Increases in HPV-linked cancers in parts of US with high smoking rates

A new paper in JNCI Cancer Spectrum, published by Oxford University Press, finds increases in both men and women for several HPV-related cancers in low-income counties or those with high smoking rates. Increases were slower in the highest-income US counties or those with low smoking rates.

In the era of collective decline in cancer rates, human papillomavirus (HPV)-associated anal, oropharyngeal, and vulvar cancer is still rising. Risk factors for HPV-associated cancers include smoking and risky sexual activities, both behaviors likely more common in poorer parts of the United States.

Researchers here used the Surveillance, Epidemiology, and End Results database, a National Cancer Institute database that provides nationwide information on cancer statistics, to investigate HPV-associated cancers by US county-level income and smoking prevalence between 2000 and 2018.

They found that anal and vulvar cancer among women and anal cancer incidence among men increased significantly in the lowest-income counties and counties with high smoking rates, while the increases were slower in their counterparts.

Cervical cancer incidence plateaued, rising not at all in the highest income counties, but increasing 1.6% a year in the lowest income counties. Oropharyngeal cancer rates among women increased by 1.3% a year in low-income counties and only by .1% in high-income areas. Anal cancer rates among women increased by 3.2% in low-income counties but by only 2.6% in high-income areas. For vulvar cancer, rates increased 1.9% a year in the lowest-income counties but only vs. 0.8% a year in the highest-income counties. Vaginal cancer rates increased by 2% a year in low-income counties and declined by .3% in wealthier areas.

Among men, oropharyngeal cancer rates increased by 2.1% a year in low-income counties and by 1.7% per year in high-income counties. Anal cancer rates increased by 3.9% in low-income areas but increased by only 1.5% in high-income counties.

Counties with high smoking prevalence, which are also often low-income counties, had marked increases in cancer rates compared to their counterparts. Anal cancer among women increased by 5% a year for those living in high-smoking counties and only 1.9% a year for those living in lower smoking-rate counties. Vulvar cancer increased by 3.8% a year a year for those living in high-smoking counties and only .6% for those living in lower smoking-rate counties.

Oropharyngeal cancer rates among men increased by 2.7% a year in high-smoking areas, but only by 1.5% in low-smoking counties. Anal cancer incidence rates among men increased by 4.4% in high smoking-rate counties, but only by 1.2% in lower smoking-rate counties.

“HPV vaccination and cervical cancer screening are the cornerstone interventions to prevent avoidable suffering caused by six cancers,” said the study’s senior investigator, Ashish Deshmukh. “Unfortunately, cervical cancer screening rates declined in recent years and HPV vaccination rates remains 15% points lower in rural low-income counties. The COVID-19 pandemic has further disrupted the delivery of preventative care. Urgent and collective efforts are needed to prevent growing disparities from worsening.”

The paper, “Trends in the Incidence of Human Papillomavirus-Associated Cancers by County-Level Income and Smoking Prevalence in the United States, 2000-2018,” is available (at midnight on March 3, 2022) at

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Everything You Should Know About HPV That You Weren’t Taught In School

For one: “Nearly everyone will get HPV at some point in their life.” Learn more about HPV vaccines, symptoms, tests, and treatment to protect yourself.

Unless your Google calendar says you’ve got an upcoming Pap test or HPV vaccine appointment, odds are you aren’t actively sitting there thinking about HPV. Still, given the statistics on just how prevalent the virus is, maybe you should. Here are some things you should know about HPV.

HPV, or human papillomavirus, is the most common sexually transmitted infection in the United States. Currently, 42 million people are infected with the virus in the United States, with 13 million new Americans being diagnosed with it each year. Even more sobering: “Nearly everyone will get HPV at some point in their life,” according to the Centers for Disease Control and Prevention (CDC).

But what exactly is HPV? What are the symptoms? And how do you test and treat the infection? All important questions about HPV. Get the answers below.

What Is HPV, Exactly?

Specifically, HPV is caused by a family of viruses called human papillomavirus, of which there are currently more than 200 different strains.

The part of the body the virus infects, the accompanying symptoms (if any), treatment, and how long it lasts all vary based on the exact strain(s) someone has, says Emily Rymland, D.N.P., F.N.P.-C., clinical development manager at telehealth platform Nurx.

As it goes, the types of HPV are usually broken down into two broad categories: low risk and high risk. Low-risk strains of HPV are unlikely to cause problems (infertilitycancer, etc.) down the line. High-risk strains of HPV have the potential of causing cancers, such as cervical cancer, penile cancer, anal cancer, and esophageal cancers. To be clear: Low risk is not synonymous with asymptomatic, but more on this below.

