Cervical cancer is a malignant growth of the cervix uteri or surrounding cervical area. Symptoms are often not visible until the cancer is very advanced although some cases will present with vaginal bleeding or an odorous vaginal discharge. Due to the lack of clear symptoms women aged between 25 and 49 are invited for a smear test every 3 years.
Diagnosis
The smear test involves taking a sample of cervical cells which are then tested for abnormalities. If abnormalities are found this is not necessarily indicative of cancer. If an abnormal smear is taken, the person will then visit a gynecologist for a colostomy which involves an internal vaginal examination. This can sometimes involve a biopsy which is where a sample of tissue is removed to examine under a microscope.
HPV
Cancer involves a change in the DNA so that cell replication and growth becomes unregulated. Causes of this are widespread and include Human Papilloma Virus (HPV), smoking, numbers of children and more. HPV is the biggest cause of cervical cancer with over 99% of cases being associated with an infection. HPV can lie dormant in mucous membranes of the body and eventually leads to cervical intraepithelial neoplasia which is the stage before cancer. HPV does not always cause cancer but it is a significant risk factor. HPV is spread through sexual intercourse and so women with multiple partners are most at risk.
HPV Vaccine
Since September 2008 there has been a recent move to vaccinate girls aged 12-13 against two of the strains of HPV which are those thought to be involved in causing cancer. It involves three injections over a 6 month period given routinely in schools.
There has been some controversy over the new program. As with any vaccination there are also some possible side effects. Most of these are very mild and might include some mild flu like symptoms or swelling. However, there is also a very small chance that the vaccination could incur a more severe allergic reaction leading to anaphylactic shock. Particular to this vaccine there has been some worry that by giving a vaccine against a virus that is sexually transmitted it could encourage sexual promiscuity or apathy against sexually transmitted diseases. Some argue that the cost of the vaccination programme is not justifiable when infection could be prevented by safe sex practices.
A girl recently died suddenly after receiving the vaccination in a school in Coventry. As of yet there has been no confirmed link between the vaccine and her death but vaccination programs have been terminated until a result can be determined. Since the start of the programme 1.8 million girls have been given the vaccine and no other deaths have been reported. Other girls given the vaccine in the same school also reported side effects but none needed admitting to hospital. This has newly awakened the debate over the vaccine and whether it should really be given at all.
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School supplies and new outfits are on parents’ minds at this time of year, but they should be aware of a new danger – the aggressive promotion of the potent vaccine Gardasil, which has been linked to the deaths of up to 39 women and a host of other problems.
Produced by Merck & Co., Gardasil is a vaccine designed to prevent human papilloma virus (HPV), a common sexually transmitted infection which can cause cervical cancer. Advertised as a “vaccine against cancer,” Merck has poured millions of dollars into a promotion campaign that has reached to the level of school and city health officials.
But an independent study by the National Vaccine Information Center (NVIC) compared Gardasil with Manactra, an anti-meningitis drug that is also given to children. The report said, “compared to Menactra, receipt of Gardasil is associated with at least twice as many emergency room visit reports; four times more death reports; five times more ‘did not recover’ reports; and seven times more ‘disabled’ reports.”
“Catalog of Horrors”
Approved by the FDA in 2006 for girls and women age 9 through 26, Gardasil is the focus of some 6,700 unsettling cases reported by the Vaccine Adverse Event Reporting System (VAERS), an agency of the department of Health and Human Services. Many of the cases seem to indicate a possible cause and effect relationship between the drug and its many problems. It is estimated that only one in ten adverse effects of such drugs are reported.
"The FDA adverse event reports on the HPV vaccine read like a catalog of horrors,” said Tom Fitten, president of Judicial Watch, a non-partisan watchdog group that says that there has not been a chance to study long-term side effects of the vaccine.
School and public health officials have been pushing the vaccine for girls in the weeks before school begins, and some states have considered mandatory vaccinations.
Many Side Effects
The FDA package insert for the drug lists these possible side effects: headache, fever, nausea, dizziness, local injection site reactions such as pain, swelling of the skin, itching, and bruising, seizure-like activity, and anaphylaxis, which is an allergic reaction.
Women in Berwyn, Oak Park, Stickney, LaGrange, Cicero, Westchester, and nearby towns are encouraged to learn more about the vaccine, and the suitability of its use for you or your daughter by contacting WomanCare Services in Berwyn, IL. WomanCare Services offers help to women facing unintended pregnancies in the near southwest Chicago area. Go to WomanCare Services. Or call 708-795-6000.
Much of the information about HPV virus centers on women, since having the virus increases their risk of getting cervical cancer. But HPV virus in men can cause health problems, too. It's important for men to understand how to reduce the risks of HPV infection. HPV infection can increase a man's risk of getting genital cancers, although these cancers are not common. HPV can also cause genital warts in men, just as in women.
More than half of men who are sexually active in the United States will have HPV at some time in their life. Often, a man with no health problems will clear the virus on his own. The types of high-risk HPV that can cause cancer rarely present any symptoms in men or in women. Genital warts are the first symptom you may see with low-risk HPV strains that cause warts but not cancer.
Abstinence is the only sure way to prevent HPV transmission. Risk of transmission can be lowered if a person has sex only with one person who is not infected and who is also monogamous. To lower the risk of HPV transmission, men can also limit the number of sex partners and pick partners who have had few or no partners in the past. Condoms can provide some protection against HPV transmission.
Unfortunately, they aren't 100% effective, since HPV is transmitted primarily by skin-to-skin contact. The virus can still infect the skin uncovered by the condom. In a recent study of young women who had just become sexually active, those whose partners used a condom each time they had sex were less likely to get an HPV infection than were women whose partners used a condom less than 5% of the time.
