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HPV and cervical cancer don’t care what month it is

Young love. Like older love, it too can spread HPV.
Image via Wikimedia Commons, public domain image.

January was Cervical Cancer Awareness Month, but we’d like to note that sexually active people should be aware of cervical cancer in any month and continue the recommended preventive and early detection measures for it, which includes keeping up with Pap tests. To maintain awareness, we’re kicking off the month for lovers–February–with a post about cervical cancer and the human papillomavirus (HPV). 


One thing that cervical cancer awareness overlooks is that HPV causes not only that cancer but also can play a role in penile, vaginal, urethral, anal, and head and neck cancers. In fact,  a recent study found that about 1 in 10 men and almost 4 in 100 women are orally infected with HPV, the most common sexually transmitted virus in the United States, and HPV-related head and neck cancer rates are higher among men. Further, HPV-related oral cancers have been on the rise for about two decades now, and HPV is now responsible for about 50% of oral cancers today.

Research also shows that about 50% of college age women acquire an HPV infection within four years of becoming sexually active. In addition, an infected mother can pass HPV to her baby during childbirth, and the virus can populate the child’s larynx, causing recurrent growths that block the respiratory tract and require surgical removal.

The remainder of this post appeared initially on the Parents of Kids with Infectious Disease site, which provides information for preventing infectious disease in addition to supporting parents whose children have them. As insidious as HPV is, the vast majority of HPV infections can be prevented now with a vaccine.

Have you or a loved one ever had an abnormal Pap test result? If precancerous cells were identified, the cause was almost undoubtedly infection with human papillomavirus (HPV). Almost all cases of cervical cancer arise because of infection with this virus. Yet a vaccine can prevent infection with the strains that most commonly cause cervical cancer.


A vaccine against cancer. It’s true.


For the vaccine to work, though, a woman must have it before HPV infects her. You may find it difficult to look at your daughter, especially a pre-teen daughter, and think of that scenario. But the fact is that even if your daughter avoids all sexual contact until, say, her wedding night, she can still contract HPV from her partner. As we noted above, it happens to be the most common sexually transmitted infection.


About 20 million Americans have an HPV infection, and 6 million people become newly infected every year. Half of the people who are ever sexually active pick up an HPV infection in a lifetime. That means your daughter, even if she waits until her wedding night, has a 1 in 2 chance of contracting the virus. Unless it’s a strain that causes genital warts, HPV usually produces no symptoms, and the infected person doesn’t even know they’ve been infected.


Until the cancer shows up.


And it can show up in more places than the cervix. This virus, you see, favors a certain kind of tissue, one that happens to be present in several parts of you. This tissue, a type of epithelium, is a thin layer of the skin and mucous membranes. It’s available for viral invasion in the cervix, vagina, vulva, anus, and the mouth and pharynx. In fact, HPV is poised to replace tobacco as the major cause of oral cancers in the United States.


The virus can even sometimes pass from mother to child, causing recurrent respiratory papillomatosis, the recurrent growths in the throat that must be removed periodically and can sometimes become cancerous. It strikes about 2000 children each year in the United States.


How does a virus cause cancer? To understand that, you must first understand cancer. You may know that cells reproduce by dividing, and that cancer occurs when cells divide out of control. Behind most cancers is a malfunction in the molecules that tell cells to stop dividing. These molecules operate in a chain reaction of signaling, like a series of well-timed stoplights along a boulevard. If one starts sending an inappropriate “go” signal or fails to send a “stop” signal, the cell divides, making more cells just like it that also lack the right signals. If your body’s immune system doesn’t halt this inappropriate growth, we call it cancer.


The blueprint for building these “stop” molecules is in your genes, in your DNA sequences. As a virus, HPV also requires a blueprint to make more viruses. Viruses use the division machinery of the host cell—in you—to achieve reproduction by stealthily inserting their own DNA blueprint into the host DNA.


Sometimes, when it’s finished with the host, a virus leaves a little bit of its DNA behind. If that leftover DNA is in the middle of the blueprint for a “stop” molecule, the cell won’t even notice. It will use the contaminated instructions to build a molecule, one that no longer functions in stopping cell division. The result can be cancer.


Of the 150 HPV types or strains, about 40 of which pass through sexual contact, two in particular are associated with cancer, types 16 and 18. They are the ones that may persist for years and eventually change the cellular blueprint. The vaccines developed against those two strains are, therefore, anti-cancer vaccines.


Without a successful viral infection, viral DNA can’t disrupt your DNA. That’s what the HPV vaccine achieves against the two strains responsible for about 70% of cervical cancers. Recent high-profile people have made claims about negative effects of this vaccine, claims that have been thoroughly debunked. The Centers for Disease Control and Prevention as always offers accurate information about the side effects associated with available HPV vaccines.

This achievement against cancer, including prevention of almost 100% of precancerous cervical changes related to types 16 and 18, is important.


Worldwide, a half million women receive a cervical cancer diagnosis each year, and 250,000 women die from it. These women are somebody’s daughter, wife, sister, friend. Women from all kinds of backgrounds, with all kinds of sexual histories.