Know How Do You Get HPV?

Roughly 40 of the strains of HPV can be contracted by having sex with a person who has HPV. Transmitted through skin-to-skin contact, it can be spread through anal sex, vaginal intercourse, oral sex, scissoring, and other sex acts that involve bare skin, according to the CDC. There’s also some research that shows the virus can live on sex toys made of silicone and elastomer for up to 24 hours — even after a proper cleaning — which suggests that sharing sex toys can also transmit the virus. What’s more, the virus can be transmitted through sexual acts regardless of whether symptoms are present.

The other strains of HPV are not caused exclusively by sexual contact, and can result in common warts such as hand warts and plantar warts, says Rymland. These are the types of warts your parents were warning against when they told you to wear flip-flops on the pool deck, she adds. Note: This article is specifically covering the strains of HPV that can be transmitted sexually.

Know The Signs and Symptoms of HPV

While most strains of the virus are asymptomatic, when HPV symptoms do appear, they can often come in the form of warts, according to Rymland. Known as genital warts, these warts are small, flesh-colored bumps that show up most often on the vulva, taint, penis, cervix, or along the anal or vaginal canal. Certain strains of HPV can also cause oral warts or lesions, according to the CDC. It’s uncommon for HPV warts — no matter where they pop up on the body — to be accompanied by any other symptoms, such as pain, itching, or discomfort, says Rymland. (Related: Everything You Need To Know About Genital Warts)

“The strains that cause warts aren’t those that are associated with cancer,” explains Rymland. So, while the warts might be annoying or unsightly, the HPV strains that cause warts are considered low-risk. But don’t read it wrong: Just because your strain doesn’t cause warts, that doesn’t mean it’s high risk. Only some of the strains of HPV that don’t cause warts can lead to cancer, she says. Indeed, some strains cause neither warts nor cancer — hence the commonality of asymptomatic cases. ICYWW: The strains associated with genital warts are stains 6 and 11. Meanwhile, the strains that could cause cancer are 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 28, according to the National Cancer Institute.

That said, it’s possible to have more than one strain of HPV at the same time. Sometimes, the presence of warts will lead someone to get tested for HPV, and find out that they have an additional strain of HPV as well, says Rymland. Your practitioner will be able to identify exactly which strain(s) you have, if any, so you can receive the proper HPV treatment.

Know How to Test for HPV

If someone has a strain of HPV that is actively causing genital warts, “sometimes health care providers will diagnose genital warts from appearance alone,” sexual health expert Amy Pearlman, M.D., with Promescent, a sexual health product retailer previously told Shape. Other times, the provider will remove a tiny piece of the wart to biopsy, or test it, for any abnormality, according to Dr. Pearlman. A biopsy allows the provider to rule out other similar-looking conditions such as skin tags or moles.

However, if you don’t have any visible HPV symptoms (as most people won’t), you’ll need to be tested for the virus via a vaginal or anal pap. In fact, even people who do have genital or anal warts should still be screened for HPV because this doesn’t necessarily rule out infection with a high-risk asymptomatic strain, or multiple strains of the virus, says Rymland.

So, what does an HPV test entail? Also known as getting HPV screened, testing for HPV varies based on sex and genital make-up, as well as the type of sex you’re having (if any).

If you have a cervix, you’ll typically get screened for HPV at the same time that you get a Pap test from your gynecologist. These tests require the provider to put a speculum into the vaginal canal, then collect a sample of cervical cells with a soft brush and/or small scraping device. The provider will send this collection of cells to the lab to test for precancerous lesions caused by HPV or for cellular abnormalities that suggest that cancer is at its early stages. Another option is to take an at-home HPV-testing kit, such as those through Nurx or Everlywell, which require a quick swab of the vaginal canal (you won’t need to reach the cervix). However, at-home HPV tests only test for certain strains of the virus. Carefully read the product description to learn exactly what strains the at-home HPV test is able to find. The Everlywell HPV Test, for example, screens for strains 16, 18, and 45, while the Nurx HPV test looks for strains 16 and 18.

Regardless of your gender or sex, if you enjoy receptive anal or oral sex, your doctor may recommend an anal pap smear to look for precancerous changes, says Rymland. To note, there are currently no FDA-approved tests for oral HPV. The only way doctors are currently able to tell if you have oral HPV is if you have a strain that causes oral legions that are visible during an oral exam).

“It’s really unfortunate that there isn’t an approved regular screening for any body part other than the cervix because HPV-related cancers of the anus, penis, and throat are all on the rise, and affect all genders and sexual orientations,” she says.

