HPV, human papillomavirus, is an infection that is passed from one person to another through direct skin-to-skin contact. When genital skin (on the penis, scrotum, vulva [area near the opening to the vagina] and near the anus [rectal opening]) is involved, the infection is called “sexually-transmitted”.

There are about 100 different types of HPV. Most HPV infections do not cause any health effects at all because the infected person’s immune system gets rid of them before they can do any damage. At times certain types of HPV (“low risk”) can cause minor changes. Usually those types do not cause long term problems. But other types (“high risk”) can cause infected cells to lose control of their own growth; if early changes are not found and treated, these changes can turn into cancer years later.

Why is this important for women’s health?

HPV infection is very common. One of the sites most often infected by HPV is the genital tract. Several studies have shown that young sexually active women become infected with HPV in the genital area at the rate of 15-20% per year. When followed for three years, about 80% of women in those studies tested positive for HPV at one time or another.

When certain “low risk” types of HPV infect the outer genital skin (vulva) or cervix, they can cause genital warts (also known as condylomata acuminata) and harmless changes on the cervix. Other “high risk” types commonly infect the cervix where they can cause changes that might become cancer in the future ( dysplasia), depending on the type of HPV and the length of time the infection has lasted. If high-risk HPV infections on the cervix are not found and not treated for years, some of those infections can result in cervical cancer.  Over 4000 women die each year in the US from cervical cancer.

How is HPV infection spread?

Vaginal, oral and anal sex can all spread HPV. Many persons who have HPV do not know they have it – they can spread it to their sexual partners without knowing it. Most people who become infected with HPV have gotten it from a partner who had no symptoms at all.

How would I know if I had HPV?

Often infected women and men do not know that that they have an HPV infection. Some persons develop genital warts or condylomata acuminata which are small, raised, skin-colored or gray rough-surfaced bumps ranging from the size of sesame seeds to the size of apple seeds or even larger. They usually don’t hurt, but they may itch slightly or feel irritated. Your clinician can identify these lesions during an exam. Other persons develop HPV infections of the cervix (the lower part of the uterus, located at the top of the vagina). These infections do not produce symptoms that patients can see or feel. The only way to know about an HPV infection of the cervix is to have a Pap test or cervical HPV test performed during a pelvic exam. A Pap showing dysplasia or intraepithelial neoplasia or cervical cancer almost always is a result of
HPV infection.

What is a Pap test?

In this test, cells are scraped off the cervix and placed on a slide. A specially trained laboratory professional examines the slide and looks for abnormal cells. If abnormal cells are found, the slide is further reviewed by a pathologist. The Pap test report gives useful and important information to the clinician, helping him or her decide whether further testing is necessary if the results are abnormal.

What is an HPV test?

The HPV test is performed either from the same specimen as a Pap test, or from a separate brush sample from the cervix. It detects HPV genetic material (DNA) from the 13 types of HPV that can most commonly be associated with the development of cervical cancer. These are the “high risk” types. Most people who are infected with these types of HPV may never have any related problems. However, women who have a high-risk type of HPV are much more likely than uninfected women to develop a cervical pre-cancer (dysplasia) or cancer over time.

Which test should I get: an HPV test or a Pap test?

The most important test for every sexually-active woman to have regularly is the Pap test. If her Pap is abnormal, further testing can be done to determine the exact location and nature of the abnormality and to treat it. Early detection and treatment are highly successful at preventing cervical cancer.

Then who should get an HPV test?

The HPV test is helpful in women whose Pap test report is “ atypical squamous cells of undetermined significance”, often abbreviated as “ASC-US”. This means that the result is uncertain – it is not normal but it is also not abnormal in any precisely defined way. Some of these Pap tests with uncertain results show HPV infection on additional testing. So the HPV test can help your clinician understand the reason for the uncertain Pap. In addition, most experts believe that for women over 30, HPV testing along with a routine Pap test is the best way to screen for dysplasia or cervical cancer. This combination of testing is so reliable that if both tests are normal, the tests should be repeated only every three years.

In addition, an HPV test may be recommended as part of follow-up after an abnormal Pap test has been evaluated and possibly treated.

Why not test women under 30 for HPV with their Pap test?

HPV is so common and so unlikely to cause problems in young women that finding it isnot helpful. On the other hand, the Pap test does find cell changes thatare important to evaluate.

What if my test is negative?

A woman whose HPV DNA test is negative has only a small chance of having dysplasia or cancer at the time of the test. But she should continue to obtain regular Pap tests to detect any hidden or future infection.

What happens if my HPV test shows that I have HPV?

If you have a positive HPV test and an abnormal Pap, you will most likely be advised to undergo colposcopy. This is a procedure in which the cervix is examined using a bright light and magnification. Often a biopsy (a small pea-sized piece of tissue) is taken and sent to a pathology lab for examination. The biopsy is the most reliable test and the results of the biopsy, not the Pap or the HPV test, are used in planning the most appropriate treatment, if any.  If you have a positive HPV test and a normal Pap test, your healthcare provider will make a personal recommendation for you based on your own individual health circumstances and your past Pap and HPV history.

Copyright © 2003, 2008 ASCCP. All Rights Reserved.
These materials were developed by the American Society for Colposcopy and Cervical Pathology (ASCCP) Patient Education Committees and approved by the Board of Directors for use by patients.

While you may download, print and distribute these materials freely, they are copyrighted materials and all rights are owned by ASCCP. Therefore, they may not be changed, edited or altered in any way.

©2012 An Inconvenient Woman. All Rights Reserved.

HPV is human papillomavirus. It is the most common viral sexually transmitted infection for both men and women. Some types of HPV are called “low risk”.

Those can infect the skin around the genitals and cause genital warts. Other types of HPV are called “high risk”. When those types infect internal genital areas they sometimes cause precancerous or cancerous changes on the cervix (opening to the uterus) or vagina. “High risk” HPV can also cause precancerous changes on the external genital areas (vulva).

How common is HPV?

HPV is very common. Most men and women who have had sex get HPV. Fortunately, many HPV infections go away on their own without causing any problems for theinfected person. Most infected people don’t even know they have had HPV.