How to test for HPV infection in men? To diagnose genital warts in men, the doctor will visually check a man's genital area to see if warts are present. Some doctors will apply a vinegar solution to help identify warts that aren't raised and visible. But the test is not foolproof. Sometimes normal skin is mistakenly identified as a wart.
There is no routine test for men to check for high-risk HPV strains that can cause cancer. However, some doctors are urging anal Pap tests for gay and bisexual men, who are at higher risk of anal cancer caused by HPV. In an anal Pap test, the doctor collects cells from the anus, and then has them checked for abnormalities in a lab.
There is no treatment for HPV infection in men when no symptoms are present. Instead, doctors treat the health problems that are caused by the HPV virus. When genital warts appear, a variety of treatments can be used. The patient can apply prescription creams at home. Or a doctor can surgically remove or freeze off the warts.
Early treatment of warts is discouraged by some doctors because genital warts can go away on their own. It can also take time for all warts to appear. So a person who treats warts as soon as they appear may need another treatment later on. Anal cancer can be treated with radiation, chemotherapy, and surgery. The specific treatments depend on the stage of cancer.
HPVCurative is a new, highly effective and potent way to cure genital warts. It is valued for its role in the realm of genital warts cures, and has provided total clearance of the infection time after time. It contains certified organic medicinal plant extracts and antiviral essential oils, which have demonstrated the ability to act as an HPV cure in laboratory tests.
HPVCurative contains certified organic antiviral extracts, which have the demonstrated ability not only to act as HPV cures, but also to stimulate CD4 T-cells, which cleanse virus-infected cells. HPVCurative thereby eradicates genital warts without any recurrence, making it superior to other genital warts cures.
The low molecular weight and lipophilic tendency of the HPV cure enables it to penetrate into the DNA of infected cell membranes, where the HPV virus resides. HPVCurative is so effective among available HPV cures because it not only contains only the most potent certified organic antiviral medicinal plant extracts, but is highly tolerable to genital tissue as well.
CURED use plant extracts for their genital warts cures that are produced in very limited quantities, and are not available in the commercial market due to scarcity. These medicinal plant extracts are purchased directly by CURED from cultivators in Sri Lanka and Madagascar. To learn more, please go to http://www.bcured.net.
staff of Nature Power Company, which is a network company dedicated to promoting customers\' websites and developing softwares. You can go to the following websites to learn more about our natural organic products. http://www.bcured.nethttp://www.naturespharma.org
Certain HPV types are classified as "high-risk" because they lead to abnormal cell changes and can cause genital cancers: cervical cancer as well as cancer of the vulva, anus, and penis. In fact, researchers say that virtually all cervical cancers (more than 99%) are caused by these high-risk HPV viruses.
The most common of the high-risk strains of HPV are types 16 and 18, which cause about 70% of all cervical cancers. If the body clears the infection, the cervical cells return to normal. But if the body doesn't clear the infection, the cells in the cervix can continue to change abnormally. This can lead to precancerous changes or cervical cancer.
When infection with high-risk HPV types occurs, there usually are no symptoms. Often, the first clue is a Pap test result that is abnormal. In a Pap test, the doctor takes a swab of cervical cells and has them analyzed in a laboratory. A positive HPV test may not mean a woman needs treatment, at least not immediately.
Having a positive test puts a woman in the "high-risk" class, alerting the doctor that she is at higher risk for cervical tissue changes and may need close evaluation. If the Pap test results are unclear, the doctor may order a HPV test to check the DNA type of the virus. This analysis can identify 13 of the high-risk HPV types associated with cervical cancer.
It does not identify cancer. But it tells the woman and her doctor if she has a type of HPV capable of causing cancer. Researchers have discovered that high-risk HPV viruses produce certain proteins. These proteins interfere with the cell functions that limit excessive cell growth. If abnormal cervical tissue changes progress, treatment of the HPV infection may be needed.
There's only one sure way to eliminate chance of HPV infection: Avoid all genital contact with another person. It's best to have a mutually monogamous sexual relationship with an uninfected partner. But many people don't know if they're infected. Using condoms can help prevent HPV transmission but are not foolproof. The virus can be transmitted to genital areas not covered by the condom.
A vaccine, Gardasil, was approved for use in 2006 for use in girls and women aged 9 to 26. Eventually, it may be approved for use in boys, too. Another vaccine, Cervarix, was approved by the FDA in 2007. Over time, widespread vaccination will help prevent transmission of the HPV types covered by the vaccines.
The Gardasil HPV vaccine protects against several high-risk strains of HPV, including HPV types 16 and 18, which account for 70% of cervical cancers. It also protects against HPV 6 and 11, which account for about 90% of genital warts. Cervarix protects against HPV types 16, 81, 31, and 45 -- all of which can cause cervical cancer.
Among the HPV treatment options are surgery, laser treatment, and freezing. Pregnant women, or women considering pregnancy, should consult closely with their doctor. The risk of passing HPV on to the baby is very low. But HPV treatments can affect pregnancy, so doctors may want to delay treatment until after childbirth.
Most doctors use cauterization or freezing as a first option to cure genital warts. Unfortunately, success achieved with this method is often temporary and the warts soon reappear. For genital warts, cures may involve having to surgically excise or burn them off. After surgical intervention or chemical acids are used, one can expect a scar in that area.
An alternative antiviral treatment is now available which represents a very promising solution to the growing epidemic of genital warts. HPVCurative is a new, highly effective and potent way to cure genital warts. It is valued for its role in the realm of genital warts cures, and has provided total clearance of the infection time after time.