Know How Often to Test for HPV

How often you should get an HPV test depends on your age, your sexual and medical history, and the results of your last HPV test. “It’s recommended that people don’t test for HPV until age 30,” according to Rymland (and the CDC, FTR). The reason? “When you’re younger it’s likely that if you do have a strain it will go away on its own [thanks to the immune system] and won’t cause any problems down the line.”

Between the ages of 30 and 65, people with cervices should get an HPV test every five years, according to The American College of Obstetricians and Gynecologists. After that, individuals who have not tested positive for cancer-causing strains do not need to continue getting screened. As always, however, it’s best to talk to your practitioner about your specific sexual practices and any other risk factors to get HPV test recommendations tailored to you.

“People with cervices should get their screenings on the recommended schedule, but unlike other STIs, you don’t need to test for it annually,” she says.

Know What Is the Treatment for HPV?

“There is no cure for the human papillomavirus itself,” says Rymland. But the immune system often clears it on its own within two years of infection, she says.

If you have a strain of HPV that causes genital warts (and they haven’t gone away on their own), you can get them removed by your doctor, usually with a process known as cryosurgery, which essentially involves freezing off the warts. Just keep in mind that removing HPV warts does not rid the body of the virus itself, and warts could return.

As for HPV treatments if you have a strain that can cause cancer that the body doesn’t clear on its own? Health-care providers will simply treat any precancerous changes, such as with the cells that line the cervix, caused by the virus, explains Rymland. These can be monitored and detected by cervical screenings and pap smears, as well as oral and anal HPV testing, she adds.

Good news: Even if cancer has developed, it’s usually treatable if caught early, she says. Treatments for these cells vary, but can include excision, lasering, or freezing of the abnormal cells, or impacted tissues. “Getting screenings on schedule is important because it allows us to catch if/when the virus has led to precancerous changes, and then provide treatment before it turns into cancer.”

Know How to Protect Against HPV

The number one thing people can do to protect against HPV is to get the HPV vaccine, according to Rymland. Known as the Gardasil vaccine, the HPV vaccine protects against 9 strains of the vaccine (strains 6, 11, 16, 18, 31, 33, 45, 52, and 58) and is FDA-approved for people of all genders over the age of 9. People should get the vaccine prior to the age of 26, as early protection offers the best protection, according to the CDC. If you’re between the ages of 27 and 45 and have not yet received the HPV vaccine, talk to your provider, as they may still recommend it as a way to protect against strains of the virus you have not been exposed to yet. Worth knowing: The age you are when you get the vaccine will impact how many doses of the vaccine you get — only two doses are needed for those who get the first vaccine before their 15th birthday, while those who get their first dose after that may need three doses, each six to 12 months apart.

Beyond the HPV vaccine, the usual safer sex practices apply here. That means knowing your own status, staying up to date on STI testing, and communicating your status with any new partner — ideally before you have sex for the first time.

It also means using barriers (dental dams, finger cots, condoms, etc) with any partner who is HPV-positive, does not know their current HPV status, or has a previous partner that has known HPV. As you now know, this can go for most pleasure-seekers, so play it safe.

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Impact of Prior HPV Infection or History of Abnormal Pap Smear and HPV

The Impact Of A Prior HPV Infection Or A History Of Abnormal Pap Smear On The Humoral Immune Response To A Quadrivalent Human Papillomavirus (qHPV) Vaccination

In 52.9% of cases, there was a history of abnormal pap smear/cervical neoplasia. At baseline, anti-HPV antibody titers at baseline: 21% were negative for all four HPV types, whereas 79% were positive for one of the four HPV types. Statistical analysis revealed that those with a history of abnormal pap smears/cervical neoplasia were more likely to have a positive anti-HPV antibody result before vaccination to one of the four kinds, (P = 0.035) Fisher’s Exact Test. In general, HPV-exposed women had greater post-vaccine GMTs and higher point estimates than HPV unexposed women. There was no indication of an anamnestic response when the rise in titers was examined using logistic regression. Prior HPV infection and cervical neoplasia in SLE had been associated with a lack of anamnestic response to the HPV vaccination. This validated the decision not to screen for HPV antibodies before vaccination.


Men and the Human Papillomavirus

In cervical cancer awareness month, Yan-Yi Lee delves into the topic of HPV, exploring why heterosexual men in particular may be less aware of the risks and consequences. Whilst availability of the HPV vaccine is increasing, there is much to be done further raise awareness. Read more to learn about Men and the Human Papillomavirus.