Is HPV infection serious?

There are lots of different kinds of HPV, and most are not serious. Infection with a “low risk” virus can cause genital warts but will not produce major problems. However, sometimes “high risk” HPV infection can cause skin cells to grow abnormally. The growth may be precancerous and could eventually become a potentially serious problem, such as cancer of the cervix, vagina, vulva, or anus.

How did I get HPV?

You probably got HPV through skin-to-skin contact with an infected person during vaginal, oral, or anal sex. It is possible for a person to have HPV in skin cells and pass it on to another person even when no genital warts are present. Most people who have HPV do not have any signs of it and do not know they have it.

What about HPV and oral sex?

If a person performs oral sex on a partner with genital HPV, there is a small chance that his or her mouth can become infected. Wart-like lesions and precancers can develop in the mouth or throat. Untreated precancerous lesions in the mouth or throat can turn into cancer after a long time. If a person receives oral sex from a partner with HPV in his or her mouth, that person can possibly develop a genital HPV infection. Currently there is no screening test for oral HPV. Your healthcare provider or dentist can carefully examine your mouth to look for lesions, but it is unknown how helpful that will be in preventing HPV-related mouth or throat cancers.

What increases my chances of developing a genital HPV infection?

The more sexual partners you have, the greater your chances are of getting an HPV infection. Using condoms may reduce your chances of getting infected, but condoms do not always help because HPV can be present in areas not covered by the condom. Your immune system also determines whether you may develop a HPV infection when you are exposed. A healthy immune system keeps you from being sick. People with poorly functioning immune systems are more likely to get a HPV infection. Smoking tobacco weakens your immune system and increases your risk for getting HPV when exposed to the virus.

How long have I had HPV?

It is impossible to know exactly how long you have had HPV. If you have had more than one sexual partner in your lifetime, it is impossible to tell which partner gave you HPV. If you had sexual contact with an infected person, it usually takes a few weeks or months for genital warts to appear or for a Pap test to become abnormal. You may have had HPV for some time before it was discovered by a physical exam, abnormal Pap test, or HPV laboratory test.

How is HPV diagnosed?

HPV can be diagnosed in several ways.

• Sometimes the skin changes on external areas can be seen on physical exam.
• Many infected women first learn they have HPV when they have an abnormal Pap test.
• At times, a specific test for the HPV virus recognizes it in infected cells on the cervix. (This test is not useful on other parts of the body or in men.
• When HPV infection of the cervix or vagina or anus is suspected, your health care provider can use a colposcope to shine a light on and magnify the cervix and vaginal walls and/or the anus. Often a tiny piece of tissue (a biopsy) is taken and examined in a laboratory to check for changes produced by HPV

How is HPV treated?

Like all other virus infections, HPV infection cannot be cured with medication. Luckily, your body’s immune system can and usually does get rid of the infection and the skin changes it causes.

However, the abnormal skin growths (genital warts or precancerous changes) caused by HPV can be treated with medication or minor surgery. The type of treatment depends on the location, number, and kind of skin changes. If the virus has caused only slight abnormalities, then no treatment may be necessary at this time. Careful monitoring for future changes with self-examination, regular Pap tests, or possible colposcopy may be necessary. If more severe skin abnormalities are found, they often need to be treated.

There are many ways that your health care provider can treat abnormal areas. Some treatment can be done at home, and other types of treatment must be done in the clinic. Your health care provider will discuss these treatment options with you.

Will I still have HPV after treatment?

There is no cure for HPV. The goal of treatment is to remove the abnormal area that contains the virus without causing damage to the normal, healthy tissue surrounding the abnormal area. It is likely that a small amount of virus will remain after treatment. Often your body’s immune system can take care of the remaining virus.

How can I prevent spreading HPV to others?

You can reduce the chance that you will share your HPV infection with other people by having any abnormal skin or genital warts treated until they are gone. Using condoms during sexual intercourse and dental dams during oral sex may also help to reduce the spread of infection. However, condoms or dams may not always completely prevent the spread of HPV infection, because HPV may be in skin that is not protected by the condom or dam. Now that you know you have HPV, you should tell your current (and past) sexual partner(s), so that they can be examined and treated, if appropriate.

Will having HPV cause problems if I become pregnant?

Problems caused by HPV in pregnancy are unlikely. There is a very small chance that your baby could catch HPV from you. The baby could inhale HPV-infected cells from your birth canal during birth. Although it rarely happens, the baby’s vocal cords can become infected with the virus. This could cause breathing problems and would require treatment. Usually, women with HPV have regular vaginal deliveries. Only women who have very large genital warts that block the birth canal need a Cesarean section because of the HPV infection.

What should I do to take care of myself?

• You may want to check yourself for the development of new warts following treatment.
• If you discover new genital warts, have them treated as soon as possible.
• Having genital warts may mean that you are at a slightly greater risk for getting
• cervical cancer.
• Women should have regular Pap tests.
• If you smoke tobacco, stop!
• Try to keep your stress level low, get enough sleep, and eat a nutritionally
• balanced diet.
• If you are a woman between the ages of 9 and 26, ask your healthcare provider whether you should get the HPV vaccine. Even if you have already been infected with one type of HPV, the vaccine will prevent infection with other types.

How can I cope with HPV?

Be sure to get regular check-ups, including Pap tests. If you see genital skin changes, make an appointment with your health care provider for an exam. These feelings are normal. It is common for people with HPV to feel angry, upset, depressed or ashamed about their condition. Some women may also be concerned about the risk for cancer. Keep in mind that HPV can be managed and cervical cancer can almost always be prevented. Talk to your health care provider about your concerns. Keeping yourself healthy and not smoking can help boost you body’s natural defense system to fight the virus.

Copyright © 2003, 2008 ASCCP. All Rights Reserved.
These materials were developed by the American Society for Colposcopy and Cervical Pathology (ASCCP) Patient Education Committees and approved by the Board of Directors for use by patients.

While you may download, print and distribute these materials freely, they are copyrighted materials and all rights are owned by ASCCP. Therefore, they may not be changed, edited or altered in any way.

