Speaker 1: My name is Stephanie. I am thirty four years old
Speaker 1: soldier with the US Army and also a government contractor.
Speaker 1: In twenty sixteen, right when I became a single mom
Speaker 1: with my two daughters, I went to get a paps mare.
Speaker 1: I had only missed two pap smears before that and
Speaker 1: didn't think anything of it. The exam itself went as
Speaker 1: normal as possibly could be. It wasn't until about two
Speaker 1: weeks later did I get a call from the gynocologist herself,
Speaker 1: urging me to come in as soon as possible. She
Speaker 1: offered to waive any co pigs and schedule me in
Speaker 1: in between clients because she said it was absolutely urgent
Speaker 1: that I went in there. So I went in the
Speaker 1: very next day and she called me into her office
Speaker 1: and sat me down, and I remember mostly how happy
Speaker 1: and cheery she was, and what I knew was going
Speaker 1: to be very bad news. She took out a paper
Speaker 1: and started with don't panic, but we found cancer cells
Speaker 1: in your cervix, and she explained that I had at
Speaker 1: no carcinoma in situ or AIS, and explained to me
Speaker 1: that although they're considered pre cancer cells, the type of
Speaker 1: cancer itself at no karcinoma tends to jump membranes quicker
Speaker 1: than the other type of cervical cancer, just squama cell carcinoma.
Speaker 1: And she told me that I needed to schedule appointment
Speaker 1: with the gynecologic oncologist at the hospital down the road,
Speaker 1: and the whole time she kept telling me not to worry,
Speaker 1: that this was good cancer and that I'm one of
Speaker 1: the lucky ones. I scheduled the appointment afterwards to go
Speaker 1: to meet the oncologist, and when I did meet him,
Speaker 1: he said the same thing. He says that I should
Speaker 1: feel very lucky. I believed that this is good cancer
Speaker 1: and that they were going to watch me for a
Speaker 1: few months and scheduled me for a cold knife conization biopsy.
Speaker 1: In those couple of months, I had to basically learn
Speaker 1: how to deal with the possibility of having good cancer
Speaker 1: as opposed to bad cancer or no cancer, and it
Speaker 1: was scary, and because it was ais, I didn't get
Speaker 1: much support from the cologists because, as he felt, there
Speaker 1: were other graver cases of cancer when he need to handle,
Speaker 1: which I did know any better, so I thought it
Speaker 1: was fine. December twenty sixteen, right before Christmas, I went
Speaker 1: in for my cold knife conization. The pre opt was
Speaker 1: way more serious than I thought it was going to
Speaker 1: be because I kept thinking good cancer, easy biopsy, and
Speaker 1: that would be out, but it was treated like a
Speaker 1: full surgery. After the surgery, I was told that my
Speaker 1: margins were clear and that I was good to go
Speaker 1: and would need no more real oncologist help outside of
Speaker 1: the follow up from that appointment. A couple weeks after that,
Speaker 1: I started getting really heavy cramping and bleeding during times
Speaker 1: that I was not on my Mestro cycle, and by
Speaker 1: April the pain became so severe that I ended up
Speaker 1: in the emergency room in the er. They ran a
Speaker 1: scan and they found a really really small mass on
Speaker 1: the cervical canal, and I had to go back to
Speaker 1: the gynocologic oncologists to see what we were going to
Speaker 1: do next. The oncologist told me, basically the best case
Speaker 1: right now I would be to have a hysterectomy, and
Speaker 1: he actually wanted to wait a couple of years to
Speaker 1: have the hysterectomy, not because the cancer wasn't serious, but
Speaker 1: because he wanted to make sure that I was done
Speaker 1: having children. I have two daughters, they were ten and
Speaker 1: four at the time, and I felt different about that
Speaker 1: he wanted to make sure that I didn't one day
Speaker 1: and wake up wanted to have a boy a son,
Speaker 1: and I kept telling him that I was done having children.
Speaker 1: So it was a really what I felt was an
Speaker 1: unfair battle I was having with my oncologists because I
Speaker 1: just wanted to get anything cancerous out of me, so
Speaker 1: I could, you know, be there for the.
Speaker 2: Children I do have.
Speaker 1: So after about a week I finally convinced him to
Speaker 1: just go ahead with the hystectomy now. And so about
Speaker 1: two weeks after that er visit, I was in the
Speaker 1: operating room again having a hysterect me. They took my cervix,
Speaker 1: my uterus, and my Philippian tubes and a little bit
Speaker 1: off the top of the vagina, and recovery was painful.
