Cervical cancer, vaccines and PAP smears.

Factual Questions
1

I just saw an interesting segment about a vaccine breakthrough.

An article can be found about it here.

I have a few questions for the more medically inclined, since there isn’t much in the way of details in the article.

Is the vaccine for those who haven’t contracted HPV ? And what exactly is the link between HPV and cervical cancer ? Does this mean that if you haven’t got HPV (and aren’t at risk of contracting it) you don’t need to get a regular PAP ? Can you be tested for HPV and then surmise that PAPs aren’t necessary anymore ?

Thanks for any explanation :slight_smile:

2

IANAD, but what the heck, I have decent layman’s knowledge of medicine. (And I’m sure the docs will correct me if I’m wrong).

HPV, or human pappilloma virus, is, among other things, the cause of genital warts. It is also associated with cervical cancer and is believed to trigger the disease. It’s one reason cervical cancer is associated with promiscuity - the more partners you have, the more likely you are to catch the virus.

However, not everyone coming into contact with the virus gets either warts or cancer, some people can fight it off on their own, some can’t.

Anyhow, the vaccine is for HPV. The idea is that if you’re immune to HPV you won’t get either warts OR cervical cancer.

Now, about those pap smears… at present, it’s recommended that evern virgins above 18 receive them on a regular basis, and those folks are, needless to say, at extremely low risk of contracting a sexually transmitted virus. They are not, however, required to get them yearly.

While the main purpose of a pap is to detect pre-cancerous and cancerous cells, they do detect abnormal cells of any sort. They might continue to have use in detecting various other infections. But yes, a whole lot fewer of them will be done.

The article on the BBC said something about the vaccine only being given to virgins, and that it was ineffective in someone who had already had HPV. Frankly, I don’t know the details on that.

3

Just wanna point out that it’s still extremely experimental, which the various media puff pieces and press releases don’t make clear.

http://www.cnn.com/2002/HEALTH/conditions/11/20/cancer.vaccine.ap/index.html

That is a small study, and it was only a “proof of principle”, as one of the researchers says way, way down in the article. And it’s not a “vaccine against cancer”, but only against HPV.

It only addresses HPV, not the “cancer” itself, and it only addresses one particular strain of HPV, the most common one, the one that Merck thinks they can make the most money from addressing with a vaccine.

And since it’s pointless to give a vaccine to someone who already has the disease, I suppose some media outlets would translate that to “you can only give the vacccine to virgins”.

4

Well, having had surgery yesterday for cervical cancer, I’ve ben doing quite a lot of reading on the subject and following new research developments rather closely. There’s some good info on the CDC, NIH, and American Social Health Association websites.

Everything I’ve read says that about 95% of cervical cancer is caused by the HPV virus, and that the virus is carried by anywhere from 50% to 80% of the sexually active population. So while promiscuity increases the odds that you will contract the virus, it’s quite possible to have had very few partners, or even only one, and still contract the virus. Most carriers are unaware that they are carriers, and will never show symptoms of any kind. I was not in a high-risk group for contracting HPV, as I don’t smoke (although why there is a correlation there, I have no idea, but it’s always listed as a major risk factor), and I haven’t had piles of sexual partners (none at all in the past year, in fact, which amazed my gynecologist). So EVERYONE who has ever been sexually active should definitely have regular Paps; the HPV virus can remain dormant in the body for many years before wreaking its havoc.

There are only a few of the 100+ strains of HPV that are connected with cervical cancer, and they are different strains than the ones that cause visible genital warts. So your partner can appear to be perfectly fine, and even be unaware of being a virus carrier, and give you the type that will cause cancer.

I am still left with some questions about all this, though: Does anyone understand the biological aspects of how immunity to HPV would work, via vaccine or otherwise? Is it like chickenpox, where once you contract it, you generally are immune for life, but still carry the virus (and can end up with related diseases, like shingles, down the line)? Can someone who has contracted one strain of HPV still be immunized against the others? Does the vaccine use live or dead virus? Does anyone even know the answers to these questions yet?

I’m no medical person, so this is all very confusing. I am rather linguistically inclined, though, and hate how most patient-focused medical literature is “dumbed down,” so any links to journal articles, etc. would be greatly appreciated.

5

Thanks for the info so far, Broomstick, DDG & ** Eva**. I hope recovery from your surgery is relatively painfree, Eva.

Can anyone explain what the link is between HPV and cervical cancer ? I was unaware a virus could cause cancer, and would love a laymen’s explanation of the processes involoved.

Is there an easy test for both male and female to be tested for HPV ?

If 95% of cervical cancer is caused by HPV, why do they recommend 18 year old virgins get PAP’s ?

6

I once knew a girl at Uni who had cervical cancer at age 15 or 16. She was sexually active, and American, which were the two main reasons she had a PAP at such a young age (from what I understand “well woman” style comprehensive health care is very good in the US, certainly it doesn’t exist on the NHS!)

But she said to me that being sexually active was incidental to the cancer, because if she had got it throught sex, it would have taken longer to develop. ie, she had got cancer anyway, and the only reason she detected it was because she had had sex and went for a routine check-up.

7

  1. Smoking is a risk factor for cervical cancer for a very good reason. The stuff you inhale… get ready for this (when I read it it grossed me out entirely) gets into your cervical mucus. Yes, if you’re a smoker, the tar in your bloodstream is less than the tar in your cervical mucus. Therefore, your cervix is exposed to lots of fun carcinogens.

  2. How HPV causes cancer: the same way it causes warts. What some strains of HPV do, simplistically, is mess up the cell’s DNA so it doesn’t remember how much it’s supposed to replicate. This can manifest as a wart, or as, well, cancer.

