Dec. 22nd, 2011

joreth: (statement)

First of all, note that this is a preliminary study.  Much more research needs to go into this hypothesis, including replicating this study a couple more times.

Second, there is no indication at this time that HPV causes heart attacks or strokes, the way we know that certain strains cause cancer (to be pedantic, even those strains don't cause cancer each time, and, in fact, the vast majority of HPV cases never cause cancer at all.  This just means that, in those cases of cancer that are linked to HPV, as opposed to other cancers for which HPV is not linked, there is a causal relationship.)

This study suggests that HPV has some role to play in increasing the risk of a heart attack or stroke in women by a significant amount.  So it is very important that 1) everyone get the vaccine if there is any way possible to afford it, and 2) we start pushing for the DNA test before the pap smear, so that we can better evaluate every woman's personal risk factors.

At the moment, we currently have women get a pap smear every year.  Then, if there is abnormal activity, her smear sample is tested for HPV DNA.  Many in the research end of things think that this is backwards.  We should be getting regular DNA tests because those DNA tests will tell us how often we should be getting a pap smear.  If we have no HPV, we might only need the invasive pap every other year (HPV is not the only cause of cervical cancer or other pelvic problems for women, just the main cause).  

Tests have sort of a rise and then plateau, or sometimes a drop off, when it comes to efficacy.  We need to be tested often enough for things like cancer to catch them early, when we can best treat them.  But for all tests there comes a point at which testing more frequently does not have any better chance of catching the problem and all it does is put the individual through unnecessary and sometimes invasive procedures, wastes money, and wastes time and medical resources that could have been spent on others with fewer means.

Every test has a different slope and peak in that efficacy chart, and every individual will have their own gradation to that slope because of personal risk factors.  I, with my family history of no breast cancer, of no cancer ever, and with small breasts, am not considered to be high risk for breast cancer so I do not need a mammogram until I am much older, and I do not need them often - regular self breast exams and an annual check with my routine pap will do fine for quite a while.  A friend of mine with a family history of breast cancer, however, does need to be checked regularly, and has since her early 20s.

The HPV DNA test can help with this more personalized style of healthcare by identifying who is higher risk and increasing their screening schedule to a peak efficient timetable while giving those of lower risk a bit of a break in money, time, and discomfort involved with annual paps.  And, apparently, more than just how often we should get pap smears, knowing that we have active strains of HPV can also help us to adjust other exams like cardiovascular exams and better refine our risk category for heart attacks and strokes as well as cancers.

To remind everyone, the HPV vaccine is currently approved by the FDA for both men and women up to age 26.  Since HPV is also known to cause anal, penile, and several oral cancers, as well as be passed on asymptomatically from males to their partners (both male and female), I strongly encourage both boys and girls to get vaccinated.  The sooner they get vaccinated, the more effective the vaccine is, hence the age limit.

Which means that if you are over 26, you can *still* get the vaccine.  You have to request it "off-label".  This does not mean illegal or black market or anything bad.  It just means that the FDA thinks that the vaccine's efficacy (that is, how well it prevents HPV) drops too low in older people to justify making claims about it or including it on governmental or insurance programs.  

The logic goes like this:  If you have already been exposed to those strains of HPV, the vaccine won't do anything.  The older you are, the more likely it is that you have had sex, so the more likely it is that you have been exposed to HPV, rendering the vaccine ineffective.

And that is all true.  The problem is that most people do not know if they have been exposed to HPV or not, and out of those who have, many don't know which strains they have been exposed to.  The main reason is that for the vast majority of people, HPV doesn't actually do anything - we catch it and it just goes away in a couple of years.  Gardasil prevents the two most common cancer-causing strains and the two most common wart-causing strains, but it also seems to work against a handful of other strains that are closely related to the big four, just not as well as against those four.

So, since we don't know if we have been exposed or not, if you have the cash (or the insurance), get the vaccine which will significantly decrease your risk of genital, pelvic, and oral cancers as well as, apparently, lowering your risk of heart attacks and strokes.  And start pushing for screening for men as well as reversing the order of the testing - DNA test first and then the pap based on your personal risk level.  Talk to your healthcare provider, check with Planned Parenthood, and keep an eye out here for opportunities to sign petitions to politicians and/or policy makers regarding better personalized healthcare.

Notes: - FDA approves automated HPV DNA test. - HPV vaccine does NOT make girls more likely to be sexually active (and girls with the vaccine are more likely to use condoms when they do have sex than girls who don't get the vaccine). - HPV DNA testing is much better than pap smears & researchers recommend reversing the order to HPV test first, paps second.


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