Speaker 1: I went into surgical menopause, which was miserable for that
Speaker 1: short time that I was dealing with that. And the
Speaker 1: follow up appointment he said everything was great, there was
Speaker 1: no more sign of any cancer civils or any cancer anywhere,
Speaker 1: and that I was clear to do annual pap smears
Speaker 1: for the next five years. So that was the first
Speaker 1: time that he told me that the cause of the
Speaker 1: cancer was actually uh HPV sixteen strand he had not
Speaker 1: mentioned it, and now that I did, Mike goin ofcollogies
Speaker 1: mention HPV up until that point, and I think that
Speaker 1: has to do a lot with the stigma behind HPV
Speaker 1: and circle cancer and my last PAS smear, which was
Speaker 1: I'm going to say a few months ago, my gynecologist
Speaker 1: told me that she once again found HPBE strand sixteen
Speaker 1: around my virgual cup. So right now it's just being observed,
Speaker 1: hopefully it doesn't turn into any kind of cancer again.
Speaker 1: In the Circle cancer support group that I am on Facebook,
Speaker 1: I see a lot of women who have to do
Speaker 1: a lot of radiation and they have to use dilators
Speaker 1: so that their vaginas don't seal, and they have to
Speaker 1: do chemo. And so I understand what my doctors were
Speaker 1: saying when they said I was one of the lucky ones,
Speaker 1: even though I went from thinking I was totally healthy
Speaker 1: to two surgeries, er visits, almost losing my job, losing
Speaker 1: my ability to ever have another child within seven months,
Speaker 1: I believe.
Speaker 3: So I do feel I.
Speaker 1: Do feel very lucky, even though I know that it
Speaker 1: was still a hard and traumatic event in my life.
Speaker 1: But there's you know, not a day that goes bad
Speaker 1: that I'm not thankful that I'm here, and I'm hoping
Speaker 1: that this new or old HPV doesn't bring back the
Speaker 1: cancer in any way.
Speaker 2: Wow, thank you so much for sharing your story. We
Speaker 2: really appreciate it.
Speaker 4: Thank you.
Speaker 1: Hi.
Speaker 2: I'm erin Welsh and I'm Aaron Allman Updyke and this
Speaker 2: is this podcast will kill you.
Speaker 4: Yeah, I'm very excited for today's episode.
Speaker 3: Me too.
Speaker 2: I mean, we say this every week and then we
Speaker 2: say that we say this every week.
Speaker 4: But listen, today we're talking about HPV.
Speaker 2: Yeah, so we are reasonably excited, understandably excited. This has
Speaker 2: been a long time coming. I feel like we've gotten
Speaker 2: a lot of requests about it. It's a big, juicy
Speaker 2: one in that like there's a big biology to it,
Speaker 2: there's a big history to it, and I think I
Speaker 2: might be most excited for like the current status type stuff.
Speaker 4: Yeah, because that's a whole big I feel like we're
Speaker 4: just gonna end up going on our own Aaron's public
Speaker 4: health tangents about it.
Speaker 2: All probably a bit on like a high horse or like, listen,
Speaker 2: here's the bottom line exactly.
Speaker 4: It's gonna be great. It's gonna be everything.
Speaker 2: It's gonna be everything. But before we get to the
Speaker 2: meat of the episode, we've got some business to take
Speaker 2: care of. It's quarantine any time, it is quarantiney time.
Speaker 2: What are we drinking this week?
Speaker 4: Well, of course we're drinking the pap Shmearr. I feel
Speaker 4: like I didn't say that great.
Speaker 3: So I've been not practicing.
Speaker 2: But every time I say it, I realize, am I
Speaker 2: enunciating papst purely enough?
Speaker 3: Like papst?
Speaker 2: Maybe we should just explain what's in it and then
Speaker 2: it might be easier to hear the pronunciation.
Speaker 4: It's PBR PAPST, blue ribbon and grapefruit juice and some
Speaker 4: simple syrup. Yeah, because it's like a pap smear. Get it? So?
Speaker 2: This just like cold as the Rocky Mountain. Spotted Fever
Speaker 2: was one of the Quarantini names that we came up
Speaker 2: with on the day that we came up with the
Speaker 2: podcast Severe.
Speaker 4: It was one of the like clinchers, like we have
Speaker 4: to make this podcast because it's too good of a
Speaker 4: name to let it go to waste.
Speaker 2: I still think of, like, even before recording this, I
Speaker 2: would still think of pap smear whenever I drank a PBR.
Speaker 4: I thought about every time I got a pap smear.
Speaker 2: Ao. Well, we will post the full recipe for the
Speaker 2: quarantini as well as the non alcoholic Plussy burrita on
Speaker 2: our website This podcast will Kill You dot com, as
Speaker 2: well as on all of our social media channels.
Speaker 4: Absolutely, do we have any other business before we dive
Speaker 4: into this big episode.
Speaker 3: Erin, there's usual stuff.
Speaker 2: There's fantastic, wonderful, beautiful merch. There is a bookshop dot
Speaker 2: org affiliate account, and also there is a good Reads
Speaker 2: list where we add the books that we read. And
Speaker 2: also it's like a nice community list where listeners add
Speaker 2: books that they think are of the podcast or related
Speaker 2: to the podcast.
Speaker 4: Yeah, okay, well, then let's take a quick break and
Speaker 4: then dive into this episode.
Speaker 2: Sounds great.
