This is a diary about a sexually transmitted disease which many people do not realize is a sexually transmitted disease.
I'm talking about cancer of the uterine cervix which is caused by Human Papilloma Virus (HPV).
Okay, guys, you don't have a cervix, but you have mothers, and sisters, and wives, and daughters, and girlfriends who do, so this is important to you, too. This virus also has been linked to squamous carcinoma of the penis, but the link is not as strong as the link to cervical cancer.
WHY I AM WRITING THIS: I have mentioned in some of my comments that I work in a medical laboratory. My title is "Cytotechnologist", cyto=cell. I look in a microscope most of the day screening slides. Most of the work is Pap smears, but we also look at urines, spinal fluids, lung specimens, needle aspirations from thyroids, breasts, lymph nodes, whatever they can drain, wash, brush, or aspirate. Not only do cytotechs find cancer, they can also find pre-malignant changes, so the patient can be treated before they develop cancer.
Today, I had a very unusual specimen, a fluid that had been drained from a patient's cerebellum. I had never seen this particular kind of specimen. I looked at the worksheet accompanying the specimen and saw that it was on a 52 year old woman. We include all the patient's previous reports of any biopsy specimen or cytology specimen that are in our computer.
Usually, on a 52 year old woman, you would have a fairly long history if the patient had been getting regular Pap smears since this is a small town and we are the only medical lab for about a 100 mile radius. The only specimen listed on this patient was a biopsy she had last month of her cervix which showed cancer. Since there wasn't even a Pap smear taken at the time of the biopsy, I suspect that she went to the doctor for some symptom and was found to have a tumor on her cervix, so they biopsied it.
I looked at the slides from the cerebellum fluid and I nearly fell off my chair. The same kind of cancer cells from her cervix were in her brain. Not only did the cancer cross the diaphragm, but I think it crossed the blood-brain barrier. I don't think she'll make it to her 53rd birthday later this year. That is way too young to die, especially of something so preventable.
FACT: A huge percentage of women who contract cervical cancer have not had a Pap smear in the last five years.
WHAT ABOUT HPV? In the last 20-25 years it has been found that certain subtypes of Human Papilloma Virus work their way into the nucleus of the cell, insert their DNA into the cells' DNA and start reproducing.
HPV is a common infection, especially in populations under 30. It can cause venereal warts if the infection is due to the low-risk sub-types. In women, the high-risk sub-types of the virus will cause detectable cellular changes in the cervix. This is usually treated by surgical removal, but even if left untreated, the vast majority of these lesions will revert to normal.
However, if a lesion caused by a high-risk subtype persists for a year or more, the odds increase that the lesion will progress to cancer. It takes a long time for the cancer to progress, sometimes as long as 10-20 years.
The Pap test is a screening test to detect cervical cancer and its precursor lesions. It is
extremely cost-effective. The price of many Pap tests over a woman's lifetime is still much cheaper than the cost of treatment of cervical cancer.
COOL NEW UPDATES TO THE TEST: There are new and improved technologies for the Pap test these days.
The last several years have seen a marked increase in the number of liquid-based Pap tests. Instead of the cellular material being spread onto the slide as it was in the past, the material is collected into a small vial of fixative which is sent to the lab and processed there. These paps are wonderful because the cells present in a monolayer and the blood and inflammatory cells are greatly reduced. The ThinPrep test has increased the detection of pre-malignant lesions greatly.
Also, additional tests for STD's can be run on these vials, including Chlamydia, Gonorrhea, and HPV typing.
Another new technology that is starting to blossom is an imaging system to help the tech detect abnormal cells. The computer-driven microscope pre-screens every slide which is then reviewed by a tech. This is also improving the sensitivity of the Pap test and reducing the number of false negative tests. It is rather costly right now, so it is mostly being used in the larger labs.
Also, the old class system of reporting is gone and a new and improved and standardized system is being used throughout the world. The Bethesda System (TBS) more accurately reflects the biological process of cervical carcinogenesis.
WHAT SHOULD I DO TO PREVENT CERVICAL CANCER? Unprotected sex is dangerous for many reasons. Condoms will provide some protection from HPV, but in a woman, HPV can also infect the vulva and vagina, as well as the cervix. I don't want to moralize, but limiting the number of sexual partners you have and being faithful to the ones you do have (and vice-versa) will probably reduce the chances of infection.
Women, get regular physicals and Paps. Your doctor should discuss the frequency of Paps based on your history.
Men and women, there is still a lot of good advice in the American Cancer Society's Warning Signs of Cancer.
There are a lot of cancer survivors now living, more than ever before. It doesn't have to be a death sentence. Healthy habits and early detection can lead to a long happy life.
So, live long and prosper, Kossacks.