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Health Talk 

Nearly 10,000 women in the United States are diagnosed with cervical cancer each year. Almost 4,000 die from it. Most cervical cancers are caused by the human papilloma virus (HPV), which has also been linked to certain types of cancer in men. HPV is a group of viruses that includes more than 100 strains, 30 of which are sexually transmitted. The Center for Disease Control (CDC) estimates that 6.2 million people contract HPV each year and another 20 million are already infected. Of those, about 9.2 million are teenagers and young adults ages 15-24. In June 2006, the Food and Drug Administration (FDA) approved a vaccine called Gardasil that protects against most HPVs that cause cervical cancer. OB/GYN and surgeon Dr. Rachel Reitan, an assistant clinical professor in the OB/Gyn Department at Tulane University, conducted research on the new vaccine two years ago at University of California-Irvine Medical Center.

 

Q: What percentage of cervical cancer is caused by HPV?

A: About 90 percent of cervical cancers are caused by an HPV virus. The new HPV vaccine protects against four types of HPV. These types are responsible for 70 percent of cervical cancers and 90 percent of genital warts.

 

Q: Have medical professionals and clinicians always known that cervical cancer was often virus related?

A: No. About 20 years ago, they started to note there was a possible connection, so the studies began in order to prove that the virus leads to cancer and pre-cancerous lesions. Then came the medical breakthrough — the development of a vaccine against cervical cancer. In the future, there will probably be proof that tongue cancer is also caused by an HPV virus.

 

Q: Why has so little of the information been disseminated until fairly recently?

A: I do not know. It is a horrible thing. This is a medical breakthrough and the first time a vaccine has been developed for the prevention of a cancer. I think that the issue is that you get HPV from having intercourse, so it is best to give it to children before they have been exposed to the virus through intercourse.

 

Q: Is the virus always transmitted as an STD?

A: Yes. A baby could also get the virus if delivered to a mom with a lot of genital warts.

 

Q: Who is at risk — and who is most at risk?

A: Anyone who is having intercourse. People most at risk are those who have multiple partners. Also, this virus causes anal and rectal cancer, more common in the gay community.

 

Q: Can a woman "carry" the virus and never be seriously affected?

A: Absolutely. It is estimated that about 20 million people have HPV, and each year another 6.2 million people become infected. It is more the persistence of the virus in a person that leads to the health issues. People get exposed and become infected with the virus every day. Most people's immune systems kick in and gets rid of the virus, but some people's immune systems do not kick in. They do not fight off the virus and then it leads to health issues.

 

Q: Who should get the vaccine?

A: The FDA has approved the vaccine for girls ages 9 to 26 years of age. But the provisional recommendations are as follows: The National Advisory Committee on Immunization Practices recommends the routine vaccination all girls between the ages of 11 and 12, and vaccinating all women up to age 26. Although the vaccine can prevent up to 70 percent of cervical cancer, it can't prevent infection from every virus that causes cervical cancer.

 

Q: Are routine Pap tests to screen for cervical cancer still critical?

A: Yes. Ideally, the vaccine should be administered before onset of sexual activity. However, females who are sexually active also may benefit from vaccination. Females who have not been infected with any [type of HPV covered by the vaccine] would receive the full benefit of vaccination. Females who already have been infected with one or more HPV types would still get protection from [those] they have not acquired. Few young women are infected with all four HPV types (covered by) the vaccine. Currently, there is no test available for clinical use to determine whether a female has had any or all of [those] four HPV types.

 

Q: Will women need to be proactive about the vaccination — or will doctors offer the vaccine as part of the patient's wellness program?

A: Very good question. ... In California, doctors were very pro-active about telling their patients about the vaccine. Here in New Orleans, they are not. The physicians in academics here at Tulane are proactive. I sent out emails about the vaccine, did a lecture on the vaccine and I was on TV talking about the vaccine. Word needs to get out about getting kids vaccinated.

 

Q: How does HPV affect men?

A: Most men who get genital HPV do not have any symptoms. However, some types of HPV can cause genital warts. In men, genital warts may appear around the anus or on the penis, scrotum (testicles), groin or thighs. A person can have the type of HPV that causes genital warts but never develop any warts. Genital warts can also be passed on by a person who has HPV but no visible warts. Since the virus can be "silent" for a long time, people can have genital HPV even if years have passed since they have had sex. Certain types of HPV have been linked to cancer of the anus and penis in men. These cancers are rare — especially in men with healthy immune systems. The types of HPV that can cause genital warts are not the same as the types that can cause penile or anal cancer. [There may be a recommendation for using the] vaccine in the gay population in the future. Merck is also currently doing studies in boys (since they can be carriers or transporters of the virus), so the vaccine should become recommended for boys in about two years.

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