HPV – the Human
Papilloma Virus – has been known for years to be the main cause of cervical
cancer in women. There are over 40 types of HPV that are transmitted by direct
skin to skin contact during vaginal, anal and oral sex, and most do not cause
disease. However, infection with
certain viral types, mainly but
not exclusively HPV 16 and 18, can
cause cervical cancer if not treated. This is why the Pap test is so important
for women who are or have been sexually active, with men or with women. The Pap test is a procedure in which
cells are scraped from the cervix and looked at under a microscope. The Pap
test can detect abnormal cells before they become cancerous, and early
treatment in the doctor’s office can get rid of the problem. However, some
women don’t know about the need for regular pelvic exams, or can’t afford them.
There were 4,200 deaths from cervical cancer in the US last year. Cervical cancer is a very serious problem
in developing countries which cannot afford to do Pap screening.
Some subtypes of
HPV can also cause cancers of the vulva, penis, anus and the mouth and
throat. Sexually transmitted HPV
type 16 causes about 85% of anal cancers according to the National Cancer
Institute. The risk for anal cancer is much higher in gay and bisexual men than
heterosexual men. Women who have
anal sex are also at greater risk.
Condoms, which
help to prevent pregnancy and HIVAIDS, can prevent HPV infection by about 70%
if used every time. Skin to skin
transmission can still occur outside of the condom. Still - condom
use is important with new partners.
The good news is that most
HPV infections are cleared by the immune system in a few years and never cause
a problem. However, some people
don’t clear the virus, and their infections remain.
In recent years
there has been an increase of cancers of the throat and base of the tongue,
caused by HPV 16. Previously known
risk factors for throat cancer included smoking and alcohol, but throat cancers
are now seen in younger people who don’t smoke or abuse alcohol. Throat cancers
from HPV are more commonly seen in men, but women are also affected. Oral sex is considered to be a major
predisposing factor. The increase
in throat cancer is considered serious, because it can be hard to detect early.
Since most
people do have genital and oral sex, how can we view this threat and deal with
it? Prevention and early detection
are vitally important. This would
include:
*consistent
condom use with new partners, even with oral sex. This may seem unlikely, especially for teenagers trying to
do the right thing to avoid pregnancy.
However, they should be informed about the problem.
*Make sure your
children get the HPV vaccine, Gardasil or Cervarix – given in 3 shots over 6
months. Both are effective in
preventing infections that cause cervical cancer. Gardasil is believed to prevent more HPV types, those that
cause cancer of the anus, vulva and vagina. HPV vaccination is recommended by the Centers for Disease
Control for 11 and 12 year old girls, and girls and women age 13 through 26 who
have not been vaccinated. Gardasil
has been found to be safe and effective for males age 9-26. Vaccinating a boy with Gardasil will
help his partners, and also help him to prevent oral cancer. The cost of the vaccine is about $130
per dose - $390 for the series.
Most health insurance plans cover the cost, and the Vaccines for Children program may be able to help.
*Pap tests are
still important for women, even if vaccinated, because the vaccines do not
prevent about 30% of HPV types that can cause cervical cancer.
*Being in a
faithful relationship with one partner, limiting the number of sex partners,
and choosing a partner with few prior sex partners can be helpful. However, it is not always
possible to know if a partner or oneself is currently infected with HPV.
*Early detection
of cervical, vaginal, vulvar and anal cancer can be done by regular medical
examinations, self exams, and alertness to anything that feels like a persistent
sore or abnormal growth.
*Early detection
of cancers of the mouth and throat can be done by regular visits to the dentist
and dental hygienist, who should look for abnormalities in the mouth and
throat, including hidden areas at the back of the tongue. Everyone should be aware of
symptoms such as a persistent sore throat or mouth sore, a feeling of a mass in
the throat, a lump in the neck, or difficulty swallowing.
Check it out!
* Keep your immune system strong by getting enough sleep,
exercising moderately, eating healthy food (lots of vegetables!), and avoiding
tobacco, dangerous drugs, and excess alcohol.
Our venerable
sage Ben Franklin told us: An
ounce of prevention is worth a pound of cure. Let’s follow his advice.
Sadja
Greenwood, M.D., MPH back issues on
this blog
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