Speaker 4: So HPV stands for human papaloma virus. This is a
Speaker 4: double stranded DNA virus. Except it's not just a virus, right,
Speaker 4: Oh No, this is an entire family of double stranded
Speaker 4: DNA viruses, the papaloma viruses, which include I don't even
Speaker 4: know how many viruses, but viruses that infect essentially I
Speaker 4: don't know every animal ever, every mammal that we've ever
Speaker 4: looked at birds, turtle, snakes, fish, I think every animal.
Speaker 2: Fish. That's the one that really got me.
Speaker 4: It was like fish. I had an advisor who studied
Speaker 4: turtle papalomma viruses.
Speaker 2: Oh cool.
Speaker 4: Yeah, But today we're talking about the human papillomaviruses aka
Speaker 4: hp V. So for HPVs, these are a group of
Speaker 4: several hundred viruses which fall into a few large kind
Speaker 4: of subgroups. They call them alpha, which is the one
Speaker 4: that we're going to focus on the most today, as
Speaker 4: well as beta, gamma, delta. There's new, there's new, there
Speaker 4: might be a chi. There's a lot of different subgroups
Speaker 4: of these viruses, and then within each of these different subgroups,
Speaker 4: there are dozens of different types of HPV, which we're
Speaker 4: probably all familiar with. You've probably all heard at some
Speaker 4: point or another a type of HPV HPV sixteen, HPV
Speaker 4: six eleven. On top of that, and kind of within
Speaker 4: these larger subgroups, you can also bin these different HPVs
Speaker 4: based on the types of cells that they tend to infect.
Speaker 4: So all HPV viruses infect epithelial cells, which are the
Speaker 4: cells that make up our outer linings of everything in
Speaker 4: our body. But we have a lot of different types
Speaker 4: of epithelial cells on our skin, the linings of our
Speaker 4: respiratory tract or our GI tract or our genital tract.
Speaker 2: So you can.
Speaker 4: Also get these HPV types as some being more likely
Speaker 4: to affect the skin, which they sometimes call cutaneotropic like
Speaker 4: cutaneous like your skin. These are the strains or types
Speaker 4: that tend to cause warts of all different kinds. Right,
Speaker 4: everyone knows warts. But then there are also the mucosotropic types,
Speaker 4: which preferentially infect cells of our mucosal lining like the cervix,
Speaker 4: which is going to be what we talk the most
Speaker 4: about today, but also the anal canal are oorrofharynks. These
Speaker 4: can also cause warts generally of the genital tract or
Speaker 4: even in our larynx or pharynx. And so in general,
Speaker 4: it's these HPV types that we're going to focus on
Speaker 4: for this episode. All of these tend to be in
Speaker 4: the alpha HPV category. It gets a little bit more
Speaker 4: complicated because on top of that you also have high
Speaker 4: risk and low risk strains or types.
Speaker 2: I'm very excited to learn more about this.
Speaker 4: Yeah, and that's because that's the biggest story in association
Speaker 4: with HPV and that is the risk of cancer. So
Speaker 4: when we say high risk, these are HPV types that
Speaker 4: have a high risk of potentially causing cancer, and low
Speaker 4: risk means they have a very low risk of potentially
Speaker 4: causing cancer. All right, So let's talk about how these
Speaker 4: viruses are transmitted. A lot of times we think of
Speaker 4: HPV as a purely sexually transmitted disease, and many types
Speaker 4: are sexually transmitted diseases, and those cause genital wards and
Speaker 4: those types also are associated with certain cancers. But there
Speaker 4: are so many different types of HPV, and really, when
Speaker 4: it comes down to it, they're all transmitted by contact,
Speaker 4: so sexual contact. But if you have HPV on your hands,
Speaker 4: then and you can transmit it from hand to anything.
Speaker 4: If you have plantar warts, which are warts on the
Speaker 4: bottom of your feet, those actually shed so much HPV
Speaker 4: that that can end up on the floor and it
Speaker 4: can live for a really long time, and then someone
Speaker 4: else can walk along that floor and get HPV from
Speaker 4: the floor.
Speaker 2: How long is a long time?
Speaker 4: I think I read months potentially, but I don't know
Speaker 4: under what conditions that would be true. Yeah, all right,
Speaker 4: But basically, if you include all these different types, all
Speaker 4: these different subgroupings of HPV. It's really everywhere, Like this
Speaker 4: is such a ubiquitous virus family. Oh yeah, and it's
Speaker 4: quite transmissible. If we look more at sexually transmitted HPV,
Speaker 4: or if we look just specifically at sexually transmitted HPV,
Speaker 4: it's estimated that the like per sexual act transmission rate
Speaker 4: is up to sixty percent.
Speaker 2: Wow. Yeah, I mean the thing is like, by the
Speaker 2: time you're a couple of years old, you are probably
Speaker 2: infected with one HPV, right, right, What.
