Rense: Over 100 Strains of HPV & Cervical Cancer 2nd Leading Cancer??

[Guest guest]

So if cervical cancer is said to be the 2nd leading cancer among

women how come " Cervical Cancer is listed as a " rare disease " by the

Office of Rare Diseases (ORD) of the National Institutes of Health

(NIH)? "

 

http://www.wrongdiagnosis.com/c/cervical_cancer/prevalence.htm

 

Misty L. Trepke

http://health.

 

 

Over 100 Strains Of HPV - No Cure

Some Cause Genital Warts, Some Invade Epithelial Cells

HPV and Cervical Cancer

By Carolyn Vachani, RN, MSN, AOCN

Affiliation: The Abramson Cancer Center of the University of

Pennsylvania

2-29-7

 

http://rense.com/general75/100.htm

 

The Human Papilloma Virus

 

The Human Papilloma Virus (HPV) is one of the most common sexually

transmitted infections (STI) in the world. It is estimated that 5.5

million people worldwide are infected annually. Sexually active

individuals have an 80 to 85% chance of being infected at some time

in their life.

 

The virus invades human epithelial cells (a type of skin cell),

including the oral mucosa, esophagus (throat), larynx (voice box),

trachea (airway), conjunctiva of the eye, and the anal and genital

areas. The time between exposure to the virus and having any

symptoms can be 3 to 4 months, yet the virus can be transmitted to

someone else during this time (unbeknownst to either person).

Although HPV is considered a sexually transmitted infection, this

can be misleading. It is transmitted by skin to skin contact,

therefore traditional methods of protecting oneself against an STI,

such as condoms can reduce, but not eliminate the risk of HPV

infection. Infection can occur through skin to skin genital contact

without intercourse.

 

Persons at higher risk for HPV infection include those with numerous

lifetime sexual partners (the higher the number, the higher the

risk), early age of first intercourse, history of other STIs,

alcohol and drug use related to sexual behaviors, and partner's

number of sexual partners.

 

The infection is most prevalent in women in the 20-24 year old age

group, with 15-19 year olds being the second largest group.

Prevalence decreases with age, dropping significantly after age 30.

It is thought that the younger, developing cervix is more likely to

be infected, but these infections tend to be short-lived and are

usually cleared by the immune system. Cases of cervical cancer are

extremely rare under age 30.

 

Researchers have identified 100 different strains of HPV, 40 of

which can infect the anal and genital areas. These strains have been

further divided into low and high risk strains, which we will

address later. Many people think of HPV as the virus that causes

genital warts, yet only a few of the 100 strains actually cause

warts.

 

There is no treatment to rid the body of HPV, but 80% of infections

are cleared by the body's immune system. For the 20% who develop

chronic infection with HPV, the risk of cervical cancer is higher.

If the HPV strain is one that causes genital warts, they can be

treated by topical methods such as freezing, acid application or

imiquimod (a medication used to boost local immune response).

Surgical treatments include laser, excision, or CUSA (ultrasound).

 

Cervical Cancer and the Pap test

 

Cervical cancer is the second most common cancer in women worldwide.

Approximately 500,000 new cases are diagnosed annually worldwide,

83% of which will be in developing countries (estimated 10,370 new

cases in the US in 2005). There will be an estimated 273,000 deaths

due to the disease annually, three-fourths of these in developing

countries. Higher income nations have the Papanicolaou (pap) test to

thank for a 75% decrease in cervical cancer cases over the past 50

years. Unfortunately, this test has not been successful in lower

income nations due to cost, ability to get the test to women and

once available, to get the results back to them. The Pap test has

made great strides in catching cervical changes early, but it is not

without problems. The traditional Pap test is not very sensitive (55-

60% sensitivity), which means that up to 40-45% of the time that the

test is read as normal, there is actually cervical dysplasia

(abnormality) present. By performing the test annually, along with a

manual exam, we increase the chance of detecting a cancer. Newer

liquid based cytology tests, called Thin Prep ® and Sure Path ® ,

reportedly have a sensitivity of 84%, which is better, but still not

great.

 

Cervical cancer is further broken down into 3 types: squamous cell

carcinoma (about 75% of cases), adenocarcinoma (15-25% of cases),

and rarely, adenosquamous (a combination of the two). It is

recommended that women start screening with Pap smears within 3

years of becoming sexually active, but no later than 21 years old.

Then annual testing with traditional Pap methods, or every 2 years

with the liquid based cytology. Women who have had a hysterectomy

should clarify with their surgeon whether or not they still have a

cervix and whether they should continue screening.

