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Cervical Cancer and Human Papilloma Virus

      “Loose lips sink ships.” I remember that phrase from my childhood during World War II. I knew what it meant, but as kids, we used to say it laughingly while making silly faces with floppy lips. We regularly saw these words on posters made by the United States Office of War Information; the wording originated from the War Advertising Council.

      Wikipedia. Loose lips sink ships. https://en.wikipedia.org/wiki/Loose_lips_sink_ships. Accessed February 15, 2016

      Many years later, when learning about the mental status exam, I was exposed for the first time to the proverb: “The tongue is the enemy of the neck.” For many people, even those who easily interpret “People who live in glass houses should not throw stones,” this proverb was a little too abstract. Taken together, the overall message from these phrases is clear—your mouth can get you or others into big trouble.
      What has this to do with cervical cancer? My lips may not be loose, but my associations often are. The word cervix is Latin for neck. One way to spread the human papilloma virus (HPV), the virus responsible for nearly all cases of cervical cancer, is through oral sex—a behavior not uncommon among teens and other age cohorts. The link between oral sex and HPV-caused mouth and throat cancer is reasonably well supported by data. The link between oral sex and cervical cancer is still ambiguous. How can many HPV-caused cancers be prevented? Vaccination of preteens and teens provides the most hope, particularly for cervical cancer.
      An old adage clearly applies here—“A stitch in time saves nine.” Consistent with this view, 13 months ago, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recommended the use of 9-valent HPV vaccine
      Trademark: Gardasil®9 (Merck & Co., Inc., West Point, Pennsylvania).
      low asteriskTrademark: Gardasil®9 (Merck & Co., Inc., West Point, Pennsylvania).
      ; it is now the third HPV vaccine available in the United States, and it protects against nine strains of the virus.

      Petrosky E, Bocchini JA, Hariri S, et al. Centers for Disease Control and Prevention; Use of 9-valent human papillomavirus (HPV) vaccine: Updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a3.htm. Accessed February 15, 2016.

      Unfortunately, this effective strategy for HPV prevention is still not as widely in use as it should be in the United States or elsewhere in the world.

      Centers for Disease Control and Prevention. HPV vaccine for preteens and teens. http://www.cdc.gov/vaccines/who/teens/vaccines/hpv.html. Accessed February 15, 2016.

      This is the second time our Update theme focuses on cervical cancer, underscoring the challenge of tackling this disease. Sadly, it is the last contribution from our former Topic Editor and current Guest Editor, Linda R. Duska, MD. Dr. Duska is leaving our editorial team because of the responsibilities and demands of her new position as Associate Dean for Clinical Research at the University of Virginia School of Medicine. We at Clinical Therapeutics thank her for her contributions and wish her the best in her new role.
      Dr. Duska’s final Update sheds light on aspects of prevention, detection, and treatment of cervical cancer. Greater use of vaccination in both girls and boys will certainly reduce the occurrence of this sometimes-deadly disease. Detection and diagnosis are enhanced by improved cytologic methods. Better treatment outcomes may be achieved through the adjunctive use of antibodies, such as programmed cell death inhibitors (PD-1 and PD-L1 inhibitors), agents that allow the immune system to reduce or halt cancer growth. Dr. Duska is leaving us with much to think about and reasons to be hopeful about conquering this widely occurring cancer.
      This month’s Cervical Cancer Update is a special feature which is available as FREE ACCESS content on the journal’s website. The previous Cervical Cancer Update, entitled “Cervical Cancer 2015 and Beyond: A Focus on Innovative Treatments and Attention to Survivorship,” was published in Volume 37, Number 1 of Clinical Therapeutics. To view the previous Cervical Cancer Update, see the articles below:

      References

      1. Wikipedia. Loose lips sink ships. https://en.wikipedia.org/wiki/Loose_lips_sink_ships. Accessed February 15, 2016

      2. Petrosky E, Bocchini JA, Hariri S, et al. Centers for Disease Control and Prevention; Use of 9-valent human papillomavirus (HPV) vaccine: Updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a3.htm. Accessed February 15, 2016.

      3. Centers for Disease Control and Prevention. HPV vaccine for preteens and teens. http://www.cdc.gov/vaccines/who/teens/vaccines/hpv.html. Accessed February 15, 2016.