HPV — a risk worth taking?

By Lia Bewusstein

The third most frequent cancer in women aged 20 to 49 in Canada is cervical cancer.

In September 2010 after a routine physical, I was told I had low-grade cell changes in my cervix. I’d had this occurrence once before at age 15, and it had cleared up before we had anything to worry about. Naturally, I let the issue go for the time being and left the office with instructions to come back in six months. In February 2011, I went back for another pap test. After around two weeks, I received a call from the nurse requesting my presence back in the office. I thought the worst, as they usually tell you over the phone if it’s not serious. I arrived at the office a few days later, was greeted by a friendly nurse who explained that, as the doctor was busy, she would deliver my results to me.

She proceeded to tell me that my cells were still abnormal and I required a procedure at the Holy Cross Hospital. This procedure, the nurse said, was minor and was only needed to take a closer look. She set my mind to ease and even said the condition might clear up before I was called for my appointment, which wasn’t for a few months anyway.

Exactly two weeks later, I received a phone call from the Holy Cross and was advised that I needed to come in immediately for a colposcopy procedure that would also include a biopsy of the cervix.

I was petrified– a biopsy? Weeks before the nurse had told me there was nothing to be concerned about.

The day of my procedure, they took three biopsies of my cervix and advised me that there was a very large lesion on the surface. They told me that the samples needed to be sent to the lab for testing. It was then and there, after a few research sessions via Google the night before, that I asked if I had the human papilloma virus. They said they didn’t know if I had HPV, and it could be anything that caused the cell changes.

After awaiting my results anxiously for two weeks, I received yet another phone call. This nurse advised me that they hadn’t found anything to cause worry on the outside of my cervix, but after conducting a swab on the inner cervical canal they had found high-grade changes, which develop into cancerous cells if not removed. I was told I needed a loop electrosurgical excision procedure in order to remove these cells. A few months later, I was standing in the Tom Baker Cancer Centre in a hospital gown, awaiting my LEEP procedure– where a small laser is inserted into the canal, cuts away the damaged cells, which are sent to the lab for further testing. I was put out for the surgery and it took about three weeks to fully heal.

I am happy to report that my results came back and I am free and clear of cancer-developing cells. I do, however, have to go back in six months to have another biopsy as the condition could return.

It was throughout this whole process that I realized how important it is to spread the word to both men and women about how serious HPV really is.

When I ask people about their knowledge of the human papillomavirus, most have no idea how widespread the infection is. Many don’t realize that both men and women can contract HPV and develop cancer. Most HPV strains don’t cause symptoms. Both sexes can get it without recognizing it and unknowingly pass it on. The two known strains to have physical evidence of the infection cause genital warts, but two strains with visible symptoms does not give sexually active adults a good chance of recognizing when they contract HPV. While it is a serious disease for men, it’s even more concerning for women, as undetected HPV is more likely to develop into cancer.

Women have a higher risk when it comes to HPV, and the best screening method is yearly pap smears. If you are a woman who gets her yearly checkups, then this is a good first step in preventing HPV. But what about those of us who are already being monitored due to what gynecologists or obstetricians call irregular cells or– for those who don’t know the textbook term– low- or high-grade squamous intraepithelial lesions?

“After a routine pap test in 2009, while on vacation in Greece, I received a phone call from my doctor,” explained Jessica, who preferred to use a pseudonym.

Jessica, a third-year communications major, underwent a similar and unpleasant experience with irregular cells and unanswered questions. She had been told on her arrival back from her trip that she was also high risk and needed to have a colposcopy, followed by LEEP surgery. Her “scary and intrusive” surgery and overall experience compared almost exactly to mine. Although scared and confused after her surgery, she felt the doctors had done a good job of ridding her of the infection. She did not experience much after-shock, and healed up very well. Unfortunately, she does have to go back twice a year now as the low-grade lesions have returned.

“Despite the initial scare, I feel good; I do think that the experience was quick and thorough,” she said. Jessica only wished doctors had explained preventative measures against HPV. “Gardasil wasn’t mentioned to me until after my LEEP. I feel like this could have been dealt with better, as I’m not sure that it’s entirely worth it ­– I’m not sure if it will be as effective now.”

Allison, also identified under a pseudonym, is a finance major in her fourth year and had similar feelings of shock as I did: “I was 19 years old when I had my first abnormal pap, so of course it greatly concerned me. After a few weeks I was told I needed a colposcopy as my cell changes had become high risk,” she explained.

Allison wasn’t prepared for the ordeal she experienced. After her first colposcopy sample came back inconclusive, she was called to find out she needed to have surgery– her cell changes had developed into stage one cancer. “I thought, at my age, why is this happening? I had read about cervical cancer and statistics said that most often it developed in women over 30– it was rare for someone at my age to develop cancerous lesions.” She was scheduled for surgery immediately. “It was a really long process to get back to normal, and it still is. I have to go back every six months for the rest of my life due to the severity of the high grade changes,” added Allison.

