Join 3,512 readers in helping fund MetaFilter (Hide)


August 21, 2002
11:02 AM   Subscribe

What's "the primary cause of cervical cancer?" Did you know that "as many as 40 million Americans are infected?" Should you be alarmed that "There is no direct treatment?" Let's talk Papilloma.
posted by zekinskia (31 comments total)

 
HPV doesn't get a whole lot of press, but there are a lot of scary statistics flying around out there. If anyone in the medical community knows some credible links, I'd really appreciate you sharing them here.
posted by zekinskia at 11:04 AM on August 21, 2002


"as many as 40 million Americans are infected?"

I bet the numbers are even higher. The obvious symptom, genital warts, does not appear in all cases so many people have HPV and don't even know it.

I dont know why HPV doesn't get more press. Condoms do not help much since warts can appear at the base of a man's penis (outside the condom) and still transmit the disease. HPV is incurable although the warts can be controlled.
posted by vacapinta at 11:10 AM on August 21, 2002


Here's the ACS page on cervical cancer prevention.

Get checked early and often, ladies. Cervical cancers are generally slow-growing and like always, the earlier caught the better. Unsurprisingly, quitting smoking will also reduce your risk.

And vacapinta has it right that condoms don't do jack about HPV, which is alarmingly common, and sometimes manifests no symptoms at all for years.
posted by Skot at 11:16 AM on August 21, 2002


Generally, women who contract HPV don't even know it until much later, when a pap smear reveals abnormal, pre-cancerous cells on the cervix. however, these cells can be removed in a painless, outpatient procedure and they usually do not grow back or cause further problems.
posted by mariko at 11:31 AM on August 21, 2002


People just don't want to talk about certain STDs? I have no idea why this doesn't get more press, although I have heard a few abstinence proponents bring it up (fortunately, there were no photos). HPV can cause cervical cancer in women, but is it a risk to men?
posted by insomnyuk at 11:37 AM on August 21, 2002


well, outside of genetics (ie: an inherited flaw in the makeup of the cervix)...what could be causing these cells to go haywire?

My guess is that many of our cancers are due to introduction of some effect (radiation) or material to the effected cells. Some people have a better ability to ward off the cellular reproduction errors that cause cancers...and so it's kind of hard to pin down what causes some of them.

Still, how could cervical cancer be so widespread? The fact that it can be transmitted makes me believe it isn't a widespread genetic abnormality. Perhaps it can be spread through sexual contact before people realize they've got it?

Otherwise, what have we been introducing into this part of a woman's body that might not be entirely wholesome?

Lung cancer is relatively easy to figure out in this manner (inhaled chemicals, mostly from cigarettes). Skin cancer too (the sun, DEET, household cleaners). Could things like latex and tampons and sexual lubricants be contributing to cervical cancer?
posted by ruggles at 11:41 AM on August 21, 2002


hrm...maybe next time I'll read the article too...
posted by ruggles at 11:42 AM on August 21, 2002


I wouldn't call the procedure "painless", mariko... for some it's damn painful, but necessary. As for growing back, unfortunately it does in many cases. The body over time eventually may "fend off" the infection, but the chances of having more abnormal pap smears are pretty good after a diagnosis of HPV.

HPV has been identified as the cause of most cervical cancers -- that's why cervical cancer is now considered so treatable, because if your dr. knows you have HPV, they can keep a far closer eye on you. HPV has also been known to contribute to penile cancers, but seems to be of far less danger to men than to women. The incidences are not as high, I think.

The American Social Health Association has some good information on HPV and cervical cancer. I've seen statistics as high as 70% of sexually active adults have been exposed to HPV. You'd think people would be talking a lot more about it, but they're not.
posted by greengrl at 11:46 AM on August 21, 2002


Well, insomnyuk, HPV can cause skin, larynx, and other cancers. Interestingly,some strains of HPV cause anal cancer and some kinds don't. Of course anal cancer has a far lesser incidence than cervical cancer.

Boy I hope I got the right strain. Heh.