HPV comes in more than 170 forms (with certain subtypes being more ‘deadly’ than others) and typically transmits through sexual activity. Despite it spreading equally easily and causing cancer in both males and females, there tends to be surprisingly low awareness of what HPV is among men. It is unbelievable to me that the term doesn’t even ring a bell among the highly educated male friends in my social circle, with some even confusing it with the Human Immunodeficiency Virus (HIV) or the Herpes Simplex Virus (HSV). Findings in recent scientific studies appear to align with my anecdotal observations. In the previous decade, data collected in one American university revealed that despite rising death rates in HPV-related cancer among men, less than 30% of males were vaccinated. Another report painted a similar picture: the awareness of HPV and the importance of its vaccination dropped by a whopping 10% among men between 2013 and 2018. Sexuality also appeared to play a role in HPV awareness, with the LGBTQ+ community appearing to be more conscious of the threat posed by HPV. It was found that men who have sex with men tend to be more aware of HPV and are more willing to get vaccinated for it in comparison with heterosexual men.

Reasons that account for this striking gender gap in HPV awareness are multifaceted, and the first concerns how HPV testing works. Designing a technically robust HPV test for heterosexual men is challenging; there are currently are no approved tests for penile HPV, and throat swabs appear to be unreliable in capturing the virus as well. Although urine-based tests have been tested scientifically for women, the reliability of urine tests for testing HPV has yet to be discussed in more detail for men. Further, for bisexual and gay males, anal pap tests are only given if especially requested. In the absence of reliable tests, men commonly do not know they even carry the virus (let alone know how dangerous their HPV strains are) and potentially spread it to their partners.

The second explanation for this pertains to the consequences. As HPV is the primary cause of the fourth most common cancer for females (and because detection is possible and can result in highly effective treatment), women tend to be more conscientious of HPV and the importance of tracking it in their bodies. Similarly, for gay and bisexual men and their attitudes towards anal cancer. On the other hand, the rate of penile cancer is a mere 1 to 100,000 for heterosexual men, so the stakes are lower and hence less awareness.

“A careless wild night may not only imply other widely-known sexually transmitted infections; it may also lead to an agonising cancer in older age”

Thus, what could the male population do to slow down the spread of HPV? Prevention measures are not hard to guess: using protection during sexual intercourse and getting all three doses of the HPV vaccine. In the UK, both girls and boys are vaccinated early on at ages 12-13; and contrary to popular belief, HPV vaccines can still be administered in adulthood. The vaccine would most likely be beneficial even if an individual has HPV, although this would depend on the strains of HPV currently existing in the individual’s system. In any case, a consultation with a health professional beforehand is always the best idea.

Demystifying intersexuality

It is commonly understood that a careless wild night may imply unwanted pregnancy and other widely-known sexually transmitted infections, but what many of us fails to see is the same carelessness may lead to agonising cancer in older age – particularly for women and non-heterosexual men. These cancerous infections often happen in one-night-stands, and it simply isn’t worth getting cancer for a person whose name you won’t even remember after some ephemeral dopamine and serotonin. Both genders have the responsibility and the power to protect themselves and their partners from HPV-related cancers. The fact that there isn’t as much reason to worry about HPV among heterosexual men should not excuse them from the responsibility to build awareness of it, and it is high time to find out how best to do so on a broader scale.

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Mouth Cancer Charter to raise awareness in rise of oral cancer

Mouth cancer charterSeb Evans reports back from the Oral Cancer Action Charter signing at the Palace of Westminster last month. Leading figures from dentistry along with MPs all joined to sign the latest Mouth Cancer Action Charter towards the end of 2021. The charter challenges the government on six key actions:

  • Conduct a government-funded public health awareness campaign on mouth cancer
  • Improve access to routine dentistry for earlier detection of mouth cancer
  • Enable enhanced training of GPs
  • Improve training programmes for healthcare staff to spot mouth cancer
  • Introduce free check-ups and treatment for mouth cancer patients
  • Support the development of better technology to diagnose mouth cancers.

The campaign also encourages patients to become more self-aware. The aim is for patients to check their mouths themselves in front of the mirror once a week.

Focusing on mouth cancer

‘With this event here today, we’re trying to raise up the politician and policy maker’s agenda the importance of mouth cancer and the impact it has,’ Nigel Carter, chief executive of the Mouth Cancer Foundation, said.

‘We’re trying to get more investment in mouth cancer. It would be great to have some central investment to have an awareness campaign.

‘Access is getting worse rather than better, even without Covid. That’s a real challenge. 

‘It is as a cancer that has so much impact on people’s lives, 50% of the people diagnosed with mouth cancer never return to work. The impact on people’s lives, their lifestyle, their quality of life is immense.

‘And survival rates just haven’t improved over the last 30 years, whereas if you look at most other cancers, they’ve improved. Mouth cancer’s five-year survival rates have remained flat and cases have doubled.

