Opening STD Awareness Month with a Success Story: HPV and Cervical Cancer


This article is published in partnership with the National Coalition of STD Directors (NCSD) as part of our joint series on STD Awareness

Each year, we recognize April as STD Awareness Month, and each year I am struck by the continued epidemics of sexually transmitted infections in this country. But this April there is an extra urgency among public health officials and practitioners to both prevent and reduce STDs. And throughout this month, NCSD is working with our friends at RH Reality Check to feature articles addressing issues of greatest urgency.

Because let’s review the facts. In total, CDC estimates that there are approximately 19 million new STD infections each year, which cumulatively cost the U.S. health care system $16.4 billion annually and have huge personal costs for individuals. We also know that certain populations, such as men who have sex with men, youth, and communities of color bear a disproportionate burden of sexually transmitted infections (STIs) and related diseases. Each year, half of new STD cases occur in people ages 15 to 24.  And yet, throughout this ongoing public health crisis, STD programs across the country are facing more and more uncertain times with reductions in funding from state, local, and federal payers.

And while we have many, many challenges in fighting STDs and their complications (a set of issues we will cover throughout the month) I want to open this STD Awareness series with a success story: fighting cervical cancer. Because here’s the thing: cervical cancer is almost completely preventable. This means that, given consistent and correct care, you will likely never been one of those 4,000 U.S. women who die each year of this preventable and treatable disease.

The reason that cervical cancer is almost completely preventable is because, unlike many cancers, which are caused by a number of physical, genetic, lifestyle and environmental factors, almost all cervical cancer is caused by a sexually transmitted virus, the human papillomavirus (HPV). HPV is very common in the United States— so common that at least 50 percent of sexually active men and women get it at some point in their lives, according to the Centers for Disease Control and Prevention. There is indication that this is a conservative estimate and that HPV is one of the most common STDs in the world and as common as the cold virus, with a prevalence of up to 90 percent. HPV is passed through skin-to-skin contact during sexual activity with another person, most often during vaginal and anal sex, as well as through oral sex. There are many different types of HPV and since it usually causes no symptoms (like many STIs), you can get HPV—and pass it on—without realizing it.

In 90 percent of cases, your own immune system clears HPV naturally within two years. But, sometimes (and for unknown reasons), HPV infections are not cleared and can cause cervical, anal, vulvar and vaginal cancers as well as genital warts. There are over 30 types of HPV, but two strains (16 and 18) cause 70 percent of all cervical cancers and are also responsible for most other reproductive cancers. In addition, two other strains (6 and 11) cause approximately 90 percent of all genital warts.

But here’s the good news about HPV: there are vaccines currently available that prevent against the types of HPV that can lead to cancer and genital warts. Let me say that again: there are now two vaccines that can prevent cancer. Currently on the market are two vaccines approved for women ages 11 to 26: Gardasil and Cervarix.

In addition, there is an HPV vaccine approved for use in men. That’s right– HPV vaccines are not just for girls anymore! Gardisal is now approved for males under 26. While they cannot get cervical cancer, HPV can cause genital warts in men, as well as cancer of the penis, anus, or oropharynx (back of the throat). Men who have sex with men, as is the case with many STIs, are at an increased risk of HPV-related disease.

Now many of us may get a little squeamish about the idea of preventing an STI in a pre-teen, even if it is one that is both prevalent and linked to cancer. But here’s the rub: a vaccine cannot prevent against something a patient already has. As a result, HPV vaccines offer the greatest health benefits to individuals who receive all three doses long before having any type of sexual activity. That’s why the HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years.

Both vaccines are administrated in a three-shot series over a six-month time frame. It is vitally important that individuals complete the full three shot series. Only through the full three shots will women and men receive the full cancer protection of the vaccine. Research released in December 2010 found that only 14 percent of girls and women who start the series finish within the recommended time period. This research also found that women of color and those who do not have private insurance were less likely to receive all three shots compared to white women and women with private health coverage. These facts are disappointing and threaten to decrease the promise of a vaccine to cut cancer, particularly in reducing the existing health disparities that currently exist in cervical cancer.

While the vaccine is a huge step in fighting a preventable and treatable cancer, it is not the end-all be-all in cervical cancer care. There are over 30 types of HPV and the vaccines only protect against two or four strains, respectively. There are still other strains of HPV that cause cancer, and it is possible that a woman could already be infected by HPV when she was vaccinated. As a result, even with vaccination routine Pap tests or other cervical cancer screening tests are still necessary.

The National Coalition of STD Directors, and its member health departments across all 50 states, seven large cities and eight US territories, are key partners in the fight against cervical cancer as well as other reproductive cancers. State and local STD programs are a key location to receive the vaccine. I encourage you to visit our website (www.ncsddc.org) to find a site for STD testing and the HPV vaccine near you.

While we have come a long way, access to the vaccine continues to be a concern. There are programs such as the Vaccines for Children program to assist those in need, but a full series of the shot retails for approximately $390, according to the Centers for Disease Control and Prevention. Along with increasing the completion of all three shots, ensuring resources are available to those who find this cost out of reach is vital to ending cervical cancer as we know it in this country.

But this is the bottom line: cervical cancer is one fight we can win.

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  • 3xsurvivor

    Unfortionately, what has made cervical cancer incidence drop and survival rise is not reductions in the spread of the virus that causes the cancer but better awareness of the risks and monitoring of the virus and pre-cancerous signs by women during regual gynecological exams.

    The same is not true for two other HPV-related cancers, anal cancer and oral cancer.  While I am not familiar with anal cancer, the growth of oral HPV-linked oral cancers has been sufficiently rapid in the past five years that in 2012 there are more HPV-linked oral cancers than cervical cancers.   In addition, by the end of this decade, there will be more HPV-linked cancers of just the oropharnx (the back of the throat, tonsils and base of the tongue) as Cerviceal cancers. 

     

    What is clear is that adults who have had vaginal or oral (male on female) sex with 6 partners over one’s lifetime has a 9 times greater risk to develop he cancer than individuals who have neve had sex and three times the risk of those that have had 1-5 partners.  But armed with that fact, ther eis little anyone can do to prevent transmission, and even knowing if one has the HPV virus in one’s mouth tells little about the risk for developing oral cancer.

     

    What is clear is all a person can do is take actions to minimize the impact of oral cancer treatment if they such a diagnosis arises.   The action involves two steps.  1) Be aware of oral cancer symptoms and see a dentist if the symptoms last more than two weeks.  Dentists are more capable than general practicioners when doing an initial screening for oral cancer as they are trained to identify both potential tumors and ares that look suspicious but the existence of a tumor is unclear. 2) Have regualar dental exams that includes a visual and tactile examination for oral cancer. 

     

    While this will not reduce the number of oral cancer diagnoses it will result in more diagnoses of smaller tumors that reduces the severity of the treatment and the side effects that are currently common for HPV-related oral cancer survivors.