You can help the Lombardi Cancer Institute's HPV studies by volunteering if you're local or sending cash.
posted by RJ Reynolds at 11:47 AM on August 21, 2002


greengrl: the LEEP cone procedure I was refering to is relatively painless since you're completely anesthetized while it is performed, unlike the colposcopy which proceeds it, and there is generally little or no pain afterwards. also, unless you have a compromised immune system, the chances of recurring dysplasia are low. But a yearly pap is still a good idea.
posted by mariko at 11:58 AM on August 21, 2002


Human papillomavirus (HPV) cause "genital warts" (condylomata acuminata). Unfortunately, infection with some subtypes of papillomavirus are also associated with a high percentage of cervical dysplasia and cancer. There is a large family tree of papilloma viruses. Types 16, 18, 31 and some others are associated with tissue changes that can lead to cervical cancer. HPV may also play a role in anal and penile cancer.

From my knowledge of the literature, the use of condoms can reduce the risk of infection (but, as even with pregnancy prevention, they are not 100% effective). My "Current Medical Diagnosis and Treatment" notes that "use of the diaphragm or condom has been associated with a protective effect", but does not quantify that effect. What I believe are the most recent Centers for Disease Control recommendations (here, in PDF format) note that:

Latex condoms, when used consistently and correctly, can reduce the risk of genital herpes, syphilis, chancroid, and HPV infection, only when the infected areas are convered or protected by the condom. In addition, the use of latex condoms has been associated with a reduction in risk of HPV-associated diseases, such as cervical cancer.

Epidemiological studies to date are inconclusive, although the CDC notes that limitations on study design would lead to an underestimation of protection against infection. As noted, however, condom use does appear to be associated with a decreased risk of cervical dysplasias and cancer.

Spermicide does not appear to be effective against HPV. As always, sexual abstinence or a monogamous relationship with someone uninfected is protective against infection.

Sexually active women should get regular Papanicolau screens. Those infected with types 16 or 18 usually require seminannual followup to monitor any dysplasia. Infection is a risk factor (just as smoking is, as noted above) - it does not mean that you are going to come down with cancer.
posted by fold_and_mutilate at 12:03 PM on August 21, 2002


Yes, it is the biopsy that can be painful, although the recovery after a LEEP can also be somewhat uncomfortable. (The discomfort is minor, when you consider the consequences of not having treatment.)

I think it depends on who you're talking to, and what you read in terms of what's said about recurrence. I'm not sure that they really know, from what I've read. I think there's a lot about HPV that has yet to be discovered. Abnormalities due to HPV can also regress on their own, and be fought off by the body's immune system. They don't necessarily always require a LEEP or other procedure.
posted by greengrl at 12:10 PM on August 21, 2002


Sexually active women should get regular Papanicolau screens. Those infected with types 16 or 18 usually require seminannual followup to monitor any dysplasia. Infection is a risk factor (just as smoking is, as noted above) - it does not mean that you are going to come down with cancer.

This seems to be the crux of the issue. Sexually active individuals with multiple partners are probably not getting enough regular testing to begin with. Furthermore, how do you broach the issue of infection with a potential partner? Do you ask on the first date? The second date? Right before you hit the sack, do you demand a synposis of their medical history? It seems rude to me, but it is probably called for. Unfortunately, social stigma probably prevents this from happening most of the time.
posted by insomnyuk at 12:22 PM on August 21, 2002


One cause:CIRCUMCISION
posted by ParisParamus at 12:34 PM on August 21, 2002


Worth noting: according to my doctors, the strains of HPV associated with cervical cancer do not cause genital warts. Lousy situation all around, though.
posted by swerve at 12:36 PM on August 21, 2002


F&M, thanks for the breakdown, that was informative.

Insomnyuk, my problem with this issue is that while Papanicolau screens can detect abnormal tissue growth, they cannot detect whether the subject has contracted a strain fo HPV.

Furthermore, because HPV occurs in such high frequency, many doctors refuse to get blood work done for their patients with abnormal paps, because they "don't want to alarm them."