©2012 An Inconvenient Woman. All Rights Reserved.

An Abnormal Pap Test

What is a Pap Test?

A Pap test (sometimes called a Pap smear) checks for changes in the cervix that could, over time, become cancer. During your recent Pap test, cells were taken from the surface of your cervix and inside its opening. These cells were sent to a pathologist, a doctor who specializes in finding abnormalities of cervical cells. The pathologist examined your cells under a microscope and noted their size, shape, color, and contents. Your cervical cells were not entirely normal.

Is having an abnormal Pap test serious?

Hearing that you have an abnormal Pap test may make you worry that you might have cervical cancer. The good news is that you probably do not. Cervical cancer is a relatively rare condition. Most abnormal Pap results are not cancer. It may be comforting to know that abnormal Pap test results are not uncommon. About 1 in every 20 Pap test results are considered abnormal.

What is abnormal about my Pap test cells?

There are many reasons why a Pap test may be interpreted as abnormal, most of which are not serious. Some of the most common causes of abnormal Pap smears are described below.

Atypical (atypical squamous cells of undetermined significance (ASCUS) or atypical glandular cells of undetermined significance (AGUS)).

Atypical means that abnormalities were found in your cells. Pathologists are uncertain what these cells actually represent. So a woman with these results needs to have follow-up. Your clinician will determine which type of follow-up is best for you. Some women need a repeat Pap testing 6 months. Others may have an HPV test. In most cases, women will not be found to have a serious problem following further evaluation. However, a few women will actually have significant cervical disease that should be treated.

Dysplasia means that cells from an abnormal precancerous growth were found on the Pap smear.

Dysplasia describes the cells that are no longer normal but are not yet cancer.
There are many stages in the process of a normal cell becoming cancer. Dysplasia is call mild (low-grade squamous intraepithelial lesion or LGSIL) and moderate to severe (high-grade squamous intraepithelial lesion or HGSIL) depending on how abnormal the cells have become and the extent of tissue affected. In a small number of women, dysplasia may eventually develop into cancer, if not treated.

Cancer or carcinoma of the cervix may be detected by a Pap smear. In addition, Pap smears can also recognize cancer cells from other sites in the body (such as the uterus) that may have moved to the cervix.

How did this happen?

It is often hard to know what exactly caused you to have an abnormal Pap smear.
Because there are many types of abnormal Pap smears, the reason for abnormal changes on your cervix varies. The changes may result from a sexually transmitted infection (including human papilloma virus), lack of a hormone, intravaginal medication, contraceptives, irritation or a cancer-associated growth.

How long have the abnormal cells been on my cervix?

It is difficult to know how long the abnormal cells have been on your cervix. Abnormal cells caused by an infection may have been present for a just a brief time. In contrast, abnormal cells caused by dysplasia may have been present for much longer. Normal cells change very slowly to become precancerous cells, and it takes many years for precancerous cells to become cancer. Most abnormal cells never change into cancer.

Does an abnormal Pap smear mean that I won’t be able to have children?

An abnormal Pap smear can be caused by lots of different things, most of which have no effect on your fertility or ability to have children. It is extremely unlikely that your abnormal Pap smear or treatment for an abnormal Pap smear will prevent you from having children, unless it was reported as invasive cancer.

Does this mean that I could pass something to my partner?

Most causes of an abnormal Pap smear are not things that you could pass to your partner.
If your Pap smear report indicates that you may have a sexually transmitted infection,you could pass this infection to your partner. Many of these infections can be successfully treated with antibiotics or other medications.

How can I make sure my next Pap smear will be of good quality?

There are a few things that you can do to ensure that your next Pap smear is of good quality. Don’t use vaginal medications, douches, or tampons 2-3 days before your Pap smear. Also, avoid having sexual intercourse for 24 hours before your appointment. Don’t schedule your appointment during your period. Menstrual blood and vaginal medicines can make it difficult to see your cervical cells clearly.

What should I do now?

If your report found inflammation or infection, you may need to return to the clinic to be examined so that your healthcare provider can determine what is causing your abnormality. Sometimes you can be treated without another examination based on the abnormal Pap smear report.

If your Pap smear report indicated atypical cells, you may need a repeat Pap smear, a test for human papillomavirus or you may need an examination by colposcopy. Your healthcare provider will let you know what type of additional test may be best for you. If you are a postmenopausal woman not taking estrogen replacement treatment, you may be asked to take estrogen and return for another Pap smear in one month.

If dysplasia or a squamous intraepithelial lesion was found, the next step may involve taking a closer look at the cervix using a colposcope. A colposcope is like a microscope positioned outside the vagina that magnifies the cervix. A vinegar solution is applied to the cervix which turns abnormal tissue white. A white region contrasts with the rest of your cervix which is pink. By using a colposcope, we can find out the source of the abnormal cells that were seen on your Pap smear by taking a biopsy (a tiny sample of tissue). If your tests show only a mild abnormality, your health care provider may recommend close follow-up with Pap smears in within 6 months because often your body overcome mildly abnormal cells. For more severe abnormal cells, treatment to destroy the abnormal area is recommended. In the rare event that your Pap smear reported carcinoma, your health care provider will discuss further evaluation and treatment options with you.

Can I be cured?

Keep in mind that there may actually be nothing wrong with your cervix. Some infections can be treated with medication. If precancerous cells or cancer are on your cervix, there are a variety of treatments available to remove the abnormal cells, including freezing, burning, laser treatment, or surgical removal. If invasive cancer is found, more intensive therapy is needed.

What can I do to prevent having cervical cancer or precancerous changes in the future?

You can increase your chances of not having cervical cancer or precancerous changes in the future by protecting yourself against sexually transmitted infections, not smoking tobacco products, and by getting routine Pap smears.

A Pap smear is only useful in detecting and preventing cervical cancer or precancerous changes if you return for follow-up evaluation and treatment appointments, when necessary. Keep in mind that it is very likely that the cause of your abnormal Pap smear can be easily treated, if treatment is necessary. In addition, the earlier abnormalities are treated, the easier they are to treat.