Speaker 4: Kid doesn't have warts at some point in their life, Like,
Speaker 4: everyone has at least a wart, right, But let's get
Speaker 4: one thing really clear right off the bat. The vast,
Speaker 4: vast majority of HPV infections are almost entirely benign, even
Speaker 4: if they present with a WART, which not all of
Speaker 4: them do. In general, over ninety percent even of genital
Speaker 4: HPV infections will be cleared completely, especially in younger age
Speaker 4: groups like teenagers and young adults. This process is not
Speaker 4: super fast. The half life of the disease, which it's
Speaker 4: interesting to talk about a disease having a half life
Speaker 4: because we don't usually do that, but that tells you
Speaker 4: just kind of how long you can end up infected
Speaker 4: with this and yet still clear it. But the half
Speaker 4: life for HPV is thought to be like eight to
Speaker 4: ten months, So almost all infections will clear in about
Speaker 4: a year or two.
Speaker 2: And so is an infection defined as like actively shedding
Speaker 2: virus or and then like at the end of that infection,
Speaker 2: the virus is cleared from your body, your immune system
Speaker 2: has taken care of it.
Speaker 4: Yes, cleared means that your immune system has taken care
Speaker 4: of it and you no longer have virus in our cells.
Speaker 2: And are you shedding that entire time or that's a good.
Speaker 4: Question as far as I believe, I believe yes, Okay,
Speaker 4: I would guess that how much virus you shed probably
Speaker 4: varies throughout that time course. Okay, But not every infection
Speaker 4: is cleared. So some types of HPV can cause a
Speaker 4: more latent infection where they essentially can stay in our
Speaker 4: cells for a longer time and over that time period
Speaker 4: end up causing cancer. HPV is associated with essentially one
Speaker 4: hundred percent of cervical cancers right as far as we
Speaker 4: can tell so far, cervical cancer. It is necessary to
Speaker 4: have an HPV infection in order to have cervical cancer.
Speaker 4: It's not the only thing, but it is a necessary
Speaker 4: part of the cervical cancer process. However, HPV infection is
Speaker 4: also associated with vaginal cancer, vulvar cancer, penile cancer, anal
Speaker 4: cancer or a pharyngeal cancers, and laryngeal cancers. So that's
Speaker 4: of the back of the throat and the throat.
Speaker 2: I think it's it's interesting because like that is not
Speaker 2: a commonly known thing or it's not something that was
Speaker 2: commonly like spread as part of the public health message.
Speaker 3: Oh arn, I.
Speaker 4: Have so many thoughts about that that we'll touch on
Speaker 4: in the current events section.
Speaker 2: All right, we'll step down from the platform like for
Speaker 2: this for the time being.
Speaker 4: For the time being, let's let's get back to our HPV.
Speaker 4: So the real question, of course, is how on earth
Speaker 4: can a virus cause cancer? Yeah? Right, And the answer
Speaker 4: is so fascinating, especially because we have talked about a
Speaker 4: virus that causes cancer previously, but in a totally different
Speaker 4: way hepsi. Hepsi. Right, this is totally different. Okay, So
Speaker 4: to understand this, we have to understand HPV and then
Speaker 4: we have to understand our epithelial cells a little bit.
Speaker 4: So let's get into it. We know that because this
Speaker 4: is a virus, it has to infect our cells in
Speaker 4: order to replicate, since viruses use our cellular machinery in
Speaker 4: order to replicate, so HPV enters into our tissue via
Speaker 4: little microabrasions, So you have to have small, tiny little
Speaker 4: cuts on your skin or mucosal membranes in order for
Speaker 4: HPV to get in. And then it infects a very
Speaker 4: specific set of our epithelial cells. It infects the basal layer.
Speaker 4: That's the bottom layer of our epithelial cells. So think
Speaker 4: of this as like if you look at a cross
Speaker 4: section of your skin. You have all the dead skin
Speaker 4: cells on top that like slough off when you wipe
Speaker 4: or wash or whatever. And then you have other layers
Speaker 4: of cells that are like differentiated and they're doing their thing.
Speaker 4: And then at the bottom what we have here are
Speaker 4: these kind of stem cells. These basal cells are the
Speaker 4: ones that replicate over and over and then produce all
Speaker 4: of these top layers. They kind of like pooshe themselves up,
Speaker 4: if that makes sense. Yeah, So that bottom layer is
Speaker 4: where HPV infects. Interesting once they're there. Once HPV is
Speaker 4: in those cells, first, that virus will use our cell
Speaker 4: machinery to replicate a few times, just so there's like
Speaker 4: a nice group of them in each cell, like maybe
Speaker 4: fifty to one hundred, okay, And then these viruses have
Speaker 4: a couple of proteins that act to help stimulate our
Speaker 4: cells to replicate. So epithelial cells, like our skin cells,
Speaker 4: they generally replicate pretty rapidly already compared to a lot
Speaker 4: of cells in our body. But this HPV infection is like, hey,
Speaker 4: let's let's kind of do this even more because every
Speaker 4: time that a cell replicates, it's going to replicate all
Speaker 4: that viral DNA as well.
