Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer
Human Papilloma Virus (HPV) Infection & Oral Cancer
Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
"A critical weekly review of important new research findings for health-conscious readers..."
Last Updated: 4/6/2008
HUMAN
PAPILLOMA VIRUS (HPV) INFECTION, PAP SMEAR RESULTS &
CERVICAL CANCER
An
estimated 11,000 women will be
diagnosed with cancer of the cervix in the United States
For
most women, annual screening
for cervical cancer includes a “Pap smear,” named after Dr. Georgios N.
Papanikolaou, the
Greek-American physician who originally developed the test. During a woman’s routine
annual pelvic
examination, a thin layer of superficial cells are scraped off of the
cervix
and examined under the microscope.
In a
few hospitals, the cells are also routinely tested for the presence of
oncogenic HPV infection. However,
in
most hospitals, if the cervical cells appear normal under the
microscope, then
the costly DNA testing for oncogenic HPV infection is omitted. A new study, just reported
in the current
issue of the Annals of Internal Medicine,
evaluated nearly 10,000 women at 26 clinical facilities, in 6 cities,
in the United States
Overall,
nearly 1 in 4 (23%) of
the women participating in this trial had DNA evidence of chronic
infection of
the cervix with one or more high-risk strains of the HPV. Women 14 to 19 years of
age were most
commonly found to be infected with these strains of HPV, while women 50
and
older were least likely to be infected.
Among
women younger than 30 years of age with an abnormal
Pap smear, a whopping 53% had DNA evidence of chronic cervical
infection with
oncogenic HPV strains, while 9% of women 30 years of age and older who
had a normal Pap smear had DNA
evidence of
high-risk HPV infection.
The
findings of this study have
several important implications, the two most important of which are
improving
prevention of cervical cancer, and improving screening for this disease. With the recent
availability of a vaccine
that appears to be more than 90% protective against cervical HPV
infection in
women, there is finally an effective method of preventing infection
with the
oncogenic strains of the HPV virus (of course, taking appropriate
measures to
avoid unprotected sexual contact should always be used, when
appropriate).
Secondly,
the results of this
test show that even among women who are already above the age range
considered
to be at greatest risk of infection with high risk HPV and
who have a normal Pap smear, nearly 1 in 10 are
already
likely to be infected with cancer-causing strains of HPV. This finding
strongly suggests that Pap smears
alone are missing a significant number of cases of chronic oncogenic
HPV
infection. Based
upon the results of
this study, it may be the case that we will have to reassess our
current
screening guidelines for cervical cancer.
HUMAN
PAPILLOMA VIRUS (HPV) INFECTION & ORAL CANCER
The
vast majority of oral cancers
are diagnosed in patients (and mostly men) who are heavy drinkers and
smokers. However,
approximately 20% of oral cancers diagnosed
today occur in patients who have never smoked.
HPV, a family of viruses that are easily passed between
people during
sexual contact, has previously been implicated in these particular
cases of
oral cancer (the same oncogenic strains of HPV that are known to cause
cervical
cancer also appear to cause oral cancer as well).
A new study in the journal Carcinogenesis
provides important
further insight into the association of HPV with oral cancer,
especially among
non-smokers.
In
this study, 186 patients newly
diagnosed with squamous cell cancer of the oropharynx and 342
cancer-free
“control” patients were compared.
All
patients participating in this study underwent a blood test for the HPV
strain
most commonly associated with both cervical and oral cancers (HPV-16). Overall, having a positive
blood test for
HPV-16 was almost 6 times more common among the patients diagnosed with
oral
cavity cancers. When
the researchers
looked at just the non-smokers in both groups of patients, the
association
between HPV-16 and oral cancer was even more striking: oral cancer was
a whopping
14 times more frequent among the non-smoking patients in presence of
HPV-16
infection.
An
additional part of this
research study looked at variations in a very important cancer
suppressor gene,
p53.
