Since the 1940s, Pap tests have been successfully detecting cervical cancer in its early stages, before it has a chance to spread. When caught early, the disease is highly curable.
Thanks to the Pap test, cervical cancer rates have gone down overall, but among the poor and uninsured, who have difficulty accessing care, the disease continues to take a toll.
Today another weapon has been added to the cervical-cancer fighting arsenal, and MD Anderson doctors are determined to make sure everyone knows about it.
A vaccine that blocks transmission of the human papillomavirus (HPV), which causes almost all cervical cancer cases, promises to prevent most occurrences altogether. HPV holds the dubious distinction of being the most common sexually transmitted infection in the United States.
“Eighty percent of women and men — pretty much anyone who’s had sex — have been infected at one time or another,” says Lois Ramondetta, M.D., a gynecologist and professor in Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center.
But like the Pap test, the HPV vaccine, which was introduced in 2006, has been slow to be embraced.
Through sexual activity, more than 40 strains of HPV can be passed along. These strains are split into two categories: those that cause cervical and other forms of cancer, and those that cause genital warts.
Two strains — HPV 16 and 18 — are blamed for the majority of cervical cancer cases, as well as most anal cancers and a large share of vaginal, vulvar and penile cancers. The strains can also cause cancers in the back of the throat, most commonly at the base of the tongue and in the tonsils, in an area known as the oropharynx. These are called oropharyngeal cancers.
Two other strains — HPV 6 and 11 — cause most genital warts. Though unsightly and contagious, warts won’t turn into cancer, even if they remain untreated. Without treatment, warts can multiply, stay the same or disappear altogether.
Most people infected with HPV will never get cancer or warts. Their bodies will clear the virus, usually over the course of two years, and they’ll never realize they were infected. During this phase of unawareness, those infected may unknowingly pass the virus along to others.
But in a small number of people, the virus persists and remains in the cells.
The longer the virus lingers, the more likely it is to cause cancer by doing what it does best — slowly and silently causing cells to grow abnormally. Ramondetta says progression from time of HPV infection to full-blown cancer can take five to 10 years, or even longer.
“This means your actions as a youth can have consequences in adulthood,” she warns. “About the time you get married or start a family or new career, you can be diagnosed with an HPV-related cancer.”
When HPV invades the cervix and causes cells to become precancerous, Pap tests can flag the abnormal cells before cancer develops, and doctors can intervene to return a woman to health. A second test, approved by the Food and Drug Administration (FDA) in 2011, detects the presence of the HPV virus that causes the cells in the cervix to change. This test, when performed in conjunction with the Pap test, provides a powerful, one-two punch in the war against cancer.
“Cervical cancer would be virtually unheard of if these two tests were used in tandem with the vaccine,” Ramondetta says.
Only about 14% of boys under age 18 are getting the complete three-dose vaccination, compared to 38% of girls, reports Erich Sturgis, M.D., associate professor in Head and Neck Surgery. This is in part because the Centers for Disease Control and Prevention (CDC) only updated its guidelines in favor of immunizing boys in 2011, while recommendations to vaccinate girls have been in place since 2006.
Vaccinating boys for HPV is also likely to benefit girls, Sturgis adds, by reducing the spread of the virus.
The HPV vaccine doesn’t cure HPV, it only prevents it. So to be effective, the vaccine needs to be given before a person becomes sexually active.
The CDC recommends vaccinating boys and girls at the age of 11 or 12 to give them time to build up immunity against the virus before they begin sexual activity.
There’s one more upside to getting the vaccine at a young age, Ramondetta says. Studies show the body assimilates the vaccine best in the preteen years, when the immune system is “revved up.”
Though 11 and 12 are the ideal inoculation ages, the vaccine is available to males and females as young as age 9. And it’s offered to males through age 21 and females up to age 26.
“Even if you’ve already had sex, remember, the vaccine protects against more than one strain of HPV,” Ramondetta says. “You may be infected with one strain only, so the vaccine will protect you against the additional strains. Cover your bases, get vaccinated.”
To make a significant dent in America’s dismally low HPV vaccination rate, gynecologist Larissa Meyer, M.D., says shots should be given to children at school. In Australia, where this model is used, more than 70% of girls have completed the three-dose course. Not surprisingly, Australia’s HPV infection rate has dropped significantly. In 2013, the country extended the program to include boys.
Schools and pharmacies are convenient alternatives to doctors’ offices for the HPV vaccine, according to a recommendation this year from the President’s Cancer Council. And Meyer, an assistant professor in Gynecologic Oncology and Reproductive Medicine wholeheartedly agrees. She hopes to pilot an HPV vaccination program in a Houston school soon.”
“Make it convenient. If people won’t come to the vaccine (in the doctor’s office), bring the vaccine to people. Whatever it takes, just do it.”