SEXUALLY TRANSMITTED DISEASE THAT CAUSES CANCER
Hollywood actor Michael Douglas recently stated that his throat cancer was caused by a sexually transmitted infection called HPV (human papillomavirus). According to the World Health Organisation HPV can cause cancer of the head and neck. Michael Douglas was quoted by the Guardian UK when asked if, given his illness, he regretted his years of smoking and drinking; to which he replied “No. Because without wanting to get too specific, this particular cancer is caused by HPV, which actually comes about from cunnilingus.” The actor who announced on August 16th 2010 that he had Throat Cancer, underwent treatment for his illness, and by January of 2011 he announced that the tumour had gone. Michael Douglas’s illness is now in remission, and he has been clear of cancer for just over 2 years now.
This has brought in discussions to the safety precautions people need to adhere to in regards to their sexual health. Abstinence and knowing your status top the list of the medical advice given to individuals; as well as the use of condoms, getting vaccinated and microbicides. With various free testing facilities available in most countries, individuals are urged to take precaution, and to take their sexual health seriously by conducting regular checks with their local health department.
What is HPV (Human Papillomavirus)?
Human papillomavirus (HPV) is a virus from the papillomavirus family that is capable of infecting humans. Recently HPV has been linked with an increased risk of cardiovascular disease with HPV 16 and 18 infections being strongly associated with the development of oropharyngeal (throat) cancer, lik in the Michael Douglas case. The known types of HPV tend not to show any symptoms, however those that do can cause warts, while others in minor cases can lead to cancers of the oropharynx, penis, vagina, vulva, anus and cervix.
More than 30 to 40 types of HPV are typically transmitted through sexual contact. Even though they do not cause disease; nearly all cases of cervical cancer are caused by HPV infection.
Most young women infected with HPV tend to have it temporarily and most of the infection around ¾ is gone within the 1st year with approximately 90% in two years. The more developed countries hold cervical screenings or (PAP) Papanicolaou tests, in order to detect abnormal cells that may develop into cancer. Those found with abnormal cells are called in for a colposcopy, at which a biopsy is administered to further detect if the cells are cancerous.
The introduction of Pap smears has reduced the incidence and fatalities of cervical cancer in the developed world, and countries with limited resources have been reported to have an estimated 490,000 cases and 270,000 deaths each year.
In 2005, the Centre for Infectious Disease Research in Zambia (CIDRZ) performed a pilot cervical cancer screening study of 150 women seeking HIV care and treatment at the University Teaching Hospital of Zambia (UTH). They found 33% of the study participants to have had Pap smear evidence of high grade cervical pre-cancer while 20% already had evidence of cancer. “These findings, coupled with the previously described epidemiology of cervical cancer and HIV in Zambia, motivated us to establish early detection and treatment services for ALL Zambian women, targeting those receiving HIV care and treatment through PEPFAR (U.S. President’s Emergency Plan for AIDS Relief) – funded primary care sites in Zambia.”
CIDRZ Outcomes as of February 2011
- Approximately 57,000 women have been successfully screened as of February 2011
- Over 6,000 women have been treated for pre-cancerous lesions using cryotherapy in the primary health care facilities by nurses. At the UTH referral clinic, close to 4,000 women have treated for pre-cancerous lesions by experts since inception.
- Approximately 35% of the women screened for cervical cancer are HIV-infected, 34% are HIV-negative, and 31% are of unknown HIV status.
- The life-saving program is safe, effective, and highly accepted by patients.
- Women who have either never been tested for HIV or were tested more than 6 months ago are offered testing by screening nurses in the clinics; 60% accept and of these, approximately 30% are found to be HIV positive. Over 10,000 women have been offered HIV testing in our clinics since June 2008.
- We offer integrated screening and treatment for sexually transmitted infections (STIs) using the WHO Syndromic Approach. 11% of women present with clinical evidence of one or more STIs and are prescribed treatment.
- Through our Global Cervical Cancer Prevention Training Program, we have trained over 70 medical personnel from within Zambia (Chongwe, Mumpashya, KCM, Kafue, Kara clinic, Mariestopes International, Monze, Mansa) and outside Zambia (Botswana, Nigeria, Zimbabwe, Cameroon, Swaziland, Kenya, Tanzania, South Africa, Peoples Republic of China).
- PEPFAR has sponsored on-site visits to the CIDRZ Cervical Cancer Prevention Program by 8 African nations (Uganda, Rwanda, Mozambique, Kenya, Botswana, Cote D’Ivoire, Namibia, Tanzania and Ethiopia). Officials from WHO headquarters, CDC, and USAID also attended the on-site visits. We offer integrated screening and treatment for sexually transmitted infections (STIs). 11% of women present with clinical evidence of one or more STIs and are prescribed treatment.
The CIDRZ HIV prevention and treatment service units support 338 public health facilities in four of the nine provinces of Zambia. Prevention of mother-to-child HIV transmission (PMTCT) services are offered in 330 clinics and hospitals. The PMTCT program has tested 1,081,137 women and provided 120,573 women with maternal ARV prophylaxis. The program has a particular focus on expanding access to more efficacious PMTCT regimens and to HAART, and on early infant diagnosis for HIV-exposed babies.
HIV care and treatment services are offered in 71 sites. Since the program began in 2004, over 279,680 people have received HIV care, with 180,688 starting antiretroviral therapy. Our related service activities include a comprehensive cervical cancer screening program that has screened over 57,000 women in its five years, and an integrated TB/HIV program that offers HIV testing to TB patients and TB screening for all HIV patients.
For more information, contact the Cervical Cancer Screening Team:
Groesbeck Parham, M.D.
Professor of Medicine University of Alabama School of Medicine
University Teaching Hospital, Zambia
Mulindi H. Mwanahamuntu, MH, MBBS, MMed
University Teaching Hospital, Zambia
Dr. Sharon Kapambwe, MBChB, MPH
Adult Infectious Disease Centre, UTH