Speaker 2: That's an interesting strategy instead of like because usually we
Speaker 2: see viruses invading, replicating in this cell and then bursting
Speaker 2: the cell, killing it, and then infecting another cell and
Speaker 2: another set and another cell and doing the same thing.
Speaker 2: But this is like contained replications.
Speaker 4: Herein You're right, isn't it exciting?
Speaker 2: This is very interesting.
Speaker 4: So if this happens on our skin or on some
Speaker 4: of our meucosal surfaces, with most of these HPV types,
Speaker 4: it might manifest as warts. Right, So warts are basically
Speaker 4: just keratinocytes our skin cells that kind of grow, they
Speaker 4: get like extra keratinized, and then as those cells slough off,
Speaker 4: that's when the virus explodes. Out and is able to
Speaker 4: go on and infect other cells.
Speaker 2: That is really interesting, yes, but that.
Speaker 4: Doesn't tell us what about cancer. That that's not cancer,
Speaker 4: that's worts. So there's another thing that certain types of
Speaker 4: this virus have that allow them to be even sneakier.
Speaker 4: So the high risk subtypes have a few extra tricks.
Speaker 4: One is that they can actually integrate into our genome directly.
Speaker 3: That's spooky, Yeah, it happens.
Speaker 2: I love it.
Speaker 4: So that means that they can do an even better
Speaker 4: job of disrupting our normal cell functioning because they actually
Speaker 4: can insert themselves inside our genome, like in between our DNA.
Speaker 4: It's like human human HPV HPV human human. Right on
Speaker 4: top of that, the high risk subtypes have a couple
Speaker 4: of extra proteins. One that's called E six, one that's
Speaker 4: called E seven, maybe also E five. And what these
Speaker 4: proteins do, so we already know that HPV has these
Speaker 4: proteins that like tell our cells, hey, replicate more than
Speaker 4: you want to. These other proteins, on top of that,
Speaker 4: function to suppress a couple of genes that we have
Speaker 4: in our bodies, which are called P fifty three and
Speaker 4: p RB or P retinoblastoma which in our normal human
Speaker 4: cells or what are called tumor suppressor genes. These genes
Speaker 4: are responsible for doing like a double check whenever our
Speaker 4: cells replicate DNA these proteins, the proteins that are encoded
Speaker 4: for by these genes, They're like, hey, hey, let's take
Speaker 4: a minute real quick. You guys, you made a mistake here.
Speaker 4: This isn't right. You can't do that. This needs to
Speaker 4: either be fixed or I'm gonna kill you. So it
Speaker 4: either stops DNA replication or they try and fix it.
Speaker 4: And if they can't do that, then they just do
Speaker 4: apoptosis and they're like, scratch this whole operation. This cells
Speaker 4: out of commission, right, So, these tumor suppressor genes are
Speaker 4: what prevent our cells from replicating out of control and
Speaker 4: what prevents our cells from replicating incorrect faulty DNA sequences.
Speaker 4: High risk HPV turns this function off. So not only
Speaker 4: is HPV convincing our cells to rep implicate more rapidly,
Speaker 4: but as they do so, they replicate incorrect and messed
Speaker 4: up DNA, which can lead to eventually, you know how
Speaker 4: these cells are in the basal layer, the bottom layer
Speaker 4: of our skin yeah, and normally skin cells replicate up
Speaker 4: up up. This uncontrolled, incorrect division can allow them to
Speaker 4: invade beyond the basement membrane, which is the layer underneath
Speaker 4: those basil cells, and invade deeper structures. That's cancer.
Speaker 2: And is that primarily in the mucosal or only mucosal?
Speaker 4: Yeah, so this is what happens in the high risk
Speaker 4: HPV subtypes, which tend to infect mucosal surfaces.
Speaker 2: This is It's so interesting to me because like from
Speaker 2: a virus's point of view, this seems like an excellent strategy.
Speaker 3: Yeah, so it's.
Speaker 2: Such a good strategy, Like, why don't we see this more?
Speaker 4: I guess I think it's very very complicated, So it
Speaker 4: must be, Yeah, because this is it's not just that
Speaker 4: this virus itself is growing really rapidly, Like this virus
Speaker 4: has to have a very intimate relationship with our genome,
Speaker 4: so it has to have evolved with us for a
Speaker 4: very long time. I would guess I actually didn't look
Speaker 4: into that. You're going to talk a little bit about it,
Speaker 4: I think.
Speaker 2: But I'm thrilled. This is so great. I love when
Speaker 2: this happened.
Speaker 4: Yes, but yeah, I mean that's what that would suggest, right,
Speaker 4: because it has such an intimate relationship with our genes.
Speaker 4: It specifically is turning off these tumor suppressor genes. And
Speaker 4: like you said, it's a great strategy because now this
Speaker 4: virus can invade our whole body, cancer can go anywhere
Speaker 4: at once once it starts going.
Speaker 3: How does it disrupt p.
Speaker 2: Fifty three?