These materials were developed by the American Society for Colposcopy and Cervical Pathology (ASCCP) Patient Education Committees and approved by the Board of Directors for use by patients.

While you may download, print and distribute these materials freely, they are copyrighted materials and all rights are owned by ASCCP. Therefore, they may not be changed, edited or altered in any way.

Copyright © 2003, 2008 ASCCP. All Rights Reserved.

©2012 An Inconvenient Woman. All Rights Reserved.

Each year 13,000 women are diagnosed with cervical cancer in the United States. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops. We now know that these cell changes are caused by human papillomavirus, commonly known as HPV.

The traditional test for early detection has been the Pap test. Now a test for HPV is being offered that can be used with the Pap test in women starting at 30 years of age and in women of any age when the Pap test alone has found slightly abnormal cell changes.

What is the Pap Test?!

The Pap test finds changes in the cells of the cervix (the mouth of the womb) that are not normal. The test involves taking a small sample of cells from the cervix, usually during a routine pelvic exam. The cells are sent to a laboratory where they are prepared and evaluated under a microscope.

What is the HPV test?

The HPV test can find any of the 13 types of HPV that are most commonly found in cervical cancer. The presence of any of these HPV types in a woman for many years can lead to cell changes that may need to be treated so that cervical cancer does not occur.

The HPV test is done at the same time as the Pap test by using a small soft brush to collect cervical cells that are sent to the laboratory, or the HPV testing sample may be taken directly from the Pap sample.!

What is HPV?

HPV is a virus that is very common. In fact, most men and women are infected with HPV at some time in their lives. There are approximately 100 types of HPV. Some HPV typesonly infect the genital area and may cause warts, some cause mild changes in cervical cells that do not turn into cancer, and some cause changes that may become cervical cancer if present for many years. The types of HPV that are found in the genital areas are usually passed on during sexual contact (sexually transmitted). HPV types that cause warts on the hands or feet do not cause genital warts or cervical cell changes, nor do genital HPV types generally spread outside the genital area.

How common is HPV?!

HPV is the most common sexually transmitted virus. The likelihood of getting an HPV infection sometime in a person’s life has been estimated to be 75% or more.! This means that anyone who has ever had sexual relations has a high chance of being exposed to this virus, but only a small number of women infected with HPV develop cell changes that need to be treated. In almost all cases, the immune system will keep the virus (including the cancer-related HPV types) under control or get rid of it completely. However, if HPV infection does not go away over many years, there is a greater chance of developing cell changes that may lead to cervical cancer. Only very rarely does the presence of HPV lead to cervical cancer.

Can HPV infections be treated?

There is currently no treatment available for the virus itself. However, good treatments do exist for the problems HPV can cause, such as cervical cell changes or genital warts. Your healthcare provider will discuss these treatment options with you, if you need them.

SHOULD I HAVE AN HPV TEST?

I am 30 or older — Should I get the HPV test in addition to my Pap test?

In women 30 and over, screening using both an HPV test and a Pap test is more likely to find abnormal cervical cell changes than either test alone. If both tests are negative (normal), a woman may safely have her next Pap and HPV test in three years depending on her past Pap test findings and other risk factors. For this reason, some women now may have an HPV test when they have their Pap test. It will still be important to continue having routine recommended preventative health exams.

I am under age 30 – Should I get the HPV test in addition to my Pap test?

No. HPV is very common in women under the age of 30 and cervical cancer is very rare in this age group. Most women under 30 with HPV will get rid of the virus without treatment. So including an HPV test along with your Pap isn’t helpful for younger women and might be harmful if it resulted in too many tests and unnecessary treatment. After age 30, HPV is much less common. If you are over the age of 30 and you test positive for HPV it is more likely that you may have gotten it many years before and your immune system hasn’t gotten rid of it. Because HPV must be present for many years to cause cell changes, testing for HPV after the age of 30 is much more helpful.

I am under 30 but my doctor suggested HPV testing after my Pap came back as ASC-US.

Why?

The most common abnormal Pap is called ASC-US, or atypical squamous cells. About half of the women with ASC-US have these cell changes because of the presence of HPV, while the other half do not. If you have a follow-up HPV test after an ASC-US Pap and the HPV test is negative, you probably need no additional follow-up other than to repeat your Pap in one year. Usually only women with ASC-US testing positive for HPV need further evaluation. HPV testing is helpful at any age for determining which women with ASC-US need follow-up. This is different from using the HPV test with the Pap as part of your normal health visit.

WHAT IF MY RESULTS ARE…

What if the HPV test and Pap test are both normal?

If both the HPV test and the Pap test are normal you have very little risk of any
worrisome changes occurring in your cervix over the next 3 years. You should discuss with your physician the optimal time for follow-up testing according to professional recommendations and the physician’s assessment of your clinical history.

If I tested positive for HPV, what does this mean for me?

Most HPV infections go away without treatment because the immune system finds the virus and either gets rid of it or suppresses it to the point that it never returns to cause problems. Cell changes that may eventually lead to cervical cancer only occur when this does not happen and HPV stays for many years. Even though HPV is found in cervical cancer, most people testing positive for HPV are not at risk for getting cervical cancer because they have the virus for only a short time (months rather than many years).

Therefore, women with a normal Pap who test positive for HPV will usually be tested for HPV again in 6-12 months. Testing positive a second time does not mean that there is great risk of cervical cancer, or even of cell changes that may lead to cervical cancer, but it does mean that further evaluation will likely be recommended.

If I test positive for HPV, how did I get it?

HPV is usually acquired by direct skin-to-skin contact during intimate sexual contact with someone who is infected. Most men and women are not aware that they have the virus. Condoms do not offer complete protection from HPV. Increasing numbers of partners increases the risk of getting HPV, but the virus is so common that having only a single lifetime partner does not assure protection. It is usually impossible to determine when, and from whom, HPV was caught. HPV may be detected fairly soon after exposure, or may not be found until many years later. For all these reasons, it is not helpful, nor fair to blame your partner.

What does my positive HPV test mean for my partner?

