In Today’s News:
Michael Douglas and Catherine Zeta-Jones are taking a break. Douglas has been battling a form of throat cancer that has been linked to HPV, and the press has been focusing in on the couple’s troubles.
What they really need to be focusing on is the HPV vaccine, HPV’s link to throat cancer, and the public health issues around this.
There’s a high probability that you have or have had HPV, the same type of sexually transmitted disease that Michael Douglas had. According to the CDC website, HPV is so common that most people get it sometime in their lives.
As a former Ob/Gyn turned preventive medicine doctor and hormone specialist, this is a conversation I have had with many patients who have had their pap smear turn up HPV positive. They consistently ask two questions, “How did I get this?” and “Does this mean my partner is cheating on me?”
While the infection is obtained from sexual activity, the majority of sexually active people have had the infection at one point or another in their lives. Yes, I mean you (and me). Diagnosis with an HPV infection DOES NOT mean that your partner is cheating on you. And it doesn’t mean that you’ve been promiscuous.
Most people are infected by HPV and live with it for many years without any symptoms. HPV infections usually come and go completely undetected, frequently disappearing without any treatment. In the case of Douglas and Zeta-Jones, one or both of them may have come into their 13 year marriage with the virus that was related to his throat cancer.
The fact is that we don’t know how long it takes from the time of infection with HPV until one gets cancer, but we do know that it takes years. It has been documented to take as long as 15 years from infection to cancer in some people.
I tell this story not only as an Ob/Gyn, but also as a patient. In my 20s, I was diagnosed with HPV and a precancerous lesion on my cervix. I can tell you firsthand that the diagnosis of cervical HPV is no fun. An uncomfortable stigma is attached to the diagnosis, and the medical evaluation can be downright scary.
I suffered lots of unwanted, but necessary poking and prodding of my private parts by medical professionals. And I was lucky enough to be treated quickly with no recurrence. Still, I am always a little nervous when I’m waiting for those pap smear results.
We have identified more than 200 different types of HPV. New ones are being found every day. Some types are more likely to cause cancer, while others are more likely to cause warts, including genital and other benign skin warts. Having genital warts does not mean you will have cancer, but warts are caused by the HPV virus.
It has been known for a while that HPV can cause cervical cancer. A pap smear can help to screen for the presence of cervical cancer and for the presence of cervical HPV. If you don’t know if you’re currently being screened for HPV with your pap smear, be sure to ask your practitioner to do it. The presence of cervical HPV may prompt your healthcare practitioner to evaluate for a precancerous lesion that could result from the HPV virus.
HPV viruses are classified in many different ways, but one of the basic classifications is risk of cancer. When you get your HPV test, make sure it screens for high risk types. Some of the HPV types that put you at the highest risk of cancer are types 16, 18 and 45.
The newer players on the stage of HPV-induced cancers include oral cancers like throat, mouth, tonsillar, and colorectal, as well as genital cancers (other than cervical cancer), including vulvar, vaginal, penile, anal cancers and possibly even bladder cancer. In terms of mouth and throat cancers, more than 70% of all of them are HPV positive. 95% of the cancers that were HPV positive were positive for types 16 and 18.
The September 2013 issue of the journal Oral Oncology is coming out this month with some interesting statistics about HPV in mouth and throat cancers. The number of mouth and throat cancers caused by HPV is rising sharply from only 16% in the 1980s to approximately 73% of the mouth and throat cancers in the year 2000.
Not only is the incidence of HPV related mouth and throat cancer rising, but the incidence of these cancers overall is rising as well. From 1988 to 2004, there was a 28% increase in the risk of mouth and throat cancers (particularly squamous cell cancers), and this rising risk was primarily in men ages 50-59. Some good news here is that HPV positive cancers tend to be more responsive to treatment than those that are HPV negative.
Since 2006, two vaccines against HPV types 6, 11, 16 and 18 have been available. And it has been shown that these vaccines actually can protect against cervical cancer. Scientists speculate that the vaccine may help to prevent other cancers that are caused by these viruses, like mouth and throat cancers, and various other cancers that have HPV as part of their cause.
Some of the factors that will make an HPV infection more likely to turn to cancer include smoking, chewing tobacco, heavy alcohol use and a compromised immune system. People with HIV are much more likely to have HPV-related cancers than non-HIV infected individuals.
HPV is not transmitted by sharing drinks or food or kissing on the cheek, but it’s not known if deeper kissing can transmit HPV. Oral HPV infection risk increases with increasing number of oral sex partners, but many people with HPV infection have only had very few sexual partners in their lives.
What can you do to prevent HPV-related cancers? Looking to the future, therapeutic vaccines that will treat HPV once you are already infected are in the works but are not currently available, so your best bet is prevention.
If you’re a woman, make sure to have HPV screening done with your next pap smear. Using condoms and dental appliances has been shown to decrease the transmission of HPV.
The decision to vaccinate yourself or your child should be made after thoroughly weighing the risks and benefits. The vaccine is for prevention only. It’s for males and females ages 9-26. After that, you’re not considered to be a candidate for the vaccine. The vaccine won’t work for people who have already been infected. I recently decided to have my children vaccinated, and they are currently undergoing the three-vaccine series.
To avoid getting HPV, consider using condoms for intercourse, anal and oral sex. Also consider the use of dental dams with oral sex.
A new August 2013 study shows that poor oral health is associated with higher risk of oral HPV infection. So it’s important to use good oral hygiene techniques like thorough brushing and flossing to decrease your likelihood of having an oral HPV infection.
Studies have shown that people with lower levels of certain nutrients have more dangerous precancerous or cancerous cells due to HPV. Make sure you take in good amounts of B vitamins – particularly thiamin, riboflavin, folate, and vitamin B12 – as well as vitamin C and vitamin E by eating a healthy, varied diet of whole natural foods; or take nutritional supplements that will help keep your immune system strong.
Again, there’s a high probability that if you have been sexually active, you have or have had HPV, the same type of sexually transmitted disease that Michael Douglas had. Get screened, prevent transmission of the virus with barrier protection, support your immune system, consider getting vaccinated or getting your children vaccinated. Become a part of the conversation.