  3. No, there are no readily available tests for HPV. I think there’s one for females, but it’s expensive and not widely offered. There is no test for males.

  4. There are lots of debates as to what happens to the virus once it stops manifesting. Is it dormant, ready to come back out when your immune system is suppressed (pregnancy, stress)? Does it go away entirely after a while? The issue hasn’t been decided.

  5. As to why they recommend 18 year old virgins getting paps… I’d say because:
    a) You DO NOT HAVE TO HAVE SEX TO GET HPV!!! IT is spread by skin contact. PLEASE remember this. Condoms do NOT protect against it if the skin that’s infected isn’t covered by the condom but still in the genital area.
    b) It gives 18 year olds who ARE sexually active a cover to their parents? I don’t know.

Of course, IANAD, I’m just using what I remembered from a book I read recently about HPV and abnormal PAP smears.

8

Any vaccine would have to include the problematic HPV strains. Even the less problematic ones can cause problems, though, so I can’t see this making Paps redundant. I’m sure the only way to know how long such a vaccine would be effective is to try it in people and see. Certainly some vaccines (e.g. pertussis) are not associated with the lifelong immunity they were once thought to have.

9

Besides, Pap smears can detect all sorts of things besides cervical cancer. That’s why they recommend that women start having them regularly at 18, even if they aren’t yet sexually active. It’s also why women who are no longer sexually active (widows who haven’t become invovled with anyone else, etc.) continue to get Pap smears.

And thanks, **Goo, ** for the good wishes; oddly enough, the pain level is OK, and I haven’t needed anything stronger than ibuprofen since the local they gave me during the surgery (and not even much of that). The bleeding is a bit disconcerting, though.

Also, IANAD by any means, but I think the whole virus/cancer connection is fascinating. (It would be much cooler, of course, if I weren’t finding this stuff out the hard way.) If viral infection can cause one kind of cancer, who’s to say we won’t find out later on that other viruses are connected with other cancers? Opens up all sorts of interesting possibilities for future research and treatment options.

10

“If viral infection can cause one kind of cancer, who’s to say we won’t find out later on that other viruses are connected with other cancers?”

They are. Hepatitis B Virus is generally regarded as one of the most common causes of liver cancer. There are various viruses that cause cancer in animals.

11

Eva, my heart goes out to you. I’m glad that you are recovering well from your surgery. About 18 months ago, I went in for my well-woman check. A few weeks went by and the dreaded phone call came: I not only had an abnormal PAP, but it was a level 4 reading. That is, I had cervical cancer. My first reaction was to cry hysterically. After that I was determined to do what I had to do. Because I was 48 at the time, I decided to have a complete hysterectomy. Gratefully, the biopsies revealed no more cancer in the organs and lymph nodes they removed.

During my recovery, I too did my research. I learned that several strains of HPV can cause cervical cancer. Before that time, I had no idea about that. Because I was a child of the 60s, I knew that some of my behaviors from my younger days had come back to haunt me. For my generation before the advent of AIDS, “unprotected sex” meant that the female wasn’t using birth control. Prior to my diagnosis, I had absolutely no symptoms of anything amiss. As a teen and young adult, we learned about syphilis and gonorrhea (mostly from our own diligent investigation, because Catholic schools didn’t really teach sex ed back then), and those were easy enough to get rid of at the time. I didn’t learn about HPV until well into my 20s when I myself started teaching a human sexuality course, and the texts available to me said nothing about cervical cancer. I have no idea when I might have contracted it, and my surgeon told me it could have been almost any time.

Physically I’m well now and cancer-free. Emotionally, I have my ups and downs about it. My fiancee (Padeye) knows and is very understanding and supportive. I am so very grateful for him. My friends now are much more diligent about getting their PAPs done in timely manner. I hope other women out there do the same thing. Thanks, all, for allowing me my 2 cents of soapbox time.

12

Here’s an interesting article my friend forwarded to me:

Cervical cancer ‘hides’ in the body
<http://news.bbc.co.uk/go/em/fr/-/2/hi/health/2409619.stm>

“A virus that causes cervical cancer disguises itself so it can hide
from the immune system, researchers have found.”

I also copied the article from the New England Journal of Medicine, and am currently trying to make sense of it, but still have some questions. Doctors/virologists/biologists, or anyone who has a clue about this stuff, maybe you can answer some general questions about vaccines and immunity that I haven’t seen addressed so far in any of the cervical cancer literature:

If one contracts a specific strain of the virus and is infected, is HPV then like chickenpox in that you won’t get sick again, at least not from that specific strain?

How likely am I to infect someone else, assuming I am now cancer-free after my surgery, with HPV?

Is there cross-immunity between other strains of HPV?

Once an HPV vaccine is released to the general public, is there any point is getting it if I’ve already been infected? Will it work? Do nothing? Make me sick? Will the answer depend on what strains are covered by the vaccine?

Anything else I should know in order to make sense of the new literature?

13

You can indeed get infected with a different strain than you first had.

As to the chickenpox analogy, it’s not quite valid bevcause, as I said earlier, many HPV researchs scientists think that once you get a strain of HPV, it NEVER goes away, just goes into remission. If that’s the case, then no, you can’t be reinfected. Then again, it’s unlike chickenpox in that chickenpox doesn’t re-manifest when your immune system is bad.

You are just as likely to infect someone as before, I would think. The treatment you had for cancer (which, btw, I hope went well for you) would have treated a specific area but would not necessarily remove the virus from other areas that are not acting up.

By the way, you can even cross-infect yourself, if you touch an infected area and then touch a different area of yourself that isn’t infected.