 

Pap Test Results

 

Pap test results in the U.S. are reported in the " 2001 Bethesda

System " . The system is quite detailed, but some of the common

results include the following (and common follow-up):

 

Mild dysplasia (also called CIN 1 or Low grade squamous

intraepithelial lesions (LSIL)): most resolve spontaneously, so

follow with Pap every 4-6 months, if it lasts more than 2 years an

excisional biopsy may be needed.

 

Moderate or severe dysplasia (also called CIN 2 or CIN 3 or high

grade squamous intraepithelial lesions (HSIL)): should be confirmed

by colposcopy and treated for the abnormality.

Atypical squamous cells of unknown significance (ASCUS): Repeat Pap

in 6 months, if still abnormal, colposcopy to test further.

Alternatively, test for high risk HPV strains, if positive,

colposcopy to further evaluate, if HPV negative, can repeat Pap in 1

year.

 

HPV Causing Cervical Cancer

 

Researchers have determined that HPV is found in almost 100% of

cervical cancers worldwide. This is unique to cervical cancer, no

other cancer has been found to have one central cause. Even the tie

between smoking and lung cancer is not as strong, with only 80 to

85% of cases caused by smoking. Although HPV is necessary to the

development of cervical cancer, it alone is not enough. About 80% of

HPV infections are transient and resolve without treatment because

the immune system is able to fight them off. Some factors that

appear to increase the risk of HPV infection not clearing and

possibly progressing to cancer include: cigarette smoking, oral

contraceptive use for more than 5 years, multiple births, and poor

nutrition. Studies have found smokers to be 2-3 times more likely to

develop cervical dysplasia or cancer than nonsmokers. Several

studies have showed a dose intensity relationship, the more tobacco

smoked, the higher the risk. In addition, researchers have found

that nicotine is present in the cervical cells of smokers.

 

There are 40 strains of HPV that can affect the anal and genital

tracts and these are further divided into low risk and high risk

strains. Thirteen strains are considered high risk, or more likely

to progress to high grade lesions (HSIL, CIN 2 or 3) and possibly

cancer, if not cleared by the immune system. These strains are: 16,

18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. Strains 16 and

18 are by far the most common types, and one or both are present in

approximately 70% of cervical cancers worldwide. Despite this strong

link, only a very small percentage of high risk HPV infections will

ever become invasive cancer (estimated at 2%). The time between

initial exposure and the development of cancer can vary from months

to years, but the average time is thought to be 15 years.

Unfortunately, the high risk HPV strains do not usually cause any

symptoms to alert someone that they have the infection. The low risk

strains are not considered a risk for cervical cancer, but they can

cause low grade lesions (CIN 1) and several of these strains can

cause genital warts.

 

Testing for HPV

 

Several years ago, a test was developed to identify high risk

strains of HPV. The test is done on the same cells that are used in

a Pap test. Studies have found the Hybrid Capture II test to detect

the presence of high risk HPV in 83-100% (depending on the study) of

high grade lesions (CIN 2 or 3, HSIL) or invasive cervical cancer.

 

In women over the age of 30, when both Pap test and high risk HPV

tests are negative, the woman should wait 3 years for the next

screening.

 

With a Pap result of atypical squamous cells of undetermined

significance (ASCUS), women have the option to repeat the Pap in 6

months and if the result is the same, proceed to colposcopy for

further evaluation. Alternatively, the cervical cells can be tested

for high risk HPV strains. A Pap result of ASCUS, in conjunction

with a negative HPV test, can be followed with a repeat Pap in 6 to

12 months. If either test is positive at that time, colposcopy

should be performed. If the initial HPV is positive with an ASCUS

Pap, colposcopy is warranted.

 

The test costs between $50 and $200, depending on the lab used. Many

insurance companies cover the cost of the test if it is being used

as screening for women over 30 (as this is recommended by several

medical organizations). Some companies will cover the cost of HPV

testing for women under 30 with an inconclusive or abnormal Pap test

result. But many experts agree that abnormalities in young women are

a result of transient infections and can be followed by repeat Pap

testing in 6 to 12 months.

 

One thing to keep in mind, almost all women will have an HPV

infection at some time in their life. The Hybrid Capture test does

not have the ability to tell what HPV strain the person has, just

whether or not they have any high risk strain. Multiple positive

results over years could be different transient infections and

cannot be assumed to be a persistent infection with one strain.

 

Vaccines

 

There has been a lot of talk about vaccines for HPV, but they are

all still in development or in clinical trials. Merck and Glaxo

SmithKline appear to be the first companies ready to apply for FDA

approval (applying in early 2006 and 2007 respectively). Their

vaccines are targeting the two most common HPV high risk strains, 16

and 18, which are responsible for 70% of cervical cancers worldwide.

An important piece of patient education regarding these vaccines, is

that they will still need to have Pap tests, as there are still

eleven other HPV high risk strains that can lead to cervical

dysplasia or cancer. The pharmaceutical companies have found that

the vaccine is less effective if they add more strains to it,

therefore they feel targeting the 2 most common types is best.