Women whose precancerous cervical changes are identified in time often still must undergo uncomfortable and sometimes painful procedures to get rid of the precancerous cells. These invasive procedures include cone biopsies that require shots to numb the cervix and removal of a chunk of tissue from it. Cone biopsies carry a risk of causing infertility or miscarriage or preterm delivery. A vaccine for your daughter could prevent it all.


HPV doesn’t care if your daughter has had sex before. It’s equally oblivious to whether the epithelium it infects is in the cervix or in the mouth or pharynx or in an adult or a child. What it does respond to is antibodies that a body makes in response to the vaccine stimulus.


Even if your daughter’s first and only sex partner passes along one of the cancer-associated strains, if she’s been vaccinated, her antibodies will take that virus out cold. It’s a straightforward prevention against a lifetime of worry—and a premature death.


For more info: Facts about the HPV vaccine from the National Cancer Institute.




By Emily Willingham, DXS managing editor

Why don’t more girls get the HPV vaccine??

Double X Science is pleased to be able to repost, with permission, this important piece courtesy of author Kate Prengaman and her Xylem blog, focused on spreading science and new ideas.

Imagine if there was a vaccine that could prevent cancer. Everyone would want it, right?
Surprisingly, no. There IS a vaccine to prevent cervical cancer, which, according to the CDC, affects about 12,000 women every year. Unlike most cancers, cervical cancer is caused by a sexually transmitted virus, Human Papillomavirus, also known as HPV. The virus can cause abnormal cell growth in the cervix, which can turn cancerous. The vaccine, approved in 2006, works against many common strains of HPV.
The vaccine is recommended for girls ages 11-12, and also provided to women up through their early twenties.  The goal is to protect girls long before they are ever sexually active, so that they never contract HPV in the first place. As of 2011, the vaccine is also recommended for adolescent boys.
Contracting HPV is so common that more than half of all sexually active men and women in the United States will become infected with HPV at some point in their lives. According to a CDC factsheet on the HPV vaccine, “about 20 million Americans are currently affected, and 6 million more are infected every year.” In most people, HPV infections never lead to symptoms but the virus can cause development of cervical cancer and, more rarely, cancers of the vagina and anus, as well as genital warts. Furthermore, men can develop cancer from HPV. The virus is transmitted through skin to skin contact, which reduces the efficacy of condoms at preventing the spread of this disease.

Yet, despite the dangers associated with HPV, only 33.9% of American girls, ages 13-17, reported to the CDC in 2010 that they had been fully vaccinated (3 doses) against HPV.  When I mapped the state by state rates of vaccination, I found a dramatic distribution, from only 19% of girls in Idaho to nearly 60% in South Dakota and Rhode Island.

Map created by Kate Prengaman
Much of the resistance to vaccinating adolescent girls against cancer-causing HPV comes from  many people who are uncomfortable with or resistant to the fact that adolescent girls will grow up and have sex. I expected to see a strong correlation between states with Abstinence-only sex education and low vaccination rates, but the pattern in the map is weaker than I had anticipated. I also considered that the cost of the vaccines might play a role, although if they are not covered by a family’s health insurance, there are federal programs in place to subsidize the cost. There’s also some correlation there, but again, not as strong as you see, for example, when mapping teenage birthrates.
Map created by Kate Prengaman
Clearly, the pink map, lovely as it is, does not provide an answer for why more adolescent girls are not receiving the HPV vaccine. There is an unfortunate anti-vaccination movement in this country, with people choosing not to protect their kids from dangerous diseases because of unfounded fears that vaccines can cause autism, among other things. Last fall, Michelle Bachmann even used a presidential debate to stir up more fears that the HPV vaccines could cause mental disabilities, a enormous error that the medical community quickly tried to correct.
The truth is that these vaccines are safe. The truth is that HPV is really common, and it can cause cancer, and if you ever have sex, you have a good chance of getting it. Why aren’t more parents of adolescents taking the lead on protecting their kids’ future health?  If you have any ideas for other factors that might explain the patterns of vaccination, let me know in the comments and I  will try adding to my map.  Thanks!

About the guest author:

Kate Prengaman is a science writer and outdoor enthusiast currently based in Madison, WI. Formerly a botanist, Kate is pursuing her masters in science journalism at UW, reading and writing as much as possible.  She loves talking to people, telling stories, finding adventures,  geeking out over wildflowers, and eating delicious things. She blogs at Xylem

Vaccine fears: What can you do?

An infant girl suffering from pertussis, a vaccine-preventable disease,
struggles to breathe. Those indentations in her ribs are
one of the signs of her extreme difficulty drawing breath. Via CDC. 

