"Cervical Cancer is a sexually-transmitted disease." It seems I'm encountering this message everywhere I turn. It appears in books, in articles, and on websites. Physicians repeat it to their patients. Today, any woman diagnosed with cervical dysplasia or cancer is inevitably confronted with this assertion.
Naturally, this message affects the way we see ourselves and others. Increasingly, in the course of my work, I am communicating with women who feel badly toward themselves when they are diagnosed with these conditions. Words like "dirty" and "ashamed", and worse terms, are creeping into conversations.
This phenomenon reflects a widespread misunderstanding of the actual medical literature, and of HPV (human papillomavirus) in particular. For example, consider the following observations:
1) HPV is incredibly common, and extremely easy to catch. It is now considered to be endemic in the adult human population, and most single adults have been infected with it - up to 80% in some samples of younger adults.
2) Sexually transmitted? Yes, but ... HPV, unlike most STDs (Sexually Transmitted Diseases), is not spread only through sexual intercourse. This is why condoms are not adequate protection (though they do reduce the risk of contagion). For example, in one study, 20% of lesbians who reported never having had sexual contact with men were infected with HPV. Skin-to-skin contact is sufficient to spread the virus. In fact, HPV has been found on the fingers. Another study sampled healthy children (by looking at cells from the inside of the cheek), and half turned out to be carrying the virus.
3) HPV may play a role in other cancers. HPV is closely associated with cervical cancer, but researchers have recently begun looking for HPV in other cancers (in the skin and esophagus, for example) ... and finding it. How transmission occurs in these cases is currently unknown.
4) Not all cervical cancer patients test positive for HPV. To some extent, it seems to depend on who is being studied. For example, one study compared groups of elderly and younger women with cervical cancer - the elderly group had a much lower rate of HPV (50%, vs 85% for the younger group).
5) Only a small proportion of women with HPV go on to get cervical dysplasia. Obviously, then, there are co-factors at work. Genetics probably plays a role, as well as other environmental factors, such as smoking.
6) More is being learned about HPV all the time. We are really just beginning to acquire knowledge about the role of HPV with regard to cancer. Interest is growing rapidly, but there is still much that is not known.
The bottom line is that it is probably too early to make grand pronouncements about the exact connection between cervical cancer and sexual behavior. This should make a difference in the way that women view themselves when diagnosed with this disease. In a follow-up to this article, I focus on helping women to deal with the emotional fallout of having a condition that not only could be life-threatening, but has been labeled in a way that makes them feel as though it's their own fault.
HPV links for further investigation:
Eyes on the Prize has a FAQ page on the topic.
Viruses and Cancer: Finding the Links - This report on some of the latest research is on the Medscape website - registration required. The HPV section is about half-way down the page.
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