Information available from ongoing trials report the vaccine to be

about 90% effective in preventing HPV infection. Researchers feel

the vaccine would be best given to adolescents ages 9-12, who have

not yet been exposed to the virus. Early trials did not include

these age groups, but are currently ongoing. In addition, it is not

yet known how long the vaccine will protect women from HPV.

Regardless of these issues, it is clear that this could be a major

step in decreasing cervical cancer mortality in lower income

countries.

 

What About the Men?

 

Researchers have historically been looking at women and HPV because

of the cervical cancer link, but men are getting a closer look.

Obviously, men are a large part of the issue of HPV rates, so it

makes sense to target them as well. Vaccines are only now being

tested in men and adolescent boys.

 

Anal cancer rates have increased 160% in men from 1973 to 2000,

which is very concerning to researchers (rates in women have

increased 78%). One study found 88% of anal tumors studied contained

HPV, suggesting it may be a causative factor. Several other factors

also increased the risk: >14 lifetime sexual partners, receptive

anal intercourse, and smokers were almost 4 times as likely to

develop anal cancer. HPV has also been linked to penile cancer in

men and head and neck cancers in both sexes.

 

Most men, like women, have no symptoms, unless they develop genital

warts. Currently, aside from treating genital warts, there is no

treatment for HPV in men. It is known that anal warts can be a

precursor to anal cancer and these warts can be tested for high risk

HPV strains. This can allow for surgical intervention for the

patients at highest risk for developing anal cancer.

 

Knowledge about Human Papilloma Virus has grown tremendously in the

last 10 years and is certain to continue. Healthcare providers and

consumers will need to keep abreast with changes in practice in

order to achieve improved health outcomes for women. Look to

OncoLink for periodic updates!

 

References

 

Abeloff, M., Armitage, J., Niederhuber, J., Kastan, M. & McKenna, G.

(Eds.): Clinical Oncology (2004). Elsevier, Philadelphia , PA.

The American Cancer Society. Facts and Figures 2005 .

<http://www.cancer.org/>www.cancer.org

 

Arbyn, Mark et al. Virologic Versus Cytologic Triage of Women With

Equivocal Pap Smears: A Meta-analysis of the Accuracy To Detect High-

Grade Intraepithelial Neoplasia. Journal of the National Cancer

Institute , 2004; 96(4):280-293.

Castellsague X, Bosch FX, Munoz N. Environmental co-factors in HPV

carcinogenesis. Virus Res 2002;89:191-9.

Daling JR, Madeleine MM, Johnson LG et al. Human papillomavirus,

smoking, and sexual practices in the etiology of anal cancer. Cancer

2004;101:270-80.

Damasus-Awatai G, Freeman-Wang T. Human papilloma virus and cervical

screening. Curr Opin Obstet Gynecol 2003;15:473-7.

Fey MC, Beal MW. Role of human papilloma virus testing in cervical

cancer prevention. J Midwifery Womens Health 2004;49:4-13.

Franco EL, Harper DM. Vaccination against human papillomavirus

infection: a new paradigm in cervical cancer control. Vaccine

2005;23:2388-94.

Goldie SJ, Kohli M, Grima D et al. Projected clinical benefits and

cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl

Cancer Inst 2004;96:604-15.

Munoz N, Bosch FX, de Sanjose S et al. Epidemiologic classification

of human papillomavirus types associated with cervical cancer. N

Engl J Med 2003;348:518-27.

Papaconstantinou HT, Lee AJ, Simmang CL et al. Screening methods for

high-grade dysplasia in patients with anal condyloma. J Surg Res

2005;127:8-13.

Raley JC, Followwill KA, Zimet GD, Ault KA. Gynecologists' attitudes

regarding human papilloma virus vaccination: a survey of Fellows of

the American College of Obstetricians and Gynecologists. Infect Dis

Obstet Gynecol 2004;12:127-33.

Sankaranarayanan R, Chatterji R, Shastri SS et al. Accuracy of human

papillomavirus testing in primary screening of cervical neoplasia:

results from a multicenter study in India . Int J Cancer

2004;112:341-7.

Washam C. Targeting teens and adolescents for HPV vaccine could draw

fire. J Natl Cancer Inst 2005;97:1030-1.

Washam C. Two HPV vaccines yielding similar success. J Natl Cancer

Inst 2005;97:1030.

Wright TC, Jr., Schiffman M, Solomon D et al. Interim guidance for

the use of human papillomavirus DNA testing as an adjunct to

cervical cytology for screening. Obstet Gynecol 2004;103:304-9.

 

Last Modified: November 11, 2005

 

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