It contains certified organic medicinal plant extracts and antiviral essential oils. Users of HPVCurative experience rapid elimination of genital warts without scarring or recurrence. The treatment is painless and provides superb results when compare to other HPV cures. It eliminates genital warts and restores skin tissue to the state it was in prior to the infection.
Organic extracts that demonstrated the greatest antiviral effect as HPV cures in comprehensive scientific trials, while having the least side effects on genital tissue, have been blended to create HPVCurative. To learn more, please go to http://www.bcured.net.
staff of Nature Power Company, which is a network company dedicated to promoting customers\' websites and developing softwares. You can go to the following websites to learn more about our natural organic products. http://www.bcured.nethttp://www.naturespharma.org
Nearly two decades ago, experts discovered a relationship between infection with HPV and cervical cancer. Since then, these experts have learned much more about how HPV can lead to cervical cancer. The following are some knowledge every woman and girl should know about HPV and cervical cancer.
There's only one sure way to eliminate any chance of HPV infection: Avoid all genital contact with another person. Actual cervical cancer is rare in the U.S. because most women get Pap tests and have abnormal cells removed before they turn into cancer. Still, lots of women will find out they have cervical cancer every year and some will die of the disease.
There are more than 100 types of HPV. About 30 or so types can cause genital infections. Some types of HPV, typically HPV 6 and HPV 11, cause genital warts. The warts are rarely associated with cervical cancers. They are considered "low-risk" HPV. Other types can cause cervical or other genital cancers.
The other 70 or so HPV types can cause infections and warts elsewhere on the body, such as on the hands. Most sexually active women and men will contract HPV at some point in their lifetime. Most will never even know it. Usually, this virus does not cause any symptoms and doesn't cause disease. Often, the body can clear HPV infection on its own within two years or less.
HPV types associated with genital infections are transmitted sexually, primarily through skin-to-skin contact during sexual activity. HPV can also be spread through oral sex. The chance of getting HPV rises with certain risk factors: number of lifetime sexual partners, young age, and women who are sexually active with men who have other partners at the same time.
To reduce risk, it's best to have a mutually monogamous sexual relationship with an uninfected partner. But keep in mind, many people don't know if they're infected. Using condoms can help prevent HPV transmission but are not foolproof. The virus can be transmitted to genital areas not covered by the condom.
A vaccine, Gardasil, was approved for use in 2006 for use in girls and women aged 9 to 26. Eventually, it may be approved for use in boys, too. Another vaccine, Cervarix, was approved by the FDA in 2007. Over time, widespread vaccination will help prevent transmission of the HPV types covered by the vaccines.
The Gardasil HPV vaccine protects against several high-risk strains of HPV, including HPV types 16 and 18, which account for 70% of cervical cancers. It also protects against HPV 6 and 11, which account for about 90% of genital warts. Cervarix protects against HPV types 16, 81, 31, and 45 -- all of which can cause cervical cancer.
Among the HPV treatment options are surgery, laser treatment, and freezing. Pregnant women, or women considering pregnancy, should consult closely with their doctor. The risk of passing HPV on to the baby is very low. But HPV treatments can affect pregnancy, so doctors may want to delay treatment until after childbirth.
Traditional theories postulated that once a person is infected, HPV remained in the body for a lifetime. However, new studies using sensitive DNA techniques have shown that an HPV cure is possible through immunological response. For example, studies on compounds to cure genital warts demonstrate that HPVCurative extracts created "significant destruction of HPV cells as evidenced from DNA tests".
These studies further concluded that among other genital warts cures, HPVCurative best extracts "inhibited skin papillomas virus and decreased the conversion of papillomas to carcinomas" which resulted in "significant disintegration of HPV cells in DNA tests" without damaging surrounding healthy tissue.
HPVCurative is undiluted and unadulterated. It contains stringently certified organic antiviral plant extracts, which have the ability to destroy HPV. The extracts are harvested and distilled by hand for medicinal use -- they are pure and complete. This is essential when creating HPV cures, and it is of critical importance when applying anything to the genitals.
To cure genital warts, simply apply one drop of product to the affected area three times a day. HPVCurative is offered at a great price compared to competing HPV cures. It treats multiple warts and is also most suitable among other genital warts cures in the market for those afflicted with stubborn strains. To learn more, please go to http://www.bcured.net.
staff of Nature Power Company, which is a network company dedicated to promoting customers\' websites and developing softwares. You can go to the following websites to learn more about our natural organic products. http://www.bcured.nethttp://www.naturespharma.org
Most pharmacology efforts now focus on developing a vaccine to inoculate the population in order to stop the HPV virus from infecting the system. HPV vaccines protect against a very common sexually transmitted virus called HPV. HPV infects at least 50% of sexually active people at some point in their lives. The virus often clears on its own. If it persists, it can lead to cervical and other cancers and to genital warts.
Vaccination is ideal for the pharmaceutical companies as it would of course reap a monetary windfall of epic proportions for the drug companies. One HPV vaccine, Gardasil, was licensed for use by the FDA in 2006. In September 2008, the FDA announced it may also be used to prevent some cancers of the vulva and vagina when given to females aged 9-26. Another HPV vaccine, Cervarix, is also popular on the market.
Like all vaccines, these HPV vaccines are not foolproof. They do not protect against all of the 100-plus types of HPV. But both vaccines are nearly 100% effective in preventing disease caused by high-risk strains of HPV (HPV 16 and 18) which together account for 70% of all cervical cancers, as well as many cancers of the vagina and vulva.