I've heard this from three of my female friends, who experienced it personally.

Don't they deserve to know whether they have HPV or not, and not just whether they have the symptoms of HP
posted by zekinskia at 12:38 PM on August 21, 2002


Warning TMI: my first LEEP was the single most painful thing I have ever been through. On the plus side (?) it completely reset my personal pain scale...now getting my legs waxed is a breeze!
posted by JoanArkham at 12:39 PM on August 21, 2002


One cause:CIRCUMCISION

From the article Paris linked to: "The general adoption of circumcision might lead to a further reduction in the incidence of cancer of the cervix of 23% to 43%"

I don't think 'cause' is the right word.

Don't they deserve to know whether they have HPV or not, and not just whether they have the symptoms of HP

Are the other screening methods that much more convenient or are docs just not doing it?
posted by insomnyuk at 12:48 PM on August 21, 2002


swerve - I have heard the same from my doctor and read the same as well (where I can't remember).

My doctor also said that there are many strains of HPV - some so small - they can actually pass through the condom. You could have HPV for years and never know it, it can remain "dormant", not showing up on tests of any kind for quite some time.

When you have your next exam girls/women/fellow chicks, request a Thin Prep Pap Test. Even if it is not covered by your insurance, if you can at all afford it - this test is far more accurate. Get a full exam - I know it's not fun - and test for everything. Even if you are in a very committed relationship or if you've been celibate for a while - keep up with your yearly exams. Remember, some things may not show up right away. I had several years in a row of completely clear paps. Until this year.

I had a colposcopy and biopsy. It was uncomfortable, to say the least, but the peace of mind knowing that things are okay, not cancer, is a big weight off your mind. For a while - I'll go back every six months, instead of once a year. But the doc thinks that the mild dysplasia should clear up on its own. Here's hoping.
posted by thinkdink at 1:03 PM on August 21, 2002


Cheer up guys.

Lots and lots of sexually active folks have genital herpes that never progresses to a visible lesion. And the best part is, these same folks are thought to still be contagious every now and then....
posted by BentPenguin at 1:09 PM on August 21, 2002


My doctor also said that there are many strains of HPV - some so small - they can actually pass through the condom.

From the CDC recommendations: "Laboratory studies that determine whether or not organisms can penetrate latex condoms under conditions more stringent than those during intercourse, demonstrate that condoms provide an impermeable barrier to organism considerably smaller than those that cause genital ulcer disease and HPV infections".

Right before you hit the sack, do you demand a synposis of their medical history?

Yes. And in an ideal world, someone who knows they are infected (or might be infected) with HPV, HIV, herpes, or any other infectious disease would volunteer this information before intimacy. It's the right thing to do.

Which, of course, begs the question of how you know if you're infected or not. I am not aware of any efficient screening tests for subclinical infection (ie HPV infection that does not manifest "warts"). There are tests available for the detection of several types of HPV DNA in cells that one obtains via a PAP smear, but the usefulness of these tests is unknown at present. The simple application of acetic acid to tissue infected with HPV can show characteristic "white spots" (acetowhitening), but this test isn't specific and is not recommended as a screening tool.

Cancer is usually seen as having multifactorial causes. In other words, infection and/or exposure to an environmental carcinogens and genetic factors all contribute to causing the disease.

Folks, you can catch serious diseases from other people, via sex -- and also via sitting close together in church. There are a lot of known viruses that are tumorigenic -- there are probably many others that we know nothing about.
posted by fold_and_mutilate at 1:28 PM on August 21, 2002


Hey F&M, you fountain of knowledge you, I have another question. You said that there are tests available for the detection of several types of HPV DNA in cells from a PAP. I was under the impression that one could also have their blood tested for the presence of HPV. Is that correct? If so, how reliable are these types of tests?
posted by zekinskia at 1:50 PM on August 21, 2002


I'm not aware of any blood test for HPV infection. However, I'm not up on all the latest gynecological literature. You might check Medline.
posted by fold_and_mutilate at 2:25 PM on August 21, 2002


Yes. And in an ideal world, someone who knows they are infected (or might be infected) with HPV, HIV, herpes, or any other infectious disease would volunteer this information before intimacy. It's the right thing to do.

