Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer and there is growing evidence of HPV being a relevant factor in other anogenital cancers (anus, vulva, vagina and penis) and head and neck cancers. Of over 100 different types of HPV, two (types 16 and 18) are responsible for about 70% of all cervical cancer cases worldwide. (World Health Organization’s Human Papillomavirus and Related Cancers Summary Report – June 22, 2010)
HPV has gained notoriety not only for the damage which it can wreak on the lives of women of all ages, but strangely enough via one of the most effective methods of prevention currently available in the fight against a number of potential diseases and illnesses: vaccination.
The first preventative HPV vaccine, Gardasil, was approved by the US Food and Drug Administration (FDA) in 2006. Since then, the vaccine has been surrounded by misinformation and controversy as conservative groups have expressed tremendous concern over the vaccine giving young women the wrong message about being sexually active. In other words, their argument has been that it will encourage young girls who are vaccinated to have multiple sex partners and engage in irresponsible sexual behaviour.
Lisa Smith (name changed to protect privacy), a young Caymanian who had to face the reality of having HPV and stage one cervical cancer at the age of 16, has a very different message.
“I was really fortunate in having the type of relationship with my mom where I could talk openly with her about things like being sexually active, and having her help me in being responsible about it,” she begins. In fact, it was her mom who took her to the gynecologist from an early age, where she had her first Pap test done and was put on birth control prior to becoming sexually active at the age of 16.
A pap test is a simple and quick procedure that is performed by a doctor, or gynecologist. During the test, an instrument called a speculum is gently inserted into the vagina. This allows the cervix (the neck of the womb) to be clearly seen. A small spatula or a tiny brush is then inserted to collect cells from the cervix. These cells are smeared onto a glass and a slide and sent to a laboratory for analysis. Pap tests can be uncomfortable but should not hurt.
Lisa and her boyfriend were in a relationship for 18 months, during which time she was being exclusive and having protected sex. In other words, she had only had one sexual partner when she was diagnosed. One day she noticed that she had developed genital warts, and went straight to the doctor to get a Pap smear done. The results of the test showed that she had abnormal cells and she was asked to come back for follow up exams.
“When they told me I had abnormal cells my first reaction was ‘what does that even mean?’. They explained it to me, but the truth is you don’t really comprehend it at first, and it takes a few days for the reality to set in. It took a week for me to really start to understand what was going on with me,” she explains.
Once she was able to wrap her brain around the virus, the upcoming procedures and what they would entail, the emotional stress began to set in.
“It was just… it was really heart wrenching,” she recalls. After finding out, Lisa was having a hard time concentrating at school. “It’s the kind of thing that will be going through your mind, because you don’t know if it’s going to develop into anything or not. I remember being in the bathroom stall [at school] and having girls in there helping me, holding my hand, and I would start crying. It was really terrible. It was really emotional to think that I might develop cancer, especially at that age, all because I didn’t know.”
Fortunately Lisa was able to rely on the support of her friends, family and boyfriend to not only get her through the procedures, but also to help her kick her smoking habit. “I was a young, dumb teenager, smoking cigarettes,” she admits. “I didn’t realize that by smoking and being on birth control I was speeding up the reactions my body was having to the virus and essentially making it easier for the cancer to grow.”
HPV can also be dangerous to an individual if there is a previous history of STD’s (Chlamydia, herpes simplex virus type 2 etc.) and those with compromised immune system (including lupus, HIV/AIDS) are also at risk for cervical cancer.
Lisa underwent cryosurgery, where the doctor takes samples from the uterus and uses a “freezing process” of the uterus which is aimed at killing the abnormal cells. “It was a very dramatic moment for me,” she says.
Following the procedure, Lisa went back to her gynaecologist to get the HPV vaccine, as she can still benefit from the vaccine even though she has been exposed to the virus already. “Some girls think that the HPV vaccine is like other vaccines, meaning that once you get vaccinated you get the virus. That is not true. It’s ignorance on their part,” she explains.
Six years later Lisa remains as committed to her own sexual health as she was when she was 16. She continues to have a pap smear done every six months and asks specifically to be checked for abnormal cells. She’s also taking advantage of the advancements being made as far as the HPV vaccine is concerned: “The vaccine has just been approved for boys and men, so I’m sending my boyfriend to get vaccinated,” she declares.
There is still no HPV testing for men, which means that male partners who have the virus may be spreading it to their female companions without knowing that they are infected. According to the National Cervical Cancer Coalition, some doctors think HPV is almost as common as the common cold virus. While it may be an unfair burden for women to bear, it is a reality and at the end of the day taking good care of oneself should be the most important priority in each girl’s life- no matter how difficult that may be for parents and other adults to accept.
“I really want girls to be more open minded to the vaccine, and I want mothers specially to be more open minded to it. Mothers think that, because they try to talk their girls out of having sex by not putting them on the pill or by not letting them have access to condoms they are preventing something from actually happening, but what they don’t know is that these things are going to happen regardless. Especially since sex is one of the main reasons that girls actually get HPV. So honestly, mothers, above all others, should be more open minded about getting their girls vaccinated and using condoms.”
Most people who have ever experienced intimate sexual contact with another person will have been exposed to this virus and will have had an “active” HPV infection at some point in their lives. For most people, the body’s immune system kicks into action and the infection is eliminated from the body often without the infected person ever knowing they had the virus. In a few people, sometimes because their immune system is otherwise compromised, the virus persists and remains. It is in persons with persistent HPV infections that cancer can develop, often 10 – 20 years after the initial infection.