Human papillomavirus (HPV)
infection is now a well-established cause of cervical cancer and there is
growing evidence that HPV is a relevant factor in other anogenital cancers
(anus, vulva, vagina and penis) and head and neck cancers.
Of more than 100 types of HPV, two
(types 16 and 18) are responsible for about 70 per cent of all cervical cancer
cases worldwide, according to a June 2010 report by the World Health Organization.
HPV has gained notoriety not only
for the damage which it can wreak on the lives of women of all ages, but
strangely enough, also via one of the most effective methods of prevention
available in the fight against a number of potential diseases and illnesses:
The first preventative HPV vaccine,
Gardasil, was approved by the US Food and Drug Administration 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 [not her real name], a
young Caymanian who had to face the reality of having HPV and stage one
cervical cancer at age 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 said. In fact, it was her mom who took her to the gynaecologist
from an early age, where she had her first Pap test done and was put on birth
control prior to becoming sexually active at 16.
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 for a Pap
smear. The results showed 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.”
Once she was able to wrap her brain
around the message about the virus, the upcoming procedures and what they would
entail, the emotional stress began to set in.
“It was really heart wrenching,”
Lisa had 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 said. “I didn’t realise 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.”
Lisa underwent cryosurgery, where
the doctor takes samples from the uterus and uses a “freezing process” in the
uterus which is aimed at killing the abnormal cells. “It was a very dramatic
moment for me,” she said.
Following the procedure, Lisa went
back to her gynaecologist to get the HPV vaccine, as she can still benefit from
it even though she has already been exposed to the virus. “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,”
Committed, five years later
Five 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 every six months and asks specifically to be checked for abnormal
cells. She’s also taking advantage of the advancements being made as far at 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 said.
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,” said Lisa. “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
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 the majority of 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.
Camila Muniz Ferreira is project coordinator at the Cayman Islands
The Cancer Society is observing September as Gynaecological Cancers