‘It really is something that needs focusing on more.’

‘Don’t just look at the teeth’

‘From the dentists’ point of view, they’ve got to remember to look at the patient’s mouth,’ Sir Paul Beresford MP said.

‘Don’t just look at the teeth, look all the way around. Patients can be aware of this and if the dentist doesn’t actually look and tell the patient they’ve had a good look round, there could be difficulties.

‘Over my career I’ve probably seen 12/15 cases of oral cancer. Because I’ve managed to get them all early, only one of those patients actually died of cancer. And that was only because the patient wouldn’t attend to see the oral surgeon. 

‘Mouth cancer rates are rising, firstly because the HPV vaccination hasn’t cut in due to the age. Secondly, it’s an increase in detection and the third thing is patients aren’t going to the dentist. Finally, general awareness is low. If we can increase awareness, people can look for it themselves. If they find something suspicious, see the dentist.

‘The treatment, if it’s beyond very early stages, is drastic and very unpleasant.

‘The Mouth Cancer Foundation is really helping make a change with patient’s awareness.’  

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The Sore Sign In Your Mouth to Never Ignore

Vitamin B12 deficiency has a wide range of symptoms, affecting everything from your mouth in the form of poor oral hygiene, to your toes (pins and needles). What are the warning signs of vitamin B12 affecting your mouth and oral health?

A lack of vitamin B12 can leave you feeling tired, groggy and can have a negative effect on your oral hygiene too.

Your body needs B12 to carry out many vital processes including maintaining a healthy nervous system, keeping your brain functioning properly and producing red blood cells.

Unlike some other vitamins, your body can’t create B12 on its own, so you need to ensure you’re getting enough of it from your diet, and if not you’re taking a supplement.

Foods rich in B12 tend to be animal products, so people who eat vegan, plant-based or dairy-free diets may be particularly at risk of vitamin B12 deficiency.

What are the symptoms of B12 deficiency in your mouth hurting your oral health?

To avoid becoming deficient in B12, try to eat a B12-rich diet.

Foods high in vitamin B12 include meat, fish, dairy and eggs.

Many people who are at risk for B12 deficiency may follow vegan diets – the National Institute for Clinical Excellence (NICE) estimates up to 11 percent of people who follow this diet are B12 deficient.

Try eating more of these 11 foods to up your vitamin B12 intake:

  • Sardines
  • Beef
  • Cereals with added B12
  • Tuna
  • Marmite (and other yeast extracts)
  • Trout
  • Salmon
  • Milk
  • Cheese
  • Yoghurt
  • Eggs

If those foods don’t fit with your diet, or you prefer the convenience of getting your vitamins from a supplement, why not add a vitamin B12 supplement to your daily routine?

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Eva Grayzel, Cancer Survivor

Eva Grayzel is an oral cancer survivor that is about increasing awareness and the need for oral cancer screening.

Eva Grayzel, a nationally recognized Master Storyteller and performance artist, was diagnosed at age 33 with stage IV oral cancer and given a 15% chance of survival. After regaining her deep vibrant voice, Eva applied her stage skills to communicate the depth of her experience in a unique and powerful way. For over a decade, Eva’s programs have captivated dental professionals worldwide. A champion for early detection, Eva founded the Six-Step Screening™ oral cancer awareness campaign for which she was recognized by the American Academy of Oral Medicine. Eva is the author of two children’s books, ‘Mr. C Plays Hide & Seek’ and ‘Mr. C the Globetrotter,’ in the Talk4Hope Family Book Series.

Part I:  Becoming a Storyteller

My life changed at the sound of a bell. I was pursuing a career as an actress in New York City while intercepting boredom with interactive stories for 8-12 year olds at an after-school program. One day, the principal came into the room furious, “Didn’t you hear the bell ring?” she demanded. “This delay has caused quite a traffic jam outside!” Students protested, “Wait! Tell us the rest of the story.” Her mouth dropped. This was unprecedented – students begging to stay after the bell. Within 5 years, ‘Story Theater’ carved out a career for me as a motivational storyteller providing value-rich assembly programs, educational keynotes at Professional Day conferences and Teacher-In-Service programs on interactive storytelling techniques. 

Part 2: Transition to Motivational Speaking

A non-healing sore on my tongue was eventually diagnosed as stage IV oral cancer. Tragically ironic for a storyteller! The radical surgery and treatment was devastating but my outcome was extraordinary.

A couple of years later, the ADA (American Dental Association) launched an awareness campaign with the message, ‘There is a painless way to know if this is serious.’ The voicemail I left on their 800 line was succinct, “You need to know my story and I want to help you.” They called back.