Gardasil targets four types of HPV: 6, 11, 16 and 18. Types 16 and 18 lead to cervical cancer. HPV 6 and HPV 11 cause about 90% of genital warts. The vaccine contains a virus-like particle but not the actual virus. Three doses are given over six months to females aged 9-26. Scientists don't yet know if an HPV vaccine will protect boys from genital warts or if the vaccine can prevent boys from transmitting HPV to female partners.
The vaccine should be given to girls at ages 11 to 12, according to recommendations from the American Academy of Pediatrics and the CDC. The vaccine is best given at a young age, before sexual activity begins and before exposure to HPV.
The recommendations note that girls as young as 9 can get the vaccine, and females up to age 26 who didn't get it as youngsters. The vaccine is also being studied in older women.
Insurance coverage is common within the recommended age ranges. The federal Vaccines for Children Program covers the vaccine for those under age 19 who qualify. No serious HPV vaccine side effects have been found. Sometimes soreness occurs at the injection site. The jury is still out on whether the vaccine is effective in boys. More research needs to be done.
Another HPV vaccine, Cervarix, is also popular. In studies, this vaccine, like Gardasil, protected against types 16 and 18, which cause 70% of cervical cancers. Cervarix also protects against HPV types 31 and 45, which also cause cervical cancer, according to the manufacturer, GlaxoSmithKline. Three doses are given over six months.
Both HPV vaccines have been shown to provide protection. New research also suggests that Gardasil, like Cervarix, also protects against HPV types 45 and 31, which account for about 10% of cervical cancers. However, HPV vaccination doesn't mean women can skip their Pap tests. Neither vaccine protects against all the types of HPV that cause cervical cancer.
Importantly, China has now banned such vaccinations as they have found injecting a pathogen into your system does just that, it stays in your system, remaining latent in the joints, only to reappear in later years causing horrendous arthritis or auto immune disorders. What's more, the vaccines are not an HPV cure and not useful at all for those already affected with warts.
HPVCurative is a new, highly effective and potent way to cure genital warts. It is valued for its role in the realm of genital warts cures, and has provided total clearance of the infection time after time. It contains certified organic medicinal plant extracts and antiviral essential oils, which have demonstrated the ability to act as an HPV cure in laboratory tests.
HPVCurative is so effective among available HPV cures because it not only contains only the most potent certified organic antiviral medicinal plant extracts, but is highly tolerable to genital tissue as well. CURED use plant extracts for their genital warts cures that are produced in very limited quantities, and are not available in the commercial market due to scarcity.
These medicinal plant extracts are purchased directly by CURED from cultivators in Sri Lanka and Madagascar. Since the treatment can effectively remove genital warts and wart-like substances on the genitals, acid or surgical HPV cures may soon become a thing of the past. To learn more, please go to http://www.bcured.net.
staff of Nature Power Company, which is a network company dedicated to promoting customers\' websites and developing softwares. You can go to the following websites to learn more about our natural organic products. http://www.bcured.nethttp://www.naturespharma.org
The introduction of the HPV vaccine, Gardasil, has been accompanied by healthy doses of both good and bad news. The good news is that the vaccine's arrival has brought the virus into the spotlight by giving it the press it deserves. But the bad news is that myths and misconceptions about the virus and the vaccine abound, and these can and have caused considerable harm. For example, one prevalent myth is that promiscuity is the main reason why people get HPV infections. The fact is, it's possible to get an HPV infection even from a monogamous relationship. Here are some more common questions about HPV, the vaccine, and how they can affect teens' lives.
The Facts of HPV:
So what is HPV, really?
HPV is the human papilloma virus. It is the most common sexually transmitted virus. It isn't the same as HIV (Human Immunodeficiency Virus) or HSV (Herpes Simplex Virus), and it's not a new virus -- it's just often overlooked in discussions of common sexually transmitted diseases. There are more than a 100 types of HPV that can cause a variety of diseases, but we'll focus on its most significant manifestation -- genital HPV. Sexual contact is the most common way to transmit genital HPV, including not only sexual intercourse, but also sexual contact without intercourse and oral sex. HPV is a silent infection, meaning that many people are unaware that they are infected and can transmit the virus to their sexual partners without even knowing.
Who gets HPV?
Anyone can get HPV infections. It is estimated that at least 50 percent of sexually active men and women will acquire a genital HPV infection at some point in their lives. Most infections clear up on their own without any medical treatment in 12-24 months. People at the highest risk of getting HPV infections are those who engage in high-risk sexual behavior such as having multiple partners, having unprotected sex, and starting to have sex at an early age. Also, having a weak immune system due to poor nutrition, stress, and smoking can make existing HPV infections persist in the body for a longer period of time and cause HPV-related diseases.
Many of my patients have asked me if two people in a monogamous relationship can get HPV. The short answer is, unfortunately, yes. Even if you are currently in a monogamous relationship, you or your partner could have acquired HPV from a previous sexual relationship; the disease can lie dormant in the body for many years and can become active at any time. The only way to prevent HPV is for both partners in a monogamous relationship to have never had prior sexual partners or to abstain from sexual contact altogether.
What are the consequences of having HPV?
There are three possible results of HPV infection. First, it is possible to become a carrier of HPV and never show symptoms for the rest of your life. Second, you could develop genital warts, which are irritating, visually unpleasant, embarrassing, and often require repeated treatments to get rid of them. Third, you could develop a HPV related cancer, the most serious of which is cervical cancer. In addition, HPV can be a cause for tremendous emotional issues, such as feelings of guilt, blame and shame.
Should you get the vaccine?