What’s not to fear directly about vaccines? There’s a needle that someone pokes into your child. Your child screams. You tense up. What’s in there? you wonder. Viral or bacterial bits that, in ways that are mysterious to a non-immunologist, will keep your child well when intuition seems to say they ought to make your child sick.
Needles, screaming, microbial bits…these naturally would make any parent blanch. The number of vaccines has added to the fear for at least a decade, leading to non–evidence-based calls to “spread out” the schedule or reduce the number of vaccinations.
In fact, the evidence supports the schedule as it’s recommended.
The fear of vaccination is not new. Since Edward Jenner and his cowpox inoculation at the turn of the 19th century, people have latched onto the fear of the known—those needles!—and unknown—what’s in those things?
What might be considered the first anti-vaccine cartoon appeared in response to Jenner’s proposed inoculation of cowpox to combat smallpox.
The vision of cows growing out of arms is comical, but the reality of possible side effects from today’s vaccines can lead some parents to keep their children away from the doctor’s office. Indeed, this anxiety has done so since the days of the 19th century anti-vaccination leagues, aligned against the widespread use of Jenner’s smallpox vaccine.
The vaccine wars in those days were just as bitter and divisive as they are today, including an 1885 march in England in which anti-vaccination forces carried a child’s coffin and an effigy of Jenner himself. Today’s most fanatical crusaders against vaccines may not carry coffins or effigies, but death threats against those who promote vaccines for public health are not unknown.
The fact that the vast majority of parents overcame those fears and had their children vaccinated has led to some of the greatest public health successes of the 20th century. Thanks to the willingness of people to participate in vaccination programs, smallpox disappeared and polio became a thing of the past in much of the world. Indeed, people in those eras knew, often from personal experience, what these diseases could do—maim and kill—and the fear of those very real outcomes outweighed fears of the vaccinations.
But today, we’re different. In the United States, most of us under a certain age have never witnessed a death from diphtheria or tetanus or smallpox or measles. We haven’t seen a child drained of life as a rotavirus rapidly depletes the molecules she needs to live. Many of us have not witnessed the sounds of pertussis, the vomiting, the exploding lungs in an agony of infant death. Why? Because of vaccines.
This very success has, ironically, led to the resurgence of fear and misgiving about vaccines. No longer weighed against anxiety of death or disability from disease, the fear of vaccines now aligns against the bright picture of a nation of children largely free of life-threatening illness.
Without the collective memory of days when children played on the playground one day and died the next of vaccine-preventable disease, the calculus of parental fear pits only the side effects of vaccines against the healthy child. Vaccination requires intentional agency—parental agreement—to impose on that healthy child the very small risk that vaccines carry. Some parents simply are not comfortable either with that intentionality or that risk.
Feeding this reluctance is the explosion of Internet sites that warn against vaccines or disseminate incorrect information about them. The Centers for Disease Control and Prevention (CDC) has provided abundant information about vaccines, including a page devoted to countering erroneous information with facts.
This information will not move the fiercest anti-vaccine groups that lump the CDC in with pharmaceutical companies and others in an alleged conspiracy to harm millions via a money-making vaccine industry. However, it certainly helps concerned parents who simply seek to calm fears, weigh evidence, and make an informed decision about choosing vaccines over the life-threatening illness and compromised public health that result when people don’t vaccinate.
Indeed, these threats to public health have grown considerably with recent large outbreaks of measles and pertussis, including a growing measles outbreak in Europe involving more than 26,000 cases of measles, more than 7000 hospitalizations, and nine deaths as of this writing. The growing threat has led to calls for more stringent requirements for childhood vaccines, including dropping exemptions and requiring that all children be vaccinated over parental objections. This tactic likely would increase vaccination rates among children attending school.
But instead of strong-arming parents into having their children vaccinated, what we really need is a two-fold approach to education. First, we need sober, non-sensationalist reporting from the news media about vaccine-related stories, including stories about side effects, research, and court cases. These articles—and their sensational headlines—are in all likelihood among the prime drivers of the rumor mill against vaccines.
Second, when parents read these stories and turn to a medical professional for input, that input must come as part of a two-way communication between the health professional and the parent, not in lecture format or as patronizing. A little, “I understand your concerns because I’ve had them, too, but here’s what I know that gives me confidence in vaccines,” is considerably better than, “Your child has to be vaccinated, or you can get out of my office.” The onus is on parents to ask with open minds and an understanding that the medical professional in front of them has likely devoted considerable time to gaining the education and expertise necessary to address their questions. Health care isn’t a competition about who knows more. It’s about evidence-based health practices.
As centuries of history attest, no efforts will completely eradicate vaccine fears. Motivations fueling anti-vaccine sentiment that go beyond information gaps range from personal economic benefit to a desire to out-expert the experts to the inertia of fear.
But a careful and persistent information campaign and outreach efforts from medical professionals in the trenches may help keep vaccination rates sufficiently high. Parental investment in gaining information from trained professionals and making decisions based on facts rather than fear is also an indispensable component. To ensure adequate rates requires either these efforts or a resurgence of the deadly diseases that have graphically demonstrated the real balance of the threats at issue here.
Which one would we rather have? 


Emily Willingham, Double X Science Editor
Twitter,
@ejwillingham
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A version of this post originally appeared on the blog of PKIDs, Parents of Kids with Infectious Diseases. The mission of PKIDs includes educating the public about infectious diseases and methods of prevention and transmission. Follow PKIDs on Twitter @PKIDs.