Patients with a specific variation (polymorphism) in the p53 gene and
with evidence of HPV-16 infection were 9 times more likely to
have oral cancer. However,
among
non-smoking patients with evidence of HPV-16 infection and
the “codon 72 polymorphism” in the p53
gene, there was a nearly 23-fold increase in the likelihood of
having oral cancer, which is an incredibly high level of increased risk
for any
disease.
The
results of this study confirm
other recent data suggesting that oncogenic strains of HPV are
significantly
involved in causing many cases of oral cancers, especially in
non-smokers; and
that certain naturally occurring variations in important tumor
suppressor genes
may further magnify the risk of developing this cancer in the presence
of
chronic HPV infection. The
findings of
this study, and others like it, have also added further weight to the
argument
that boys and young men should also be considered for vaccination
against HPV,
rather than the current guidelines which recommend its use for girls
and young
women, only.
HORMONE
REPLACEMENT THERAPY (HRT) & THE RISK
OF GASTROESOPHAGEAL REFLUX DISORDER (GERD)
Gastroesophageal
reflux disorder (GERD) has
been linked to the increasing prevalence of a high-fat diet among
people in
westernized societies, and especially to the rising incidence of
obesity
throughout the world. In
addition to the
symptoms of chronic heartburn that often (but not always) accompany
GERD,
severe GERD has been linked to chronic scarring of the esophagus, and
to an
increased risk of esophageal cancer, a particularly deadly form of
cancer. Pregnancy
is another risk factor that has
long thought to increase the risk of GERD, due to a combination of
increased
levels of female hormones known to cause relaxation of the sphincter
muscle in
the lower esophagus (and that prevents reflux of acid up from the
stomach), and
increased pressure within the abdomen of pregnant women, which also
increases
the tendency for acid to percolate up from the stomach and into the
esophagus.
A new study in the
journal Gastroenterology has
evaluated the role
of female hormones, in the form of hormone replacement therapy (HRT)
following
menopause, and oral contraceptives, in the development of GERD. In this Swedish study, a
registry of twins
was utilized to collect data on 4,365 women with known GERD and 17,321
women
without GERD. A
history regarding prior
use of oral contraceptive pills (OCPs) and various forms of HRT was
obtained
through telephones interviews and questionnaires.
Among the women
who previously or currently
used estrogen-only HRT, there was a 32% increase in the risk of having
GERD
when compared to women who had never used HRT or OCPs.
However, the prior or current use of OCPs did
not appear to be linked to an increased risk of GERD.
While, as I have
previously commented upon, survey-
or questionnaire-based epidemiological studies have great potential to
be
biased on the part of those asking the questions, and by those
answering them,
this study does at least suggest the possibility that estrogen-only HRT
medications may be associated with an increased risk of GERD. However, there is a large
randomized,
prospective, double-blinded HRT study, the landmark Women’s Health
Initiative
(WHI) study, that should be able to definitively corroborate or
contradict this
Swedish epidemiological study’s findings.
I look forward to that analysis of the WHI study’s
enormous collection
of data in the near future.
Disclaimer:
As always, my advice to readers is to seek the advice of your physician
before making any significant changes in
medications, diet, or level of physical activity.
Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center
http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html
Send your feedback to Dr. Wascher at
rwascher@doctorwascher.net
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Copyright 2008. Robert A. Wascher, MD, FACS. All rights reserved.
Dr. Wascher's Archives:
3-16-2008: Benefits
of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen
Conversations about Sex; Soy (Genistein) & Prostate Cancer
2-23-2008: Universal
Healthcare Insurance Study; Glucosamine & Arthritis
2-3-2008: Vitamin D
& Cardiovascular Health; Vitamin D & Breast Cancer;
Green Tea & Colorectal Cancer
1-12-2008: Statins,
Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
12-31-2007: Minority Women, Hormone Replacement Therapy
& Breast Cancer; Does Health Insurance Improve Health?