There are now two vaccines available to prevent most HPV related diseases. Only one, Gardasil, is currently available in the United States. The vaccine is preventative in nature, meaning it can only prevent and not treat existing HPV infections. The vaccine protects against four different types of HPV, two of which cause 70% of cervical cancers, and the other two which cause most genital warts.
The CDC recommends the vaccine for girls at ages 11-12 years for maximum benefit. However, if you didn't receive the vaccine at this age, you can still get it up until the age of 26, even if you are sexually active. This is because even if you have already been exposed to some types of HPV, the vaccine will still prevent against any of the four types that you haven't. It is important to note that the vaccine does not prevent against pregnancy or other sexually transmitted diseases such as HIV/AIDS, Chlamydia or Gonorrhea. Therefore, it's crucial to continue to be abstinent or practice safer sex even after receiving the vaccine.
Should you get the Pap test?
A Pap test (also called a Pap smear) detects abnormal cell changes in the cervix, some of which if not treated, can progress to cancer. Therefore, once the abnormal changes are detected, they sometimes require close follow-ups and uncomfortable procedures. Pap tests, no doubt, have dramatically reduced the rates of cervical cancer in this country. But the vaccine, on the other hand, prevents these abnormal changes from occurring in the first place. Obviously, prevention is preferable to detection and treatment. But as the vaccine only protects against 70 percent of cervical cancer, it's important to keep getting Pap tests to detect the other 30 percent. Consult your health care provider to find out when you should start getting Pap tests.
What are the ways to prevent and fight HPV infections?
There are some basic tips to follow to keep healthy and avoid HPV infections.
Follow the "ABCDE" rules of prevention: Abstinence, Being monogamous, Consistent condom use, Delayed sexual activity and Education.
Avoid drugs and excessive alcohol: These activities can lead to risky sexual behavior that make getting HPV more likely.
Get vaccinated: Getting the Gardasil vaccine before you become sexually active can protect you from HPV strains that cause 90% of genital warts and 70% of cervical cancers. If you are already sexually active and haven’t been vaccinated, you should still consider getting vaccinated, as this can protect you from the vaccine strains that you may not have been exposed to.
Boost your immune system:
• Quit smoking: Smoking weakens your immune system and makes HPV hang around longer in your body which can then cause disease.
• Reduce stress: Look into techniques such as exercise that help you relax and make you feel good about yourself.
• Eat healthy: Add foods rich in Vitamins C and E such as fruits and vegetables that have cancer-fighting properties to your diet. In addition, it's a good idea to take a multivitamin daily.
HPV can be a potentially serious and chronic disease that can have tremendous medical, psychological and sexual consequences. It can turn your life upside down overnight. One chance encounter is all it takes to be potentially infected by the HPV virus. By seeking accurate information and taking productive steps, you can prevent the spread of HPV. Knowledge and education about HPV infections will help contain the spread of infection -- ignorance will not.
Author Bio Shobha S. Krishnan, M.D., is a board certified gynecologist and family practice physician at Barnard College, Columbia University. Her new book, "The HPV Vaccine Controversy: Sex, Cancer, God and Politics: A Guide to parents, women, men and teenagers" was published on August 30, 2008, by Greenwood Publications. The book presents the most up to date information about the vaccine without the influence of pharmaceutical companies or other interest groups.
Over the past two years, the O-N-E L-E-S-S campaign for Gardasil, the new HPV vaccine to protect against cervical cancer, has brought discussion about the human papilloma virus to the forefront, shining new light not only on the vaccine itself, but also on the issues that surround it.
HPV is ubiquitous. Nearly 50% of sexually active people will have HPV at some point in their lives. There are around 20 million people with HPV infections in the U.S., with 6.2 million new cases occurring every year. The most serious consequence of HPV infections is cervical cancer, yet public knowledge about HPV is poor -- less than 50% of women have heard about HPV and its link to cervical cancer.
It's crucial that the public gains more knowledge about HPV and cervical cancer, particularly in the present climate where the merits of the vaccine have been clouded by a political rhetoric. Information on the link between HPV and cervical cancer, how common the disease is and who gets it, detection methods, other effects of the disease, and the role and effectiveness of the vaccine have to be addressed. Examining these topics will help guide decisions as medical professionals recommend this vaccination to a whole generation of 11-12 year old girls, and perhaps boys in the future.
The relationship between HPV and cervical cancer: There are over 100 types of HPV. About 15 of them are "high-risk" types that cause cervical cancer. HPV infections are more common in the younger population, with nearly 75% occurring in the 15-25 age group. Most HPV infections are "silent" -- people who carry the virus don't know they have it and transmit it freely to their sexual partners. The good news, however, is that most of these infections are self-limiting, meaning that nearly 90% of them resolve on their own within 24 months without causing any problems. In a minority of people, however, the infections persist, either as a result of high-risk sexual behavior (such as multiple partners and unprotected sex), or weakened immunity because of smoking, stress, and long term use of certain medications like steroids. These factors can propel HPV infections to cause precancerous and cancerous lesions of the cervix. Over 99% of cervical cancers are caused by HPV. HPV infections are necessary, but not sufficient on their own to cause cervical cancer.
Pap tests and cervical cancer: A Pap test detects early changes in the cells of the cervix due to HPV or other effects, which if left untreated, may progress to cervical cancer. Fortunately, due to a well organized Pap test program in the U.S., the incidence of cervical cancer has dropped by 75% over the past 50 years. Therefore, for women who get regular Pap smears, the incidence of cervical cancer is low. Currently in the U.S., about 11,000 new cases of cervical cancer develop each year, and around 4,000 deaths occur from it. Even though one would wish that there were no cases of cervical cancers to reckon with, when compared to the number of HPV infections that occur each year, the ratio between HPV infections to cervical cancer is low. According to the American Cancer Society, four out of five women who died of cervical cancer did not have a Pap test in the previous five years. These numbers show that the Pap smear has been very successful in curtailing the incidence of cervical cancer in this country.