Most sexually active couples share the HPV until the immune response eliminates the infection. Partners who are sexually intimate only with each other do not pass the same virus back and forth. In other words, when the virus is shared, being exposed to more of the same virus by one’s partner does not make it more difficult to eliminate the infection. When HPV infection goes away the immune system will remember that HPV type and keep a new infection of the same HPV type from ever occurring again. However, because there are many different types of HPV, becoming immune to one HPV type may not protect you from getting HPV again if exposed to another HPV type.

If I have HPV or a cell abnormality, is there anything I can do?

Don’t smoke. Smoking has been shown to increase the chance that cell abnormalities might progress to more severe changes. Be sure to keep your follow-up doctor appointments.

Will I have the HPV virus forever?

Probably not. HPV infection is very common, but it usually goes away within 1-2 years.

I am shocked to have a virus that is usually sexually transmitted! How should I respond?

Just remember that almost everyone gets HPV at some time. HPV is not likely to change your life. If you have tested positive for HPV there may be a short period of time during which follow-up may seem to be a bother, but little more. Cervical cancer, the most serious problem associated with HPV, is rare and almost always prevented through regular testing for cervical cell changes that could lead to cancer.

Key Points to Remember:

• Cervical cancer is preventable. Early detection of abnormal cell
• changes is important.
• Almost all women will have HPV at some point, but very few will develop cervical cancer. The immune system of most women will usually suppress or eliminate HPV. Only HPV infection that does not go away over many years can lead to cervical cancer.
• It can be helpful to know your HPV status. This can help determine how often your clinician will recommend that you be tested.
• Don’t blame. Your HPV status is not a reliable indicator of your sexual behavior nor that of your partner.

Resources on HPV and Cervical Cancer

National HPV & Cervical Cancer Resource Center
www.ashastd.org
Women’s Cancer Network
www.wcn.org
American Cancer Society
www.cancer.org
1-800-ACS-2345
The American Society for Colposcopy and Cervical Pathology
www.asccp.org
National Cervical Cancer Coalition
www.nccc-online.org
National HPV & Cervical Cancer Public Education Campaign
www.cervicalcancercampaign.org
National Women’s Health Resource Center
www.healthywomen.org
The HPV Test
www.thehpvtest.com
Eyes on the Prize: Support and Information for Gynecologic Cancers
www.EyesOnThePrize.org
The Centers for Disease Control (CDC)
www.CDC.gov

Copyright © 2003, 2008 ASCCP. All Rights Reserved.
These materials were developed by the American Society for Colposcopy and Cervical Pathology (ASCCP) Patient Education Committees and approved by the Board of Directors for use by patients.

This material is provided for informational purposes only. It does not constitute medical advice and is not intended to replace professional care. Please consult your health care provider with any questions or concerns you may have regarding your condition. The ASCCP National Office does not provide individual consultation on cases or diagnoses.

While you may download, print and distribute these materials freely, they are copyrighted materials and all rights are owned by ASCCP. Therefore, they may not be changed, edited or altered in any way.

©2012 An Inconvenient Woman. All Rights Reserved.

Vaginal and Vulvar Cancers

Cancer is a disease in which cells in the body grow out of control. Cancer is always named for the part of the body where it starts, even if it spreads to other body parts later. When cancer starts in the vagina, it is called vaginal cancer. The vagina, also called the birth canal, is the hollow, tube-like channel between the bottom of the uterus and the outside of the body.

When cancer starts in the vulva, it is called vulvar cancer. The vulva is the outer part of the female genital organs. It has two folds of skin, called the labia. Vulvar cancer most often occurs on the inner edges of the labia.

When vaginal and vulvar cancers are found early, treatment is most effective. Treatment of vulvar cancer, in particular, often leads to a cure.

Learn more by downloading the Inside Knowledge campaign’s vaginal and vulvar cancer fact sheet. (PDF-268KB)

Signs and Symptoms

Early on, most vaginal cancers do not cause signs and symptoms. But if there are symptoms, they may include:

• Bleeding that is unusual for you because of when it happens or how heavy it is.
• Pain in your pelvis, the area below your stomach and in between your hip bones, especially when you pass urine or have sex.

Many women who have vulvar cancer have signs and symptoms. They may include:

• Itching of the vulva (mostly on the labia) that does not go away.
• Changes in the color of the skin of the vulva, so that it looks redder or whiter than is normal for you.
• Skin changes in the vulva, including what looks like a rash or warts.
• A sore on the vulva that does not go away.

It is important for you to pay attention to your body and know what is normal for you. If you have any of these symptoms for more than two weeks, talk to your doctor, nurse, or other health care professional right away. Symptoms may be caused by something other than cancer, but the only way to know is to see your health care professional.

Who Gets Vaginal and Vulvar Cancers?

Vaginal and vulvar cancers are very rare. While all women are at risk for these cancers, very few will get them. In 2004,* vaginal cancer accounted for only 1 to 2 percent of all gynecologic cancers. Vulvar cancer accounted for approximately 5 percent of all gynecologic cancers. In 2004, 1,130 women in the United States were told that they had vaginal cancer and 3,631 women learned they had vulvar cancer.^†

^†U.S. Cancer Statistics Working Group. United States Cancer Statistics: 2004 Incidence and Mortality. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2007.

*The most recent year for which statistics are currently available.

Please note: Some of these publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed. Please review the information on downloading and using Acrobat Reader software.

Reprinted with CDC permission

©2012 An Inconvenient Woman. All Rights Reserved.

Merck has a growing economic interest in Virginia. In December 2006, Merck announced it would invest $57 million to expand its Elkton, Va., plant to make Gardasil, helped by a $700,000 grant from a state economic development agency that is part of the executive branch. Two months later, Gov. Tim Kaine, who has been mentioned as a possible Democratic vice presidential candidate, signed legislation requiring Gardasil for schoolgirls. Four months after that, Merck pledged to invest $193 million more in the plant to make drugs and vaccines, helped by a state grant of $1.5 million.

Source: New York Times

©2012 An Inconvenient Woman. All Rights Reserved.

“Merck lobbied every opinion leader, women’s group, medical society, politicians, and went directly to the people — it created a sense of panic that says you have to have this vaccine now.”