I agree. But I doubt a majority of people that ought to be doing this are. Call me a cynic.
posted by insomnyuk at 2:34 PM on August 21, 2002


(another TMI warning) ... all of which leaves those of us who might have HPV (abnormal cells, no warts, no definite diagnosis) in a bit of a bind, sexually speaking. I'm not, uh, active these days, but I don't plan on being celibate forever. I haven't got a clue what to tell my next partner.
posted by swerve at 2:38 PM on August 21, 2002


I FULLY believe in being responsible and having an open an honest dialogue - but if you don't know, you don't know.

Should you be so honest to say that you one day may or may not have evidence of this virus that he may or may not get and if he does it may or may not cause him any problems?

In a way, to me, that's almost like saying, "I might have cancer one day and die - so we shouldn't consider a long term relationship." No, that's silly.

Yes, be open and honest, and discuss, use condoms and common sense, and get regular tests - but realistically, there is no cure for this virus, you could be asymptomatic for years. If you don't know - you don't know.

Same goes for your partner. You (and he/she) are not being dishonest if you've done everything you know to do and don't have any positive results.

Create a relationship where there is enough trust that you can discuss what may come up and work through it together.
posted by thinkdink at 2:56 PM on August 21, 2002


HPV is also generally touted by people arguing for pathogens as the cause of cancers. It is a
growing argument even covered in mainstream media. Several books have been written on the subject.

The idea is, essentially, that we are inhabited by many organisms (some argue up to 20% of our cells are foreign). Most of these organisms we know next to nothing about, and they have always been assumed to be benign. The argument goes that perhaps some of these foreign organisms are largely benign, but over enough time they cause fatal errors in our biology.

Annoyingly, my father always tried to tell me this was going on all the time I was growing up. Perhaps, he may end up being right ><.
posted by rudyfink at 5:44 PM on August 21, 2002


From bbc.co.uk ;
"Cervical cancer killed around 1,250 UK women in 2000."
It's worse than I thought!

I have some anecdotes and knowledge but as my friends know I post here under this name I'm going to just listen :(
posted by Dillonlikescookies at 10:21 PM on August 21, 2002


The general adoption of circumcision might lead to a further reduction in the incidence of cancer of the cervix of 23% to 43%

Sort-of related discussion here.
posted by dg at 12:17 AM on August 22, 2002


To put it in perspective though Dillonlikescookies, in 2000 in the UK lung cancer killed 33,770 people, large bowel cancer killed 16,270, breast cancer 12,840 and prostate cancer 9,280 out of a total of 151,185 deaths from cancer, according to Cancer Research. Cervical cancer wasn't even common enough to have its own separate stastic. Bladder cancer killed more women than cervical cancer.

According to Cancer Research the high incidence of lung cancer is directly related to smoking. So if you're a smoker, getting regular smear tests is missing the point a bit.

Prostate cancer kills far more people than cervical cancer and although there is a screening programme you don't hear much about it and men aren't called by the health authority to have tests. Why? Is it because 90% of men who die from it are over 65? Or because men aren't expected to go through the indignity of being screened?
posted by Summer at 4:32 AM on August 22, 2002


Prostate cancer kills far more people than cervical cancer and although there is a screening programme you don't hear much about it and men aren't called by the health authority to have tests. Why?

Most all physicians make a point of insisting on regular digital prostate exams for men (get one yearly if you are 45 or older). The prostate specific antigen (PSA) level test is insufficiently sensitive and specific for use as a routine screening test. Serum PSA elevations can be seen in non-cancer diseases like prostatic hyperplasia, prostatitis, and prostatic infarction. Indeed, I was taught that PSA levels rise even after a patient's digital exam.
posted by fold_and_mutilate at 12:13 PM on August 22, 2002


« Older Go, Speed Racer, Go. ...  |  We, the undersigned, think you... Newer »


This thread has been archived and is closed to new comments