Role of the HPV vaccines in preventing cervical cancer: There are now two HPV vaccines available worldwide to protect against two major types of cancer-causing HPV. Gardasil, manufactured by Merck, has been available in the U.S. since June 2006. Cervarix, manufactured by Glaxo Smith Kline, is planned to be introduced in the U.S in late 2008 or early 2009. Both vaccines target HPV types 16 and 18, which cause the majority of cervical cancers. HPV type 16 causes nearly 50% of cervical cancers and HPV type 18 causes about 20% of cervical cancers. Clinical trials have shown that both vaccines prevent 70% of cervical cancers with almost 100% effectiveness. However, this only true when the person has been vaccinated prior to exposure to the virus types 16 and 18. The efficacy of the vaccine drops once these virus types gain access to the body. This is why the CDC recommends administering the vaccine to young girls, ages 11-12, before their sexual debut to obtain maximum benefit.
Pap test versus HPV Vaccine: Both Pap tests and the HPV vaccine prevent cervical cancer, but they do so in different ways. The vaccines produce antibodies to fight against the HPV virus well before it can invade the cervix. Therefore the vaccine prevents the development of any HPV related pathology on the cervix. On the other hand, the Pap test, detects abnormal changes in the cervix as a result of HPV, many of which require follow up visits and procedures in order to prevent these abnormalities from progressing to cancer. Most people would agree that prevention is better than detection or treatment. Managing abnormal Pap smears alone costs $2-3 billion a year in this country. But as the vaccine only provides protection against 70% of cervical cancers, Pap tests should be continued to detect the remaining 30% of cervical cancers that are not covered by the vaccine. It is important to note that apart from cervical cancer prevention, the vaccine has also been found to be beneficial against many other HPV related diseases, and it could eventually help in reducing the medical and emotional toll that such diseases take on people.
Those most prone to cervical cancer in the United States are those groups of people who have no access to Pap smears or will not obtain them because of inadequate access either as a result of poor socio economic status, poor knowledge or cultural differences. These groups are overwhelmingly comprised of women from ethnic minorities and whites in the Appalachian regions. Therefore, education aimed at the public should not only include comprehensive cervical cancer prevention programs in layman's terms, but also should be culturally sensitive to meet the needs of people from various backgrounds. The HPV vaccine has the potential to save millions of young lives and families, but, unless it reaches the same group of women who are not obtaining their Pap smears today, it will miss out on keeping its "one less" promise both here at home and around the world.
Shobha S. Krishnan, M.D., is a board certified gynecologist and family practice physician, at BarnardCollege, ColumbiaUniversity. Her new book, The HPV Vaccine Controversy: Sex, Cancer, God and Politics: A Guide to parents, women, men and teenagers was published on August 30, 2008 by Greenwood Publications. The book presents the most up to date information about the vaccine without the influence of pharmaceutical companies or other interest groups.
The vaccine, Gardasil, is a shot given to prevent certain strains of cervical cancer caused by HPV. HPV stands for Human papillomavirus. The vaccine offers protection against the four most common strains of HPV; types 6, 11, 16 and 18. Types 16 and 18 account for 70% of cervical cancers while types 6 and 11 account for 90% of all cases of genital warts. It is given in three shots over a period of six-months. The vaccine is recommended for young girls ages 11 and 12 but is also recommended for girls and women 13 to 26 who have not yet been vaccinated or have not yet completed the series of shots for the vaccine.
This vaccine is important in the saving of women's and young girls' lives. Genital HPV is a virus that is most often passed on through sexual contact. Though most will not know it, most sexually active people will get the virus at some point in their life. There is somewhere around 40 strains of HPV that can infect both men and women. Most strains cause no symptoms or harm and go away on their own. There are a few strains that can be deadly and cause cervical cancer in women as well as other genital cancers, while other strains of HPV can cause genital warts in both men and women.
It is ideal for females to receive Gardasil before they become sexually active and may be exposed to the virus. However, this is not to say that those who are already sexually active will not benefit from receiving the vaccine. Most females are not infected with all strains of HPV and therefore will still be protected from those types of the virus to which they have not yet been exposed. Both young girls and women do not need to receive a Pap or other tests before receiving Gardasil. Testing is currently underway to find out the effectiveness and safety of the virus on those over the age of 26. It has yet to be found if the vaccine is effective in men or young boys. If Gardasil is found effective, the vaccine may help to prevent genital warts as well as both penile and anal cancer.
Gardasil is highly effective in the prevention of HPV. Due to the fact that the vaccine will not fully treat HPV, the vaccine has little effect on the virus in women who have already been exposed to the disease. Research is being done to test how long the vaccine lasts and if there may be a need for a booster shot later down the road for those who are receiving the vaccine. The vaccine is not effective in protecting from all strains of HPV, rather it protects against the most common strains of cervical cancers, so it is very important that women continue their regular checkups and screenings. Gardasil has been approved by the Center for Disease Control and Prevention as effective and safe. Side effects of the shot are typically soreness of the injection site, fever, nausea and dizziness as well as other rare side effects.