She was prescribed Gardasil to protect against future outbreaks and infections, and has received all of the required shots. “The worst thing about this whole experience was the fact that I needed surgery to remove it,” explained Allison. “I felt they had taken a lot of tissue out. This made me start to question whether or not it would affect my future ability to have children.”

Like Allison, losing my ability to have children terrified me. There are a few complications that can stem from the procedure, like cervical stenosis, which causes your cervix to close up due to too much tampering with the tissue, causing the tissue to become scarred and hardened. Another issue is that your cervix will not be strong enough to hold a fetus– termed cervical dysplasia, which causes your cervix to become weakened. Rest assured, it takes a lot of invasive tampering with a cervix for these issues to occur, but it’s a serious concern nevertheless.

Most of the students I’ve spoken with are unaware of the effects of HPV and are unsure of the precautions that we need to take in order to prevent cancer. Dr. Jillian Nation, a specialist in oncology, agreed that most women are in the dark about the realities of HPV. “Most patients that we see have heard something about HPV, but many are not aware that the abnormal changes on their pap test may be caused by HPV infection, or that this is a common virus mainly transmitted through sexual activity,” Nation said. “Patients are also usually unaware that over 80 per cent of women will get HPV at some time,” she continued.

When I experienced my first pap with irregular cell changes, I felt as though I was too young to be having these issues, though Nation explained it’s common for abnormal cells to develop in the early twenties. “The majority of women with abnormal pap tests are in their twenties and thirties, but the majority of cervical cancers are in older women, as it takes several years for cancers to develop after the first infection with oncogenic HPV,” Nation said. This is why regular pap tests are a necessary screening tool.

“As a side note,” said Nation, “current evidence suggests that women under 21 are likely to clear HPV infections quickly.” She explained that new evidence shows women do not need pap tests younger than 21, and should start screening three years after becoming sexually active.

Nation recommended staying generally healthy as a way of inhibiting HPV development. “Individuals need to have regular sleep, eat healthily, exercise regularly, stop smoking and protect themselves from other sexually transmitted diseases in order to support good cervical health,” she said. Of course, the obvious way to protect yourself is ensuring you know your partner’s sexual past, knowing your own sexual past and present, and being careful to use protection. In the case of HPV, it is a bit more difficult as any contact with your partner’s genital area can transfer the virus. Protection from HPV mainly comes from knowing your sexual partner and making sure you’re vaccinated.

“Sexual health is everyone’s personal responsibility to understand the health risks. The major education piece for this disease is from primary care providers [like your family doctor or a nurse clinician], STI clinics and women’s health clinics,” added Nation.

“Along with Cervarix,” which prevents against multiple strains of HPV, “[Gardasil] is an excellent method to protect yourself from HPV infections if you fall into the target age groups of age nine to 26,” Nation explained. “However, it does not protect you from all HPV infections– only the most common subtypes that cause either pre-cancer changes or genital warts.” Nation added that many gynecologists will still recommend the vaccine even if you are outside the target age group.

The vaccine is also available for men, though it is most effective for men who are not yet sexually active. Gardasil is recommended for men as, like women, the disease can develop into cancers, though the risk to males is lower.

There are also vaccines like Gardasil available for both men and women. But many are apprehensive to get the shot due to lack of long-term side effect studies as well as rumoured controversies associated with it.

Overall, Gardasil is 90 per cent effective against the two genital wart strains of HPV and is 70 per cent effective against the cancer-causing HPV strains. The vaccine doesn’t cover 30 per cent of HPV types, but those types are rare. In order for Gardasil to be effective you need three shots at $120 each– a hefty price for most students. Though, if I would have bit the proverbial bullet and paid for the shot, I probably wouldn’t be in the position I was in this past year.

Money wasn’t the only issue weighing on my mind– according to the Public Health Agency of Canada website, 22 hospitalizations and one death related to HPV vaccinations have been reported as of April 2010 since Gardasil’s Canadian approval in 2006. The death has been investigated and, to date, there have been no conclusive evidence showing a relationship between the vaccine and cause of death.

It’s most important for your health to keep asking questions, no matter how many times you must, until you get answers that you are satisfied with. Know your body and when to take action when something isn’t right. Get checked yearly, ask your doctor questions, to make sure there are no surprises and take good care of yourself. After all, you only get one body in your lifetime. As Baz Lhurmann sang in the ever popular song, “Sunscreen”: “Be good to your body, as it is the greatest instrument you’ll ever own.”

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