‘I thought I was safe...’
Fifteen-year-old Jennifer Sanchez had heard about human papillomavirus — HPV — but didn’t think much about the sexually transmitted virus.
What she didn’t know is that by adulthood, over 80 percent of women are or have been infected with the virus at some point in their lives.
What is more alarming is that Sanchez wouldn’t even have known about HPV’s high infection rate unless she had attended a forum designed to make young women aware of HPV and its link to cervical cancer.
Sanchez and 22 other women from Teen Voices, a Boston-based nonprofit girls’ organization, learned a great deal about HPV after their recent visit to Brigham and Women’s Hospital with Dr. JudyAnn Bigby.
“I wanted [the girls] to get engaged in a relevant health topic,” said Dr. Bigby, who is the director of community health programs at Brigham and Women’s. “And with African American women having a higher rate of cervical cancer, this visit has the potential to really benefit these teens.”
The HPVs are a group of over 100 types, each of which is designated by a singular number. HPVs cause warts, or papillomas, and are very common.
It is estimated that over 6 million people are infected each year in the United States. More than 50 percent of the people who have had sex will at some point have the virus, and the majority of those people will be between 15 and 25 years old.
The numbers are more troublesome for young women. Dr. Bigby pointed out that girls who begin having intercourse before the age of 16 are twice as likely to develop HPV than those who have intercourse after age 20.
She also explained that women who have more than five sexual partners in their lifetimes are much more likely to contract HPV as well.
“I thought I was safe,” said Natasha Labbe, a recent graduate of Boston Latin School who has not been sexually active. “Why isn’t there more awareness about HPV? Why did I never know about this?”
Closing the information gap is a major priority for Dr. Bigby, and, as such, the next stop for the teens was the cytology lab. Cytology is the branch of biology that deals with the study of cells.
For the most part, HPVs are harmless and look worse than any real medical threat. But some HPVs, specifically HPV strains No. 16 and 18, can lead to cervical cancer. The Pap smear is one effective screening test for finding HPV.
Developed in the 1920s by Dr. George Papanicolaou, Pap smears enable doctors to detect and diagnose suspicious cells before they become cancerous. If left unchecked, the suspicious cells can turn to cancer and cancer could then invade other parts of the body.
At the time, the medical community was slow to embrace Dr. Papanicolaou’s findings. But the use of Pap smears survived the initial scrutiny and its use over the years has resulted in an incredible medical feat. Cases of cervical cancer in the developed world have dropped from one of the top cancer killers to under two percent of all estimated cancer deaths in women in 2006.
Between 1975 and 2003 alone, the age-adjusted incidence and mortality rates for cervical cancer dropped by 200 percent for white women and over 300 percent for black women.
The key is early screenings. In many underdeveloped countries, where Pap smears and condom use are not readily available, cervical cancer remains a leading cause of death in women, causing more than 270,000 deaths annually.
The statistics in the United States are also illustrative of the importance of early diagnosis. The five-year survival rate of cervical cancer is more than 92 percent if found early, and decreases to roughly 17 percent if it spreads to distant organs.
But even with early screenings, a racial disparity persists. In Boston, for instance, a slightly larger percentage of black women report having had Pap smears than whites, but the mortality rate from cervical cancer in blacks is more than twice that in whites.
The reasons for the disparity remain unclear. On this particular day, however, Dr. Bigby was trying to teach the basics.
“What happens with the Pap smear samples after they are taken are a big mystery to most people,” said Dr. Bigby. “We wanted to show the girls, step-by-step, what happens and how we detect HPV.”
The teens saw where the samples are stored, how potentially abnormal samples are screened by computers and how technicians can recognize the difference between normal cells and abnormal, HPV infected cells.
The teens also looked at abnormal Pap smear samples with the help of Cytology Technician Janet Cronin.
“Infected cells have much larger nuclei than normal cells,” Cronin explained. According to Cronin and Dr. Bigby, the increased activity within the nuclei can be due to various infections, cellular repair processes or it can be a simple abnormality that corrects itself.
Sometimes, however, the increased nuclear activity can indicate that the cell is more rapidly dividing and thus replacing normal cells. This is called dysplasia and is considered a pre-malignant change. HPV is one of the main causes of dysplasia, which can become cervical cancer.
For the most part, cancer of the cervix develops very slowly. Located near the lower part of the uterus, the cervix is part of a woman’s reproductive system and, during pregnancy, closes to keep the fetus in the uterus and opens to allow the infant to be born.
“I was very impressed by the girls’ ability to understand the complexities of HPV and its connection to cervical cancer,” said Dr. Bigby. “The questions they had while looking in the microscopes showed that they could really connect this to the big picture.”
This big picture connection was clearly demonstrated when the teens discussed the HPV vaccine, Gardasil™, a revolutionary new drug that is scheduled to be widely available later this year.
Approved in June 2006 by the Food and Drug Administration, Gardasil™ is designed to prevent the spread of the HPVs that are responsible for 70 percent of all cervical cancers, namely HPV strains 16 and 18. It will also protect against HPV strains 6 and 11, which are responsible for 90 percent of genital warts.
Provisional federal guidelines recommend that the vaccine be given to females aged 11 to 12, or even as young as 9. Women aged 13 to 26 who have not received the vaccine should receive “catch up” vaccinations. To be most effective, the vaccine should be given to a person before becoming sexually active.
Gardasil’s three-shot regimen, administered over a six-month period, will cost about $360.
The last stop on the teen’s tour was a colposcopy room to learn about pelvic exams and how samples are collected.
Dr. Roxane Gardner talked the girls through the process, using pictures and the tools (speculum, spatula and brush) to simulate an actual pelvic exam and Pap smear.
“I have a better understanding of what happens in a pelvic exam,” said Sanchez. “It’s less scary for me now and [the doctor] really explained the importance of getting it done.”
Sanchez has already done her part to help share the information and break the cycle of ignorance. “As soon as I got home I got on the phone and told my friend ‘You might not even know you have [HPV]. You should get tested.’” |
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A member of Teen Voices studies HPV under a microscope.
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