By contacting your health care provider, you can get information about coverage for the vaccine. Call the phone number on your medical card to learn more about co-pays, co-insurance, deductibles, or other limitations. Most large insurance providers will cover the cost of the vaccine which is about $125 per dose, totaling about $375 for all three shots in the series. Those who are younger than 18 years of age may still be able to get Gardasil for free through the VFC (Vaccines for Children) program, although certain criteria and restrictions may apply. Merck, the maker of the vaccine, offers a vaccine assistance program to women who want to receive Gardasil but cannot afford it. In order to qualify for the program, women must be at least 19 years of age, uninsured, reside in the United States (need not be U.S. citizen), and have an annual income less than $20,800 for individuals, $28,000 for couples or $42,400 for a family of four. Texas, New Hampshire and South Dakota as well as other states have made the cost of the vaccine free or at low cost.
Women should continue regular cancer screenings and follow-ups. Pap smears can detect cell changes in the cervix before they turn into cancer. The HPV test can detect HPV on a woman's cervix, which can be done along with a Pap. There is no cure for HPV so the vaccine is one of the best ways to prevent cervical cancer as well as using protection. The vaccine is not to be used in place of other contraceptive devices. If a person is infected, it may take weeks, months or even years to see signs or symptoms and should be addressed right away. The choice is yours to make. Protect yourself.
In recent weeks, attitudes about the HPV vaccine have often shifted from fanfare to fear as newspapers, blogs and medical journals have inundated the media with conflicting opinions. While the public wants information about the vaccine in simple and clear terms, the potential benefits and limitations of this vaccine have been somewhat difficult to see in black and white. Some of the questions that have dominated the media about the vaccine are:
Is the vaccine safe? -- The recent concerns over Gardasil's safety have many parents worried. No doubt, adverse effects have to be carefully monitored to assure that the vaccine has a good safety profile. Being a parent myself, I can fully understand these concerns, but as a physician, I have had the opportunity to take a closer look at Gardasil's safety profile. So far, nearly 8 million doses of Gardasil have been administered and all adverse effects have been carefully analyzed by medical experts at VAERS (Vaccine Adverse Effects Reporting System), a branch of the CDC. So far, no common pattern of reports has emerged to show that the vaccine is directly responsible for any of the adverse effects reported. Therefore, both the FDA and CDC continue to find that Gardasil is a safe and effective vaccine with benefits far outweighing the risks.
Will the vaccine cause "Replacement disease?" -- The August 2008 issue of the New England Journal of Medicine voiced several concerns over the HPV vaccine. One of the concerns was that the protection Gardasil provides against the two major HPV strains would give the currently less dangerous HPV types an opportunity to grow stronger and cause disease more often. This phenomenon is called replacement disease. Replacement disease was seen, for example, when the vaccine Prevnar was introduced in 2000 to fight against respiratory disease caused by the pneumococcal bacteria in children. And, even though there were a few cases of the disease caused by types of pneumococci that were not covered by the vaccine, they were insignificant when compared to the millions of lives that were saved by the vaccine. With the HPV vaccine, there are currently a few reports alluding to the emergence of non-vaccine covered HPV types, but these have not been of any clinical significance.
When is the best time to vaccinate? -- revisited -- Public health treats populations, not individuals. Therefore, when making recommendations for a whole generation of American women, public policy makers have to take several factors into account in order to calculate the most cost effective way to obtain maximum benefits from a drug or vaccine. The HPV vaccine is preventive in nature, meaning that it can't cure existing HPV infections. Therefore, from a public health standpoint, it is best to administer the vaccine to 11-12 year old girls before their sexual debut, rather than later (catch-up vaccination is currently recommended between the ages of 13-26 years) when they may have already been exposed to the virus. This is also the time when middle school children go to their doctors or clinics to receive other recommended shots, making it an easier time to offer the HPV vaccine. Vaccinating girls at this age will give the best protection because it will reduce HPV related disease consequences later in life, including the unexpected potential for exposure due to events such as infidelity within a long term relationship or having new sexual partners after widowhood or divorce.
Will the vaccine affect natural immunity? -- Natural immunity to a particular disease is acquired when a person is exposed to the specific organism that causes the disease. Obviously, this involves considerable risk -- for example, in order to gain natural immunity from polio, one would become paralyzed in the process. Immunity acquired from the vaccine causes a person to produce antibodies without developing the actual disease in most cases. In the case of HPV, it is not clear if natural infections offer adequate protection for life, but studies have shown that the vaccine produces antibody levels which are nearly tenfold higher than antibody titers produced by natural infections. Whether this heightened immunity leads to stronger and longer effectiveness is not yet known.
Is it true that there's no proof that the vaccine will reduce the rate of cervical cancer? -- Very few HPV infections lead to cervical cancer, as over 90% of infections clear up on their own. Of those that persist, the lag time between acquiring an HPV infection and the development of cervical cancer is nearly 20 years. Therefore, the young women who are being vaccinated today have to approach the ages of 35-50, when cervical cancer peaks, before we will have conclusive results. However, there is enough scientific evidence to support the theory that the vaccine can prevent cervical cancer. Clinical trials look at cancer surrogates -- conditions which when left alone will invariably progress to invasive cervical cancer -- as end points of the study. In the case of the HPV vaccine, they look for significantly abnormal cells or precancerous lesions in women who have been vaccinated. The vaccine has been found to prevent the development of these abnormal cells by the HPV types that are covered by it. Thus, it has been predicted that the vaccines will prevent cervical cancer. Obviously, no one can predict with complete accuracy how the vaccine will work in the "real world" over the next several decades. It is a leap of faith to some extent, but a leap that most of us are willing to take because of our trust in the "miracles" of medicine that have served us so well over the years.