Speaker 4: Oh gosh, Aaron, don't ask me that, Okay, it just does. Yeah,
Speaker 4: that's that's what I have for the path of physiology
Speaker 4: of this disease.
Speaker 2: It's very fascinating and it's like, it's very scary. Cervical
Speaker 2: cancer is the one that we hear the most about.
Speaker 3: Yeah, why is that?
Speaker 2: Well, first of all, why are those areas so much
Speaker 2: more susceptible to cancer caused by HPVs? And why cervical
Speaker 2: cancer most of all? Or is it just that we
Speaker 2: hear more about it.
Speaker 4: It's a good question. I think in part, we do
Speaker 4: hear more about it, and we'll talk about kind of
Speaker 4: why that is. And part of that's because we can
Speaker 4: screen for it, which is great. It's also I think
Speaker 4: because other cancers that are associated with HPV also have
Speaker 4: other risk factors or other things that can cause them
Speaker 4: without necessarily having HPV, whereas cervical cancer, it seems that
Speaker 4: HPV is a necessary precursor. Like if there's not HPV,
Speaker 4: the cervix is never going to become cancerous.
Speaker 2: Okay, if that makes sense, Yes, that is interesting.
Speaker 1: Yeah.
Speaker 4: The cervix, by the way, is the bottom part of
Speaker 4: the uterus. Some people might not know that.
Speaker 2: It's very true.
Speaker 4: Yeah, it's the bottom part of the uterus. It looks so.
Speaker 4: I guess we'll talk about this so that we can
Speaker 4: understand why we're able to screen for cervical cancer. And
Speaker 4: I think aarin you'll talk a little bit more too,
Speaker 4: about like how someone came up with this. Oh yeah, yeah,
Speaker 4: So it's the bottom part of the uterus, which is
Speaker 4: also if you are looking into the vagina, it's the
Speaker 4: very top part of what you'd see at the vaginal canal.
Speaker 4: It looks like a little doughnut. It's kind of cute,
Speaker 4: with a little hole in the middle. That little hole
Speaker 4: in the middle goes up like through that hole would
Speaker 4: go up into the uterus. And at that zone right
Speaker 4: in the middle of that hole is where the outside
Speaker 4: body meets the inside body, and there's a transition zone
Speaker 4: in there where our cells change type that transition zone
Speaker 4: is also very susceptible to HPV infection. Huh, the same
Speaker 4: is true. We think of the transition zone because there's
Speaker 4: a similar transition zone in the anal canal where we
Speaker 4: go from outside of the body to the inside of
Speaker 4: the body, and that transition zone in the anal canal
Speaker 4: is also very susceptible to HPV infection.
Speaker 2: So the transition zone where you so you have cells
Speaker 2: turning into different kinds, like that's what the border. Yes,
Speaker 2: and does that have something to do with it? Just
Speaker 2: the fact that there are like different instructions and so
Speaker 2: like a different type of cell might not receive the
Speaker 2: same amount of like scrutiny.
Speaker 4: Yeah, it's possible. So I think from what I have read,
Speaker 4: we don't fully understand exactly that process, but it is
Speaker 4: thought that, yes, something about that transition zone and the
Speaker 4: kind of what's called metaplasia or cell type change that
Speaker 4: happens there might have something to do with why this why.
Speaker 3: The cervix interesting?
Speaker 2: Interesting?
Speaker 4: But the good news when it comes to cervical cancer
Speaker 4: at least is that it's a really preventable type of cancer.
Speaker 4: It's at this day and age, it's a very preventable
Speaker 4: type of cancer, at least in theory. We can prevent
Speaker 4: it in a number of different ways. One is by
Speaker 4: This is kind of fun because we can talk about
Speaker 4: the types of prevention, right, Yeah, So in public health
Speaker 4: we have a lot of different types of prevention, and
Speaker 4: one is called secondary prevention, and that's what screening is.
Speaker 4: So that means we're trying to find precursors of something
Speaker 4: like cancer or very very early cancer that we can
Speaker 4: treat before its severe disease. So screening like breast cancer
Speaker 4: screenings or cervical cancer screenings are secondary prevention. And we
Speaker 4: can do that. We can scrape off cells at that
Speaker 4: transition zone from the inside of the cervix and then
Speaker 4: look at them under a microscope and look for pre
Speaker 4: cancerous changes, and that can tell us, hey, you're at
Speaker 4: risk of having cancer. And then you can go one
Speaker 4: step further and do a second test where you basically
Speaker 4: put acetic acid on the cervix and look with another
Speaker 4: type of special lens to see if there are any
Speaker 4: changes and then remove those as well before they become
Speaker 4: cancer or before they become invasive cancer. So that's one
Speaker 4: type of screening, and that's the PAP smear combined with
Speaker 4: what's called kolposcopy, which is the more invasive test. Nowadays,
Speaker 4: we have another type of screening which I get rare
Speaker 4: very excited about because it's a lot less invasive, it
Speaker 4: doesn't have to be done as often, and it's as good,
Speaker 4: if not better, and that is direct HPV testing. So
Speaker 4: because cervical cancer necessarily has HPV infection, you can test
Speaker 4: cervical cells really like just a vaginal swab. It doesn't
Speaker 4: have to be all the way jamming into the cervix,
Speaker 4: which is a lot more painful, and you can just
Speaker 4: test for the presence of certain types of high risk
Speaker 4: HPV and then if you see it, then you go
Speaker 4: from there in terms of like what you do about it.