In 2003, for the first time, I told my very personal story in a public way, with 9K dentists in the audience at the Annual ADA Conference. My call to action motivated doctors from across the country to request a presentation for their regional dental meetings. My speaking career took off. Patient stories matter. 

Part 3: A Calling to Patient Advocacy

As I contemplated my own extraordinary recovery, silence was not an option. I couldn’t stand by and allow what happened to me, happen to others. Dental offices seemed to lack the material to educate patients about oral cancer. Committed to raising awareness, Six-Step Screening was born. More than a personal choice, I feel an obligation to be a part of the revolution, awakening healthcare providers to the urgency of detecting oral cancer in the early stages and educating the general public.

Part 4: Using Storytelling to Build Business

After a keynote presentation at a dental conference, a Henry Schein sales manager confessed, ‘If my team could tell a story like you do, we would be golden.’

I was all in, “Let me give a workshop for your team on finding and crafting the story to build rapport with clients and inspire trust.” Three weeks later, a rookie to the team claimed it was her story that scored the sale of their highest ticket item. Since then, I’m hired to do what I love, what comes naturally to me: craft stories to have a meaningful impact and create a lasting impression.


Eva Grayzel, Master Storyteller and Visionary Survivor


Author of: M.C. Plays Hide & Seek

Award-winning children’s book to minimize fear and promote dialogue around cancer.


Biggest Misconceptions about HPV

Every year, around 3,000 new cases of cervical cancer are reported in the UK. Despite approximately 99.8 per cent of cases being preventable, there are still many misconceptions surrounding cervical cancer. Human papillomavirus (HPV) is the cause of the majority of cases of cervical cancer. HPV is a group of viruses that are spread during sexual activity, some of which do not cause any noticeable symptoms, the NHS explains.

Due to the way in which HPV is spread, some believe that it is similar to other sexually transmitted infections.

However, considering the fact that most women are likely to get HPV at some point in their lives and that it cannot be fully prevented, this isn’t necessarily the case. On Thursday, a new study found that the HPV vaccine cuts cervical cancer by almost 90 per cent. Rebecca Shoosmith, head of support services at Jo’s Cervical Cancer Trust, has spoken with The Independent to help dispel 11 of the biggest misconceptions that continue to perpetuate conversations about HPV.

1. Only women get HPV

While cervical cancer is seen as a cancer that affects women, as it can afflict any person with a cervix, HPV can affect anybody.

The majority people are likely to contract HPV in their lifetime if they are sexually active “regardless of gender”, Ms Shoosmith explains.

“HPV doesn’t discriminate!” she adds.

2. HPV is rare

Because HPV is known as the primary cause of cervical cancer, this may lead to the assumption that it is only contracted by a small number of people.

“HPV is actually really common with around four in five of us getting it at some point,” Ms Shoosmith says.

3. HPV is an STI

While it is typically transmitted through sexual contact, Jo’s Cervical Cancer Trust is trying to encourage people not to call it a sexually transmitted infection.

“Unlike many STIs, it can’t be fully prevented nor can it be treated,” Ms Shoosmith explains.

“Also due to how common it is, it is really unhelpful to call it an STI. It’s much more rare to not get HPV.”

4. Having HPV means you will definitely be diagnosed with cervical cancer

“Having it does not at all mean you will be diagnosed with cancer,” Ms Shoosmith states.

“Infections are really common and cervical cancer is rare.”

The Jo’s Cervical Cancer Trust representative outlines that the human body typically clears itself of the HPV infection “without it doing the body any harm”. “In some cases it can cause cells to change, which is why smear tests are so important as they mean any changes can be picked up.”

5. HPV is curable

Ms Shoosmith emphasises that while it cannot be fully treated, the majority of cases of the infection – nine in 10 – are cleared by the body’s immune system.

She adds that treatment can be provided for cells that have changed.

6. A vaccination isn’t safe

“The vaccine is very safe and extremely effective,” Ms Shoosmith affirms.

“It protects against seven out of 10 cases of cervical cancer, so combined with cervical screening it offers a fantastic degree of protection.”

7. If someone’s partner has the virus, this means they have cheated

While it can be transmitted through sexual activity, it can live undetected in the body for around two decades.

This means it can be extremely difficult to pinpoint exactly when a person contracted it.

“Having the virus is no sign that someone has cheated at all,” Ms Shoosmith says.

8. People who use condoms are not at risk of contracting the virus.

While wearing a barrier-form of contraception such as a condom can reduce a person’s risk of getting the virus. It is not a 100 per cent foolproof preventative measure.