Author Bio
Dr. Shobha S. Krishnan, M.D., is a Staff Physician at Columbia University's Barnard College Health Services. A board certified gynecologist and family practice physician, she has also worked as a surveillance physician for the federal Centers for Disease Control and Prevention. Prior to joining Barnard, she was in private practice for 10 years. In addition, Dr. Krishnan has worked as a physician at the Institute on Aging and as Chief Resident in the Family Practice Department at St.Vincent Hospital, Indianapolis. Her new book: The HPV Vaccine Controversy: Sex, Cancer, God and Politics -- A Guide to parents, women, men and teenagers is scheduled to be published on August 30, 2008 by Greenwood Publications. The book presents the most up to date information about the vaccine without the influence of pharmaceutical companies or other interest groups.
Ever since the FDA approved the HPV vaccine two years ago, its introduction into the health community has been embroiled in a medical, social, cultural and political controversy. At first glance, the debut of a vaccine to fight most cervical cancers looks like an exciting advance in the history of women’s health. However, many people are unable to separate the ethics from the basic scientific facts: the virus is transmitted through sexual contact and hence the vaccine is recommended for 11 or 12-year-old girls, before they first become sexually active. The perceived possibility that administering such a vaccine to prevent a sexually transmitted disease could promote sexual promiscuity has trumped all other ethical debates, leading some people to cast its benefits aside. As a mother, I can understand why many parents are concerned about this issue and put off vaccinating their daughters. However, in addition to being a mother, I am a physician, and I therefore believe that by putting off vaccination, we effectively strip our daughters from their chances of protecting themselves from the two major cancer causing HPV types.
According to a Newsweek article from February 25, 2008, only two out of every 10 women in the U.S. in the approved age group have received the vaccine so far. In another new survey of almost 10,000 parents, only 49 percent said they would get their daughters vaccinated with the HPV vaccine at the recommended age of 9 to 12 years. Even though 68 percent planned to vaccinate their daughters at 13 to 15 years of age, and 86 percent said they would vaccinate at 16 to 18 years of age, they might be too late -- because the vaccine can only prevent and not cure HPV. The National Survey of Family Growth (NSFG), an agency that collects data on the sexual behavior of American teenagers, reports that teenage girls are already sexually active: 13 percent of them by the time they are 15, 43 percent of them by age 17, and 70 percent of them by age 19. Of the sexually active 13-21 year age group, 70 percent show evidence of HPV infections within a few to several months of when they start having sex -- most of which could easily be prevented by vaccinating preadolescent girls. In addition, many parents are uncomfortable talking to their preadolescents about sexual issues; meaning uneducated teens could make problematic sexual choices not only without realizing the consequences of their actions, but also without the protection from HPV that the vaccine provides.
Again, bear in mind that the vaccine is preventive -- it is only effective if administered prior to exposure to the virus. Therefore, the vaccine will not treat the existing infections. This is why it's so crucial to administer the vaccine when girls are young, before any chance of sexual activity, including sexual contact without intercourse. In addition, there are several other scientific reasons why the vaccine is recommended in the 11-12 year old groups. Unfortunately, it is beyond the scope of this article to discuss those facts.
But, won't vaccinating young girls against a STD cause them to become less sexually inhibited and more promiscuous by giving them a license not to worry about the consequences of sex? Won't it eliminate a deterrent to teenage sex and therefore encourage it? Highly unlikely: because teens rarely factor the possibility of getting HPV into their decisions to have sex.
Current research in adolescent sexual behavior shows that not one, but a variety of factors influence teenage sexual behavior, such as their socio-economic status, their moral and religious values, their sexual attitudes, and the influence of family, friends, and the society they live in. Therefore, it is highly unlikely that a vaccine against a single kind of STD would play a more significant role in adolescent decision making than these factors paired with their responsibility, good judgment, and the boundaries of accepted sexual behavior.
According to NSFG, the top two factors influencing teenagers who choose to remain virgins are fear of pregnancy (94 percent) and contracting HIV/AIDS (92 percent). Since knowledge and awareness of HPV in this age group is poor to begin with, teens will not view this vaccine as a reason to become sexually active at an age sooner than intended. And parents who worry about the vaccine causing promiscuity should remind themselves of the two most dangerous and important factors that influence teenagers to become sexually active and engage in high-risk behaviors: peer pressure and the use of alcohol and/or drugs.
Parents who worry about their teens becoming promiscuous can also focus on a crucial method to keep them from becoming sexually active too soon: raising their awareness. Research has shown that parental guidance is one of the most important factors in delaying teenage sexual activity -- teenagers who do not have involved parents are most likely to engage in high-risk behaviors. The HPV vaccine can actually help parents guide their teens' sexual decisions by giving them a window of opportunity to talk about the topic, and to get health care providers involved in the discussion. There is no reason why parents cannot, without any hypocrisy, inform their daughters that the vaccine is not a green light for them to immediately have sex. Rather, it is a strong message that you, their parents, care about their health, and that it’s important to take proactive steps to become a healthy adult. Think of it this way: Getting a car with an airbag, traction control and anti-lock brakes means that the car is safer in the long-run, but these features aren't a reason to drive recklessly -- accidents are still possible. No matter what, the vaccine will not, cannot and should not take the place of good, solid parental guidance.
The bottom line is we as we as parents want to do what is best for our children. We all want to teach them well while they are still in our protective cocoon so that we can trust them with their own judgment when they become independent. If they always followed our best wishes, we wouldn’t need to worry about administering the vaccine at all. However, even teens with the best judgment can face peer pressure and fall victim to bad decisions or other reasons that may cause them to engage in risky sexual behavior, and this makes the case for vaccinating all the more compelling.