Speaker 4: So that's really exciting because that's secondary prevention that's possible.
Speaker 4: But even better than secondary prevention is primary prevention.
Speaker 2: Oh yeah.
Speaker 4: Primary prevention means preventing somebody from ever getting a disease
Speaker 4: in the first place, and for cancer, we often can't
Speaker 4: do that. So for cancer, secondary prevention is often kind
Speaker 4: of like the mainstay of public health prevention. That's usually
Speaker 4: all that we can do is try and find it
Speaker 4: early and do something about it. But for cervical cancer,
Speaker 4: we can prevent it because we have a vaccine.
Speaker 2: It's amazing.
Speaker 4: We have a cancer preventing vaccine.
Speaker 2: I know, it's we're living in the future. We really are.
Speaker 4: So there are three different types of HPV vaccines that
Speaker 4: are currently licensed. One covers four types of HPV, two
Speaker 4: that are high risk, which are sixteen and eighteen. Those
Speaker 4: cover seventy percent of all cervical cancer in the world,
Speaker 4: as well as six and eleven, which cause about ninety
Speaker 4: percent of genital warts, which is awesome. Yeah, there's another
Speaker 4: one that was licensed a couple years later that only
Speaker 4: covers sixteen in eighteen, so it doesn't protect against genital warts,
Speaker 4: but it does protect against seventy percent of cervical cancers.
Speaker 4: But recently, in the last couple of years, there's another
Speaker 4: one that covers nine strains, including sixteen and eighteen, which
Speaker 4: are the most common causes of cancer, but also thirty one,
Speaker 4: thirty three, forty five, fifty two, fifty eight, which are
Speaker 4: all high risk types that all together account for ninety
Speaker 4: percent of all cervical cancers.
Speaker 2: That's amazing.
Speaker 4: And then it also covers genital warts. We'll talk about
Speaker 4: all of the pitfalls with this vaccine and with screening
Speaker 4: in general. A little bit more later on in this episode,
Speaker 4: But first, Aaron, ooh, where did we? How did we?
Speaker 4: What is this virus? Is cancer virus?
Speaker 3: Like what?
Speaker 2: I know? I know, I'm very excited to talk about it.
Speaker 2: Let's take a quick break first. So first off, to
Speaker 2: say that papollomaviruses in general, papollomaviruses have been around since
Speaker 2: humans became human, would be a bit of an understatement,
Speaker 2: kind of an enormous understatement actually, because papalomaviruses are thought
Speaker 2: to be hundreds of millions.
Speaker 3: Of years old.
Speaker 4: Have they been around since viruses were viruses?
Speaker 2: I mean not far off? The number in diversity of
Speaker 2: hope that they infect, like you mentioned, Aaron, fish, birds, mammals, reptiles,
Speaker 2: et cetera. And also their diversity within the host species.
Speaker 2: It just like highlights how ancient this group of viruses is.
Speaker 2: All Right, So I found one paper that puts the
Speaker 2: root of the papilloma virus tree back to four hundred
Speaker 2: and twenty four million years ago. What like this is
Speaker 2: beyond what anything that we've talked about in terms of
Speaker 2: like ancientness.
Speaker 4: Wow.
Speaker 2: Yeah, And then the first big divergence was around one
Speaker 2: hundred and eighty four million years ago, and that was
Speaker 2: during the period when mammal evolution and diversification led to
Speaker 2: the development of a whole lot of new real estate
Speaker 2: for these viruses, specifically some of the mammalian skin characteristics
Speaker 2: like hairs, sweat glands, sebaceous glands, milk glands, et cetera.
Speaker 2: So this is just like open space to occupy tons
Speaker 2: new territory, absolutely, and so from that point there are
Speaker 2: several other additional diversification events or periods where the Papaloma
Speaker 2: virus diversity kind of like fanned out even further. But
Speaker 2: I'm just gonna leave it at that because it gets
Speaker 2: sort of like and then, and then and then. Basically,
Speaker 2: the bottom line is that papalomaviruses are incredibly old and
Speaker 2: have evolved with their hosts, and that the cancer causing
Speaker 2: genes in papaloma viruses are not specific to human papalamaviruses,
Speaker 2: and so those genes it's likely that those genes evolved
Speaker 2: before humans did. What, so like, those genes are likely
Speaker 2: similar across all of the like in different animal viruses.
Speaker 4: Honestly, that makes sense. Because P. Fifty three is highly conserved.
