com/cancer-news/article/35971.htm?c=NL20110302
"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. http://children.webmd.com/vaccines/news/20110623/can-hpv-vaccine-stop-throat-cancer
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. http://www.livescience.com/16061-hpv-vaccine-controversy.html
" 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. http://www.cancercompass.com/cancer-news/article/35971.htm?c=NL20110302
"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. http://children.webmd.com/vaccines/news/20110623/can-hpv-vaccine-stop-throat-cancer
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: MicheleBachmann.com/contact/
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.
http://www.washingtonpost.com/blogs/blogpost/post/michele-bachmanns-hpv-claims-just-latest-in-gardasil-debate/2011/09/14/gIQA9FjESK_blog.html
"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. http://children.webmd.com/vaccines/news/20110623/can-hpv-vaccine-stop-throat-cancer
"Gardasil." U S Food and Drug Administration Home Page. N.p., n.d. Web. 26 Sept. 2011. http://www.fda.gov/BiologicsBl
"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. http://www.npr.org/blogs/health/2011/09/13/140445104/pediatricians-fact-check-bachmanns-bashing-of-hpv-vaccine
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: MicheleBachmann.com/contact/
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.
http://www.washingtonpost.com/blogs/blogpost/post/michele-bachmanns-hpv-claims-just-latest-in-gardasil-debate/2011/09/14/gIQA9FjESK_blog.html
"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. http://children.webmd.com/vaccines/news/20110623/can-hpv-vaccine-stop-throat-cancer
"Gardasil." U S Food and Drug Administration Home Page. N.p., n.d. Web. 26 Sept. 2011. http://www.fda.gov/BiologicsBl
"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. http://www.npr.org/blogs/health/2011/09/13/140445104/pediatricians-fact-check-bachmanns-bashing-of-hpv-vaccine
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. http://www.cdc.gov/media/releases/2011/p0825_hpv_vaccine.html?source=govdelivery
http://www.gardasil.com/ Web September 12, 2011
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. http://www.cdc.gov/media/releases/2011/p0825_hpv_vaccine.html?source=govdelivery
http://www.gardasil.com/ 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. http://www.srm-ejournal.com/srm.asp?id=7285
"Anal Cancer: Statistics | Cancer.Net." Doctor-approved cancer information from ASCO | Cancer.Net. N.P., n.d. Web. 7 Sept. 2011. http://www.cancer.net/patient/Cancer+Types/Anal+Cancer?sectionTitle=Statistics
"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. http://www.news-medical.net/health/Cervical-Cancer-Prevention.aspx
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. http://www.srm-ejournal.com/srm.asp?id=7285
"Anal Cancer: Statistics | Cancer.Net." Doctor-approved cancer information from ASCO | Cancer.Net. N.P., n.d. Web. 7 Sept. 2011. http://www.cancer.net/patient/Cancer+Types/Anal+Cancer?sectionTitle=Statistics
"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. http://www.news-medical.net/health/Cervical-Cancer-Prevention.aspx
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." ABCNews.com: Daily News, Breaking News and Video Broadcasts - ABC News. N.p., n.d. Web. 5 Sept. 2011. http://abcnews.go.com/Health/ReproductiveHealth/hpv-oral-cancers-rise-oral-sex-popular-spread/story?id=11916068&page=2
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.
http://cancer.ucsf.edu/people/palefsky_joel.php
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. http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1126667028463.html
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." ABCNews.com: Daily News, Breaking News and Video Broadcasts - ABC News. N.p., n.d. Web. 5 Sept. 2011. http://abcnews.go.com/Health/ReproductiveHealth/hpv-oral-cancers-rise-oral-sex-popular-spread/story?id=11916068&page=2
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.
http://cancer.ucsf.edu/people/palefsky_joel.php
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. http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1126667028463.html
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.
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. http://www.cancer.org/Cancer/CancerBasics/is-cancer-contagious
"Hepatitis B Foundation: Hepatitis B and Primary Liver Cancer." Hepatitis B Foundation. N.p., n.d. Web. 28 Aug. 2011. http://www.hepb.org/professionals
The Oral Cancer Foundation. Web.28 Aug. 2011. http://www.oralcancerfoundation.com/
“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. http://www.cancer.org/Cancer/CancerBasics/is-cancer-contagious
"Hepatitis B Foundation: Hepatitis B and Primary Liver Cancer." Hepatitis B Foundation. N.p., n.d. Web. 28 Aug. 2011. http://www.hepb.org/professionals
The Oral Cancer Foundation. Web.28 Aug. 2011. http://www.oralcancerfoundation.com/
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.
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.
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.
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