“As HPV lives on the skin, condoms won’t fully protect against it,” Ms Shoosmith explains.

“Other sexual contact like touching or oral sex can pass on too.”

9. If you don’t have sex, you won’t contract HPV

The virus lives on the skin, it is not only spread through penetrative sex.

It can pass from person to person through other forms of sexual activity, Ms Shoosmith outlines.

“If you’ve ever had any kind of sexual contact – that includes oral sex, any touching of genitals or sharing sex toys – you could have come into contact with HPV.”

10. There are HPV screenings for men

While there are currently no screenings for men, boys are now being offered the vaccine in schools, Ms Shoosmith states.

In July 2019, it was announced that boys in the UK were to be offered the jab for the first time in a bid to reduce cancer rates.

11. People with HPV always exhibit symptoms

“There are no symptoms and most people who have it will never actually know that they have it,” Ms Shoosmith explains.

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HPV Affects 90% of Population

It might surprise you to know that the papilloma virus will affect almost every one of us. HPV, as it’s commonly known, won’t affect most of the people infected with it, but some will have a higher risk of developing various cancers. Two experts from Hillel Yaffe Medical Center in Hadera discuss the virus and its effects, the vaccine and how each of us can manage it. Read the comprehensive advice here.

HPV has been in the headlines in recent years and awareness of it has grown, especially in light of the vaccine that is now administered to young teens.

The vaccine aims to significantly reduce cases of cervical cancer that the virus can cause, and protect against genital warts. We asked Prof. Ilan Baruchim, director of the Department of Gynecology and Gyno-Oncology. Dr. Tomer Bar-Noy, a senior physician in the Gynecology-Oncology unit at Hillel Yaffe, to explain all aspects of HPV.

What is human papillomavirus (HPV) and how dangerous is it?

HPV is a group of over 200 species of viruses belonging to the Papillomaviridae  family. Some varieties, like the HPV6 and HPV11 strains are low risk and can cause conical warts – so-called “condyloma.”
This is a problem that is primarily aesthetic and not dangerous or linked to cancer. Warts are transmitted through sex via direct contact with a partner who has active or dormant condyloma. In some cases only individual warts are seen, but widespread infection can also occur.  Warts can be present in the vulva, vagina, cervix, anus and/or penis. Treating the warts depends on the location and areas affected.
If there’s a limited number of warts or a limited infected area, usually the treatment is topical, like ointments or gels.
In the case of more advanced cases with widespread warts. The proposed treatment will usually include using a laser or freezing with cold nitrogen that will “burn” off the warts, or surgical removal in cases where there is no adequate response to the various treatments, explained Dr. Bar Noy.
He added that these methods aim to destroy the condyloma lesions while trying to preserve the surrounding healthy tissue.
Another part of the same family of viruses, about 15 strains, are considered high-risk, mainly the strains HPV16 and HPV18. This can actually lead to the development of cervical cancer, and at a lesser but significant rate, also cases of vaginal and anal cancer and malignancies in the mouth and the throat.

Even in these cases the strains are transmitted by sexual contact.

How contagious  is HPV? 

“It should be noted that the rate of infection with the papilloma virus is very high, and in fact more than 90% of men and about 80% of women will be infected during their lifetime.  According to the Centers for Disease Control and Prevention in the United States about 50% of new cases of infection occur each year among young people aged 2-15. But Prof. Baruchim said that the good news is that in most cases the body’s immune system can defeat the virus and eliminate it.
In a small proportion of cases (about 5%) in which the immune system won’t eliminate the virus, it will remain in the cells of the cervix or vagina for a long time, and then it’s called asymptomatic.
Usually at this stage there will be no signs of HPV in the body, so most of those infected with it may be unaware that they have been infected. If it’s one of the strains that is a high risk factor and it stays in the body, it may develop into pre-malignant cells first and later malignant cells. The process of developing from infection to a malignant tumor may take between 10 and 15 years, the professor added.
In Israel, every year, about 5,000 women develop a precancerous condition and about 200 new patients are diagnosed with cervical cancer. The average age is 40.

There is difficulty in predicting which of these cases will “persist” and become a premalignant or malignant condition. Yet, various risk factors are known to affect the chance of the disease progressing to a malignant condition, including the strain of the virus, duration of infection, smoking, chlamydia infection, dietary factors, use of hormonal birth control and more.

