One of the most important advances we have made in modern medicine is with cervical cancer. While it is now considered one of the more rare cancers in the United States, it still continues to be a leading cause of death related to cancer in developing countries. The reason for this discrepancy is the Pap smear. This very simple test can detect early abnormalities in the cells of the cervix, and proper follow up procedures can stop the development of cervical cancer. Although this has decreased the rate of cervical cancer in the US dramatically, there are still cases that occur because many women donâ€™t get the Pap smear as recommended. Because of the HPV vaccine, these cases can be additionally prevented, as well as follow up procedures that are performed after an abnormal Pap smear is taken.
HPV, or the human papilloma virus, is a group of over 100 viruses. These viruses can cause all types of problems – the majority of them cause benign warts, usually on the surfaces of the hands and feet. However, there are about 30 or 40 strains of the virus which are â€œmucosalâ€ viruses. â€œMucosalâ€ refers to the lining of organs or body cavities that are exposed to the outside world. For example, the vagina and the anus have a mucosal layer, and are therefore susceptible to infection. Since these are the most common mucosal areas affected by these HPV strains, they are known as genital-type HPV. Some of the genital HPVâ€™s can cause benign warts in the genital areas and rarely cause cervical cancer, and therefore are known as â€œlow-riskâ€ viruses. The â€œhigh-riskâ€ viruses have been linked to 99% of cervical cancers, and some anal cancers (in men and women). There are about 15 of these subtypes – out of these, the HPV-16 and 18 cause cervical cancer 70% of the time.
One usually gets the genital-type HPV during vaginal or anal intercourse. There are no symptoms of infection, unless one develops warts. These warts can develop over weeks to months after exposure, and most people may not develop them at all. Many people may actually inactivate the virus with their own immune system, but there are a fraction of people who end up getting manifestations of the virus. It is this unfortunate group of people that are at the highest risk of getting cervical cancer. Since in the US this virus infects 6 million men and women per year, this small fraction may actually amount to a much larger number than we would like. Another unfortunate aspect is that about half of these cases affect women between 15 and 25 years of age.
There is no treatment for HPV as of yet. Recently however, a vaccine was developed to prevent HPV-16 and 18, the two types that most commonly cause cervical cancer. There are two vaccines on the market right now, Gardisil and Cervarix. In addition to preventing HPV-16 and 18, Gardisil also prevents two of the viruses that cause genital warts. Once these two vaccines hit the market, the National Cancer Institute commented: “Widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds, if all women were to take the vaccine and if protection turns out to be long-term. In addition, the vaccines can reduce the need for medical care, biopsies, and invasive procedures associated with the follow-up from abnormal Pap tests, thus helping to reduce health care costs and anxieties related to abnormal Pap tests and follow-up procedures.”
Since its implementation into the market, the vaccines have been approved for women between the ages of 9 and 25 who have not contracted HPV. However, since most women have not likely contracted all four strains of the virus, the CDC has recommended that the vaccine be given to all women up to the age of 26. The manufacturer of Gardisil (Merck) is seeking an indication from the FDA for women up until the age of 45. As of 2008, more than 8 million women and young girls have received the vaccine. The vaccine has been relatively safe, although there have been some reports of Guillian Barre Syndrome that are being investigated by the National Cancer Institute.
We have made tremendous progress in the world of medicine. The implementation of the Pap smear has shown that a standard screening method for a cancer can essentially make a cancer a rare cause of death. However, there are challenges that remain, such as compliance and follow up. The HPV vaccine will help eradicate the need for such rigorous health maintenance, especially in low-income women. If you are reading this article, you know enough at this point to ask your doctor about your choices. Whether you can get the vaccine, or if you should be getting Pap smears, this is one thing you can do to save your life, guaranteed.Â â€”Â Dr. Reema Batra