31 August, 2005  21:29 GMT
 HPV exists in more than a hundred strains, only some of which (HPV16 and HPV18, for example) put women at higher risk of developing cervical cancer.
The way rocker Christine Baze belted out the national anthem recently at Madison Square Garden, you'd never know that much of her inner cavity was removed years ago.
Baze, 36, is a survivor of cervical cancer. She was never tested for the human papilloma virus, or HPV, before being diagnosed and becoming one of a small percentage of women for which the Pap test alone wasn't enough.
"Choosing to know your HPV status can save your life," she said after her performance at a recent New York Liberty basketball game, where she hoped to educate more women about HPV.
There is a test that can determine whether women have a high-risk strain of HPV, the virus present in at least 95 percent of cervical cancer cases. But most women and men don't know about HPV -- or testing for it. Those who do know often don't talk about it because there's a stigma attached: HPV is not only a cause of cervical cancer but also a sexually transmitted disease.
Genital Warts
Eighty percent of women by the age of 50 will have had HPV at some point in their lives, but many don't know it, says the
Centers for Disease Control and Prevention.
Both men and women carry the virus and contract it through skin-to-skin contact of the genital area. HPV is responsible for 90 percent of genital warts, but infections often occur without any obvious symptoms.
Most people contract HPV when they're younger, and their bodies get rid of the virus on their own, before it can cause the cell changes that lead to cervical cancer, says gynecologist Allison Wagreich at the Cancer Institute of New Jersey. No conclusive data exist about what factors help most younger women get over the virus, in the same way they would a common cold. Smoking and multiple partners, however, increase the risk that the body will retain HPV.
Baze had minimal sexual experience before marrying at age 21. For the next decade, she says, she did everything right: She was monogamous, a vegetarian, a runner, did yoga and went to her gynecologist for annual Pap tests. In 2000, at age 31, she was diagnosed with invasive cervical cancer and had a radical hysterectomy.
Because of the high rates of HPV infection and low rates of cervical cancer in younger women, testing for HPV is recommended only for those 30 and older.
"If you screened people in their 20s, everyone would have it," Wagreich says. "But if you're over the age of 30 and still have HPV, you might be one of the people more at risk of developing a pre-cancerous or cancerous condition."
Request HPV Test with Pap
According to the
American Cancer Society, Pap tests are not always effective in detecting cancerous cells that develop in the lining of the cervix -- adenocarcinoma. These cells are responsible for 20 percent to 25 percent of cervical cancers in the United States.
In the Pap test, humans use a microscope to examine cells for abnormalities. The HPV test, in comparison, detects genetic material, or DNA, of the virus. Therefore, doing both tests simultaneously may increase detection of cervical cancer in its earliest stages.
Gynecologists routinely give HPV tests only to women who have abnormal Pap results. However, all women may request an HPV test in conjunction with the Pap, regardless of its result.
HPV exists in more than a hundred strains, only some of which (HPV16 and HPV18, for example) put women at higher risk of developing cervical cancer. Of those with higher-risk strains, only 5 percent develop cervical cancer, according to the CDC.
What is important, says Carmel Cohen, professor of clinical gynecology at Columbia University Medical Center, is that a woman over 30 with a high-risk strain of HPV is closely monitored so that if the virus does cause cellular changes, they're caught early.
If the mutations are detected in what's known as the "carcinoma in situ" stage, the cure rate is virtually 100 percent, Cohen says. Treatment often takes place in a doctor's office and involves techniques such as radiating or freezing cervical cells.
Cervical Cancer Task Force
While older women with high-risk strains of HPV need surveillance, women who have three consecutive negative HPV tests and normal Pap tests do not need to be retested for the next two to three years, unless they have a history of cervical cancer or a suppressed immune system.
Latina women have the highest incidence rate of HPV, and African-American women have the highest fatality rates from cervical cancer, but no one knows whether that's because of a lack of screening or a genetic disposition in the population, Wagreich says.
Such questions are part of the reason State Assemblywoman Loretta Weinberg introduced legislation this year to create a cervical cancer task force.
"It's going to look at all the research that's available, including that about early detection testing, [and] disseminate information and bring back to the legislation what we should be doing," Weinberg says. She expects the bill (No. A4071) to pass this fall without resistance.
Vaccines that might prevent HPV infection are in the experimental stages. Merck's Gardasil, for instance, is in clinical trials, and the company expects to seek FDA approval before the year's end. The vaccine would be given to teenage girls before they become sexually active to prevent infection.
Knowing options now and for the future, Baze says, will help ensure that "no one's going to fall through the cracks like I did."
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