(Credit: Ingimage)(Credit: Ingimage)

How to deal with papillomavirus

The only safe way to avoid infection is to abstain from any form of sex. However, in recent years we have witnessed a revolution in the field with the advent of the HPV virus vaccine.
This vaccine is considered a scientific breakthrough that allows for the initial prevention of pre-malignancy of cervical cancer and even prevention of condyloma. This synthetic vaccine is injected into a muscle in two or three doses over a period of six months.
The vaccine consists of treated parts of the virus and is therefore effective in producing antibodies, but won’t cause infection or disease. The vaccine is approved in most countries worldwide and is included in 58 different countries as part of the recommended vaccination routine for boys and girls.
Today there are three vaccines that protect against different strains. One is against the two high risk strains mentioned, the other is against these two strains and against HPV6 and HPV11, which don’t cause cervical cancer but are responsible for most cases of condyloma.
Both of these vaccines provide close to 70% protection against precancerous tumors and cancers of the cervix. The third (newer) vaccine protects against nine strains of HPV that are mainly involved in cervical cancer, and provides protection of close to 90%.

At what age can you get vaccinated against the papilloma virus?

In Israel, the vaccine has been included in the health basket since 2013 and is given to eighth-grade boys and girls free of charge in order to protect adolescents from infection before the start of sexual intercourse. As the effectiveness of the vaccine decreases significantly after exposure to the virus. In addition, it’s been verified that vaccination at younger ages leads to a better, more effective immune response.
Sexually active women can also be vaccinated even if they have had a pap smear that showed infection or conical warts. As the vaccine may prevent conditions caused by the virus strains to which they haven’t yet been exposed. One can be vaccinated until age 45. Although in Israel the health basket subsidizes the vaccine until the age of 18 (for girls and boys) and up to the age of 26 for men at increased risk.
Most supplementary health insurance programs subsidize vaccines for men and women over the age of 26, and from the age of 27 to 45 you can consult a doctor to assess risk factors and the need to receive the vaccine.

How safe and effective is the vaccine?

Despite several press reports of unusual side effects, the vaccine’s safety profile is high and the World Health Organization has determined that the vaccine is safe and effective, and the known and side effects after testing are local only and include redness, pain and swelling at the injection site. More rare side effects can include fever, headache, nausea, dizziness and even fainting. During pregnancy, studies show that receiving the vaccine won’t harm the fetus. But the information about it is considered partial, so at present, it isn’t recommended for a pregnant woman to receive a vaccine until after pregnancy.
It should be noted that resistance to vaccines isn’t new and some people avoid vaccinating their children with any vaccine, and rely on theories and opinions which cause unnecessary anxieties and fears, the experts clarify.

Are there other ways to reduce the risk of exposure to the virus?

Using a condom, which doesn’t completely protect exposed areas, does help reduce infection. It’s important to use it throughout vaginal intercourse, and also during anal and/or oral intercourse. Of course, a healthy lifestyle strengthens the immune system such as adherence to a healthy diet, not smoking or using drugs. Exercise, improves protection against viruses and infections. Also remember that the vaccine doesn’t provide complete protection against the risk of contracting the virus that causes cervical cancer or premalignant conditions, so periodic screening should continue, emphasizes Dr. Bar-Noy.
The Israeli Society for Cervical Colposcopy and Pathology recommends a routine scan of all women to prevent cervical cancer. It is recommended to perform a Pap test from age 25 once every 3 years.
The Pap is a good screening test, but its sensitivity as a single test amounts to only 50 percent reliability. HPV strains can now also be tested from the age of 25 once every 3 or 5 years. The test is performed by taking a vaginal or cervical surface. Sending it for PCR where the results will provide information on whether there is a carrier of the virus and if so which strains are present. If an incorrect finding is obtained in the Pap or the test is positive for high-risk strains, further investigation or close follow-up is required, depending on the results, states Prof. Baruchim.
In conclusion, HPV is very common  and there is a high probability that most of us will “meet” it during our lives. Also, this virus can cause warts (condyloma) and there is even a risk that the cervical cells will be transformed into pre-malignant and even malignant conditions if infection with high risk strains occurs. Today there are many ways to diagnose, treat and most importantly – prevent by vaccination. Therefore, be aware of the virus, its various strains, the screening and diagnostic tests and of course – coping and prevention. It’s possible that in the not-so-distant future, through immunization and prevention, we will be able to eradicate the severe disease, cervical cancer.

Increasing VELscope Acceptance: Session 6 – Case Study & Conclusion

How to Improve VELscope Acceptance – An Interview with Dr. Ray Morgan

Over the past few sessions, you have learned how to approach the topic of oral screening with your patients, address objections and, as a result, improve case acceptance. In our final module, Janet Hagerman interviews Dr. Ray Morgan with The Art of Cosmetic Dentistry, a Georgia practice with a case acceptance rate of 90% for VELscope screenings. Watch and learn what this practice does that makes them so successful.

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