When Will Cervical Cancer Stop

The Human Papilloma (HPV) virus epidemic can be halted with widespread effective HPV vaccination. Three million individuals worldwide are infected with one or more HPV viruses, and this includes over 40 million Americans: men, women, and children. Although we naturally make antibodies that should both neutralize the disease and clear the infection, persistence is prevalent, leading to an epidemic of HPV disease. Three of 10 individuals will never clear their infection. HPV virus persistence causes a variety of conditions; the most dramatic is cervical cancer, but it also can cause genital warts, precancerous conditions and cancers of the urogenital tract of men and women, and a disease of the oral cavity and larynx called RRP (recurrent respiratory papillomatosis, which is warty tumors of the larynx), and anal cancers. There are 2,500 new RRP cases in the U.S. each year. Cervical cancer is a worldwide epidemic with 500,000 new cases diagnosed a year; more than 250,000 women die from it annually. Deaths in the U.S. due to cervical cancer have been greatly reduced in the last 50 years due to wider availability of pap smears, accurate tests to diagnose the primary causative agent, and the high risk types of HPV. But we still have a rate of about 7/100,00 women and about 11,000 cases and 4000 deaths from Cervical Cancer each year in the US. And if diagnosed, most patients are getting appropriate triage from gynecologists and primary care doctors, leading to the effective elimination of most pre-invasive cervical disease. The real tragedy of the disease here is the ever increasing numbers of young women who have contracted precancerous disease and have to deal with the consequences: financial, emotional, physical and mental. There many young women who have had large areas of the cervix permanently removed in an attempt to ward off the cancer. Genital warts are treated in much the same way, removing the affected tissue. Because elimination of the wart is not always accompanied by elimination of the viral infection causing the wart, recurrences are common and resistance to treatment is common, as well. In older women we are currently seeing a dramatic rise in external genital precancerous changes. Other consequences of infection are depression, lower sex drive, lower self-esteem, anxiety, and the issues of “pre-existing,” i.e. “not-covered,” conditions on your next insurance policy, which causes economic burdens for those in treatment. Prevention of disease acquisition is the only strategy available to eradicate HPV disease. There is no known treatment for persistent HPV disease. Even acquisition of one virus doesn’t protect against acquisition of one of the other HPV types, of which there are over 100. The U.S. Centers for Disease Control and Prevention says condoms do not completely prevent HPV disease acquisition, but new statistics show they do significantly lower the risk. To be most effective, they should be used with used with appropriate microbial concentrations of spermicide, but if any skin-to-skin contact occurs in an affected area transmission will occur. There are two HPV vaccines approved by the FDA. HPV is a DNA virus that infects skin and mucosal tissues and causes cell changes that lead to what is known as cell proliferation (overgrowth) and conversion to neoplastic changes (premalignant and malignant). These vaccines have the ability to prevent the majority of cervical cancers, a cancer thought to be virtually 100 percent preventable. The  Merck quadrivalent vaccine, Gardasil, targets four types of the HPV virus: 16, 18, 6, 11. It is a vaccine that when given the individual develops fairly rapid immunity to one of four types of the HPV virus. They have targeted the HPV 16 and HPV 18 viruses because they together are the responsible for more than 70 percent of cervical cancer cases. This vaccine has also been shown to protect against vaginal, vulvar and anal cancers caused by the HPV virus. The vaccine has other benefits. The Merck vaccine included 6 and 11 because they cause genital warts and abnormal pap smears, and the vaccine effectively prevents 90 percent of those cases. Who will need the vaccine? We know that about 50 percent of adolescent women will contract HPV within three years of becoming sexually active. So it is most likely to help those prior to their debut into sexuality, although there are studies that show as long as you are negative to a particular type of HPV when you get the vaccine you will be protected. The Merck vaccine is approved for girls and boys, and young men and women ages 9-26, and insurance companies and state and federal plans rapidly have begun to cover the injections. The HPV vaccines have the ability to prevent disease, save money, and save lives. This is not debatable. The prevention of this epidemic is in our hands, and we must rapidly as a nation move to vaccinate all eligible individuals. What is debatable is how to overcome the significant political, economic and social obstacles to accepting the vaccine. Is getting vaccinated promotion of loose, or so-called unsafe, sexual behavior? Both sexes will need to be vaccinated, but will public distrust of vaccine safety allow boys to be vaccinated to prevent diseases in women? Vaccinated boys and men still will see health benefits in themselves with prevention of genital warts and penile cancer. Until all HPV virus infections can be prevented we will not truly eradicate the disease, but we will eradicate the epidemic. The last case of wild small pox in North America was October 26, 1977. In my medical career I hope to be able to tell you the last date known for an HPV-induced cervical cancer.By  Dr. Suzanne Trupin is a physician with Women's Health Practice in Champaign has been a clinical researcher for women’s health companies. She can be reached at (217) 356-3736 or at Suzanne.Trupin@womenshealthpractice.com. Adapted from the News Gazette Health Magazine submission.


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