— Dr. Diane Harper, a professor of medicine at Dartmouth Medical School

Those who follow BIG PHARM have noticed some interesting trend-lines lurking in the infamous ‘9-point Helvetica, grey ink’ Corporate 10-K, Annual Reports. Over the past several years, research budgets trended downward, while “Marketing” expenditures accelerated.

What would be considered a BIG PHARMA marketing expense?

Marketing expenses would include clever print and electronic media ads, along with brochures for health professionals. This print material is usually given to Doctors at “Sponsored” events, “Educational” resort-based retreats, private dinners, and that basic and most appreciated pharmaceutical freebee, the “Free Lunch”! On any given day an army of pharmaceutical reps drop off Lunches and other “Goodie packages” to busy practices with free drug samples and good cheer.

Speaking of “good cheer” Marketing expenses also include BIG PHARMA lobbyists spending largest amongst the very representatives “we the people” sent to our local, state, and federal to look after our interest. The amount of cash laid down by MERCK in 2005-2006 to grease the skids for one of the fastest new drug roll outs yet witnessed is staggering. Whoever said you couldn’t buy happiness, hasn’t talked to a MERCK stockholder.

Go to: THE EVIDENCE GAP; Drug Makers’ Push Leads to Cancer Vaccines’ Rise

August 20, 2008 – By ELISABETH ROSENTHAL (NYT) – Front Page –

… DRUG MAKERS’ BIG PUSH A marketing campaign in the United States and Europe by Merck has made Gardasil, its cervical cancer vaccine, a best seller. Cervarix, a similar vaccine from GlaxoSmithKline, has also proved popular, and profitable.

Read the full article and send the link out to anyone who cares about the health issues of women and girls!

Inconvenient Women do not get angry…We get ACTIVE!!

The lobbyist/legislator ‘hook-up’ only works if no one is looking. Make sure your representatives know you are watching them and are holding them accountable for the health and wellfare of the nations’ women and girls.

©2012 An Inconvenient Woman. All Rights Reserved.

In June of 2006, my writing partner, Leslie Botha, and I, started writing articles cautioning women against the use of Gardasil® for girls and young women. We cited the limited nature of the clinical trials (the number, and ages of women tested) and the length of time from the clinical trials and the FDA approval; which in our opinion precluded a reasonable amount of time to follow-up for adverse reaction to the injection.

The RUSH-TO-APPROVAL, combined with MERCK’s, MEGA-Money State and Federal legislative-lobbying efforts, made us very nervous. Anytime a State or Federal agency mandates the use of a vaccine, the manufacturer is essentially, held harmless. That means adverse reaction victims cannot sue them directly. MERCK gets hide behind the shield of the very government agencies WE pay to protect us.

In our articles, Leslie and I cited European researchers who questioned not only the efficacy of the HPV vaccination plan, but the cost effectiveness of what could be one of the largest transfers of public money to private industry in history. With early detection, cervical cancer can be successfully treated; and the best early detection tool is the inexpensive, easily attainable PAP test.

“In developed countries, Pap smear screening and treatment have effectively reduced cervical cancer death rates to very low levels already. There are 3,600 deaths annually from cervical cancer in the United States, 1,000 in France and 400 in Britain.”

Each of those women were mothers, daughters and sisters, and very dear to their families. Most of the deaths were a result of lack of access to preventive medical care. The poor and uninsured can’t get a $30 PAP test, but our public heath officials think its justifiable to mandate BILLIONS of dollars to inoculate young girls with a vaccine that could do more harm than good.

MERCK has sold $1.5 BILLION worth of Gardasil® vaccine in less than two years. Those Gardasil® sales are saving their Vioxx-ravaged balance sheet. How many PAP tests would that amount provide women who have limited, or no, access to preventative care? If the safety of young girls doesn’t make you want to take action and stop this madness, how about cost-effect, use of limited health care resources?

Breast cancer kills hundreds of thousands of women every year…and the numbers are rising. Would 1.5 BILLION dollars be better spent on breast cancer research? We think so.

Spending 1.5 billion on Gardasil®, chasing the ghost of “possible cancer” in the distant future, is not good stewardship of time, talent and treasure — unless you own MERCK stock.

Two years ago Leslie and I sent information to major media outlets, asking that they at least investigate the possibility that HPV vaccines might not be effective or safe for young girls.

We felt like the mythical Cassandra…no one was interested in the news.

To date, there have been 17-deaths and thousands of reported hospitalizations of previously healthy young women and girls. As adverse reactions started to be recorded to the NVIC database, investigative reporters began questioning the HPV vaccine’s safety and cost-effectiveness. Harvard just published a “Follow the Money” report delineating the cost benefit of the mostly, publicly, funded HPV-vaccination initiative.

In the fall of 2006, using published US census data, Leslie and I estimated the number of targeted girls and women (nine to twenty-six year old) and the reported cost of the series of three of the Gardasil® inoculation and estimated the cost to public health budgets. I was sure some bean counter in the bowls of MERCK had preformed the same calculations, with far better resources, when determining the Lobbying budget that got Gardasil® approved.

I wish I could say, we are please to report that with about 20-hrs work, an old calculator and a new MAC laptop we came within a $60K of the Harvard study; but it is actually kind of depressing. All it proves is that we need more inconvenient women, asking more questions, more often, with greater insistence.

Excerpt of Harvard Study

“The vaccines, which require three shots for a complete series, cost about $400 to about $1,000, depending on the country and the fees for doctors’ visits. Unlike older vaccines that save money by preventing costly disease, these vaccines cost health systems money.

The Harvard study concluded that giving the vaccine to 12-year-olds would cost $43,600 for every “quality adjusted year of life” it saved by preventing a cancer death; that price would often be considered acceptable by health officials in wealthy countries, experts say.

But if the vaccine were given to all girls and women up to age 21, the cost per year of life saved would be far higher — $120,400, the Harvard study concluded. And if the vaccines prove to require a booster shot, as many critics believe, that cost rises to $140,000. In such cases it might make more economic sense to rely on Pap smear screening alone, the researchers said.”

Read the full text of following NY Times article.

Email the links to as many women, and health professions as you can.

Inconvenient Women take ACTION!

Click here for the full ELISABETH ROSENTHAL’s NY Times article on Gardasil®, Published: August 20, 2008

“Two vaccines against cervical cancer are being widely used without sufficient evidence about whether they are worth their high cost or even whether they will effectively stop women from getting the disease, two articles in this week’s New England Journal of Medicine conclude.”

“The two vaccines, Gardasil by Merck Sharp & Dohme and Cervarix by GlaxoSmithKline, target two strains of the virus that together cause an estimated 70 percent of cervical cancers. Gardasil also prevents infection with two other strains that cause some proportion of genital warts. Both vaccines have become quick best sellers since they were licensed two years ago in the United States and Europe, given to tens of millions of girls and women.

“Despite great expectations and promising results of clinical trials, we still lack sufficient evidence of an effective vaccine against cervical cancer,” Dr. Charlotte J. Haug, editor of The Journal of the Norwegian Medical Association, wrote in an editorial in Thursday’s issue of The New England Journal. “With so many essential questions still unanswered, there is good reason to be cautious.”

In her article, Dr. Haug points out the vaccines have been studied for a relatively short period — both were licensed in 2006 and have been studied in clinical trails for at most six and a half years. Researchers have not yet demonstrated how long the immunity will last, or whether eliminating some strains of cancer-causing virus will decrease the body’s natural immunity to other strains.

More to the point, because cervical cancer develops only after years of chronic infection with HPV, Dr. Haug said there was not yet absolute proof that protection against these two strains of the virus would ultimately reduce rates of cervical cancer — although in theory it should do so.

Both vaccines target the human papillomavirus, a common sexually transmitted virus that usually causes no symptoms and is cleared by the immune system, but which can in very rare cases become chronic and cause cervical cancer”

For more information read:

The Evidence Gap: Drug Makers’ Push Leads to Cancer Vaccines’ Rise (August 20, 2008)

Send these links out to anyone who cares about the health issues of women and girls!

Inconvenient Women do not get angry…We get ACTIVE!!

©2012 An Inconvenient Woman. All Rights Reserved.

In the July 20, 2008 edition of the, New York Post, SUSAN EDELMAN told Jessica Ericzon’s story. It serves as a cautionary tale for girls, their mothers and guardians. In my opinion it should be required reading for every state official who controls public health policy, every school nurse and every pediatrician, gynecologist and family practice physician. Email it to your local, state and congressional representatives. Bring it to PTA meetings. Send it to anyone who loves his or her daughters, sister, mother, and wife. Jessica’s chance to be a wife, a mom, and a grandmother has been taken from her by a system more focused on profi,t than patient safety. It is past time we stand up to the lobbyist that grease the wheels of government with cash and favors and the representatives more concerned with the next campaign donation than the health and welfare of their most vulnerable constituents.

TRAGIC: Jessica Ericzon collapsed dead days after receiving a shot of the cervical-cancer vaccine Gardasil.

She loved SpaghettiO’s, pepperoni, lilies, listening to her iPod and making her pals laugh.

In her senior yearbook, she wrote, “The best things in life aren’t things, they’re friends.”

Now that’s the quote chiseled into her gravestone.

Jessica Ericzon, 17, was “an all-American teenager,” as described by one of her upstate LaFargeville teachers.

Last February, she was working on her softball pitches, getting ready for a class trip to Universal Studios in Florida and hitting the slopes to snowboard with her older brother.

Then one day, the blond, blue-eyed honors student collapsed dead in her bathroom.

It started with a pain in the back of her head. On the advice of her family doctor, Jessie had taken a series of three Gardasil shots. The vaccine, marketed for females ages 9 to 26, is the first found to ward off strains of the sexually transmitted human papillomavirus, or HPV, which can cause cervical cancer.

Jessie got the first injection in July 2007. After her second shot in September, she complained of a pain in the back of her head, fatigue and soreness in some joints, said her mom, Lisa.

On Feb. 20, while on winter break from school, she got her third and final dose of the vaccine.The next night, “she told me the spot on the back of her head was bothering her again,” her mom said. The next morning, Feb. 22, Lisa, a hospital technician, left for work just after 5 a.m., leaving Jessie asleep.

Jessie never showed up for the class she was taking at Jefferson Community College.

When her mom got home at 3:20 p.m., she found Jessie sprawled on her back on the bathroom floor, with blood spots on her head where it had hit a flowerpot.

Jefferson County Medical Examiner Samuel Livingstone is stumped. “She was essentially dead by the time she hit the floor. Whatever it was, it was instantaneous,” Livingstone said. His autopsy found no cause. He speculates she suffered a cardiac arrhythmia, or irregular heartbeat, extremely rare in young people.

Jessie had been on birth-control pills for a year to treat acne, records show.

Livingstone reported Jessie’s death to the federal Vaccine Adverse Events Reporting System. Run by the FDA and the Centers for Disease Control and Prevention, it has collected 8,000 reports of problems after Gardasil shots, including paralysis, seizures and miscarriages.

Seventeen other deaths following the vaccine have been reported since Merck & Co. introduced it in 2006.

Officials have confirmed 11 of the reported deaths so far, said CDC spokesman Curtis Allen.They have found “no pattern or connection” to Gardasil in eight deaths and are still reviewing three, he said.

Lisa Ericzon now feels her daughter was “a guinea pig” for Gardasil, and is urging parents to research the vaccine before letting their daughters get it.

“I want other mothers to know,” said Lisa, the first parent of a girl who died after Gardasil to speak publicly.

“I don’t want them to go through what I went through.”

Jessie planned to major in psychology at SUNY Plattsburgh and pursue her greatest ambition – to become a New York state trooper. Just six days before she died, she got to ride along with a trooper canine unit. She was ecstatic.

The full article can be found at:

http://www.nypost.com/seven/07202008/news/regionalnews/my_girl_died_as_guinea_pig_for_gardasil_120737.htm

Read it. Become an Inconvenient Woman — Don’t Get Angry — Get Active!

Send this article link to every mom you know.

©2012 An Inconvenient Woman. All Rights Reserved.

 Reported by Barbara Loe Fisher

The reports of HPV vaccine reactions, injuries and deaths continue to roll in, not only to NVIC but also to the federal Vaccine Adverse Events Reporting System (Search HPV4 at: http://www.medalerts.org/vaersdb/index.html) newspapers, and television stations.

And the only response that comes from officials at the CDC, FDA and drug companies when perfectly healthy teenage girls collapse into unconsciousness, suffer a massive seizure, get paralyzed or die suddenly after being injected with GARDASIL is the buracratic mantra: “It is a coincidence.”

“I just kept thinking about the good outcomes rather than what could actually happen.” What happened to Crystal Olivera was arm pain so severe that it left her unconscious immediately after a Gardasil shot, something she had never experienced with her hepatitis and meningitis vaccines. “The next thing I know I am on the floor in the fetal position.” Had she known more about Gardasil – “I wish I’d waited a little until it was out in the public more and also that they did more research about the negative side effects.” – Jamie Colby, Fox News (July 11, 2008) SEE VIDEO at http://www.foxnews.com/video2/video08.html?maven_referralObject=2233990&maven_referralPlayli

stId=&sRevUrl=http://www.foxnews.com/health/index.ht ml

“Jessica Ericzon, 17, was “an all- American teenager,” as described by one of her upstate LaFargeville teachers. Last February, she was working on her softball pitches, getting ready for a class trip to Universal Studios in Florida and hitting the slopes to snowboard with her older brother. Then one day, the blond, blue-eyed honors student collapsed dead in her bathroom. It started with a pain in the back of her head. On the advice of her family doctor, Jessie had taken a series of three Gardasil shots. The vaccine, marketed for females ages 9 to 26, is the first found to ward off strains of the sexually transmitted human papillomavirus, or HPV, which can cause cervical cancer. Jessie got the first injection in July 2007. After her second shot in September, she complained of a pain in the back of her head, fatigue and soreness in some joints, said her mom, Lisa. On Feb. 20, while on winter break from school, she got her third and final dose of the vaccine. The next night, “she told me the spot on the back of her head was bothering her again,” her mom said. The next morning, Feb. 22, Lisa, a hospital technician, left for work just after 5 a.m., leaving Jessie asleep. Jessie never showed up for the class she was taking at Jefferson Community College. When her mom got home at 3:20 p.m., she found Jessie sprawled on her back on the bathroom floor, with blood spots on her head where it had hit a flowerpot. Jefferson County Medical Examiner Samuel Livingstone is stumped. “She was essentially dead by the time she hit the floor. Whatever it was, it was instantaneous,” Livingstone said. His autopsy found no cause.” – Susan Edelman, New York Post (July 20, 2008)

http://www.nypost.com/seven/07202008/news/regionalnews/my_girl_died_as_guinea_pig_for_gardasil_120737.htm

” Katherine Kimzey got her first injection of Gardasil along with a Hepatitis-A vaccine and a chicken pox booster. She got the second injection two months later, along with the D-TaP vaccination. Six weeks after the second injection of Gardasil, Katherine passed out. “I tried to get up and my neck was stiff, and I couldn’t move it,” the teenager explained. “I couldn’t move at all.” Katherine spent five days in the hospital.

Shannon Nelson, 18, from the Chicago area, got the Gardasil shot and two other vaccines– at the same time. Within a week the soccer star could barely move. “When I went into the hospital I couldn’t walk at all. I had to have a wheelchair. It just got worse each day,” she explained. Nelson spent 23 days in the hospital and while she’s better now the teenager believes one of the vaccines she received is responsible for her illness and her neurologist says it’s certainly possible.

Katherine Kimzey is back on the soccer field in North Texas. But she still has occasional pain and doesn’t know what the future will hold. Thinking about her past experience she says she still worries and so does her mom. Michelle Kimzey says next time; she won’t be so quick to jump on the new vaccine bandwagon. “I think the connection is huge,” she said.

In a statement to CBS 11 News, Merck — the maker of Gardasil — said it has analyzed the reports of paralysis and death, and believes: no safety issue related to the vaccine has been identified.” – Ginger Allen, CBS News 11 – Dallas (July 21, 2008) http://cbs11tv.com/health/Gardasil.cervical.cancer.2.776277.html

“Consumer concerns over safety have not been assuaged by “reassurances from the government,” said Barbara Loe Fisher, cofounder of the National Vaccine Information Center (NVIC). “We have heard reassurances about safety before – for example, with the whole-cell pertussis (diphtheria- pertussis-tetanus [DPT]) vaccine in the 1980s,” she said, noting that this was subsequently withdrawn and replaced by an acellular version in the United States in the 1990s. Ms. Fisher has a son whom she believes was damaged by the DPT vaccine 28 years ago, and she has worked ever since as an activist in the vaccine safety field in various capacities, including a 4-year stint as a consumer member of the FDA Vaccines and Related Biological Products Advisory Committee.

In addition, the NVIC has been running its own private vaccine reaction registry for the past 26-years, and it currently has about 140 reports on Gardasil, Ms. Fisher said. “These include reports of injury and death, and we are seeing a pattern of what we have termed ‘atypical collapse,’ ” she commented. “These include cases where a girl suddenly passes into unconsciousness either immediately or within 24 hours of vaccination and then revives feeling weak and unable to speak properly or exhibiting other neurological signs. What we are concerned about is that girls are not aware of this possibility and could be crossing the road or driving a car and suddenly pass out.” Ms. Fisher also outlined concerns about how Gardasil has been studied. She pointed out that very few of the participants in the clinical trials were aged 11 to 12 years, which is the recommended target age for the vaccine. The New York Times reported in 2006 that of the 20,000 trial participants, 1200 were younger than 16 years.” – Zosia Chustecka, Medscape Medical News (August 8, 2008) http://www.medscape.com/viewarticle/578110

Sources:

http:://www.vaccineawakening.blogspot.com

http://www.NVIC.org

http://www.StandUpBeCounted.org

©2012 An Inconvenient Woman. All Rights Reserved.