Speaker 2: Exactly exactly, so it's probably not like convergent evolution, I
Speaker 2: would guess anyway, also because complexity, but whatever, And because
Speaker 2: of how old and widespread these viruses are, it probably
Speaker 2: doesn't surprise you to learn that there are lots and
Speaker 2: lots of ancient writings about them, or at least about
Speaker 2: the things that they caused, like warts. Genital warts, for instance,
Speaker 2: have been written about since at least the time of Hippocrates,
Speaker 2: so like for one hundred and sixty to three hundred
Speaker 2: and seventy BCE. And the medical term for them, condolomata acuminata,
Speaker 2: comes from the ancient Greek and Latin condoloma meaning knob
Speaker 2: or round tumor, and acuminata from the Latin for sharp points.
Speaker 2: And a term for plannar warts mirror mesia mirror mechia
Speaker 2: comes from the Greek word for ant hill.
Speaker 4: I can see that.
Speaker 2: And in ancient Rome, genital warts were called pycus or
Speaker 2: thymus because apparently they looked like an open fig or
Speaker 2: resembled the leaves of the time plant. Yeah, and besides
Speaker 2: just writings about warts, there was also a toe wart
Speaker 2: found on the embalmed body of an ancient Egyptian worker
Speaker 2: from like thousands of years ago. But you know, like
Speaker 2: all types of warts, the warts common on fingers, genital warts,
Speaker 2: planter warts, they all made appearances in ancient Roman and
Speaker 2: Greek medical texts, and it was commonly assumed that sexual activity,
Speaker 2: particularly excessive sexual activity, was the cause of genital warts.
Speaker 2: The causes of other warts, like those commonly found on fingers,
Speaker 2: were often chocked up to females addicted to solitary habits
Speaker 2: in quotes aka, do you know what I mean by that?
Speaker 4: Oh? I know what you mean by that?
Speaker 2: Okay? And or also those that like regularly were hen testers,
Speaker 2: so they would stick their finger up the cloaca of
Speaker 2: a hen to see how close it was to laying
Speaker 2: an egg.
Speaker 4: Oh my god, I have never thought about a finger
Speaker 4: going up a cloaca. I don't like the thought of it.
Speaker 2: I hope that won't become an intrusive thought for you.
Speaker 4: I think it might.
Speaker 2: Yeah, well, you know, there are worse things. So anyway,
Speaker 2: the precise cause of wartz was not known, like the
Speaker 2: fact that they were viral, but they were recognized to
Speaker 2: be contagious. But for the most part, this early focus
Speaker 2: on warts wasn't so much on uncovering the cause of wartz,
Speaker 2: but rather how to treat them or get rid of them,
Speaker 2: which brings me to one of my favorite things, which
Speaker 2: is old timey cures.
Speaker 4: Oh, I feel like it's been a very long time
Speaker 4: since we've discussed old timey cures.
Speaker 2: Well, and I feel the same way. And so because
Speaker 2: of that, I have like quite a big section on
Speaker 2: this because I was like, oh, let me find my
Speaker 2: favorites and I'll put them in here, and I just
Speaker 2: kept adding more so and I'll link to papers that
Speaker 2: have even more. So this is like specifically old timey
Speaker 2: folklore of Europe in terms of how to get rid
Speaker 2: of warts.
Speaker 4: Okay, worts or just or genital worts.
Speaker 2: Some of them didn't specify, but for the most part
Speaker 2: it seemed like skin warts, like finger toe whatever, all right,
Speaker 2: because I mean some of them, you will it's very
Speaker 2: clear that it's not genital warts, okay, but yeah, oh dear, okay.
Speaker 2: So these can be grouped into the following categories. One
Speaker 2: was transference, so like transferring your wart to somebody else
Speaker 2: or something else. Number two was animal, plant or mineral remedies.
Speaker 2: Number three was prayers or incantations, and number four was
Speaker 2: miscellaneous that things like crossroads, moon phase, funeral, et cetera.
Speaker 2: What okay, yeah, I'll get there. Okay, So a couple
Speaker 2: examples of transference. You should rub the warts against a
Speaker 2: man who is the father of an illegitimate child without
Speaker 2: his knowledge. So that one you'd probably just want to
Speaker 2: do with hand warts, right, like, I don't think you
Speaker 2: could do genital warts.
Speaker 4: Yeah, no, nope, not without his knowledge.
Speaker 2: And then quote, if a bag containing as many small
Speaker 2: pebbles as a person has warts be tossed over the
Speaker 2: left shoulder, it will transfer the warts to whoever is
Speaker 2: unfortunate enough to pick up the bag. Another one quote,
Speaker 2: take one of the large black snails which are to
Speaker 2: be found during summer, rub it over the wart, and
Speaker 2: then hang it on a thorn. This must be done
Speaker 2: nine nights consecutively, at the end of which the wart
Speaker 2: will completely disappear. You could also rub your wort with
Speaker 2: a piece of bacon. Cut a slit in the bark
Speaker 2: of an ash tree, and slip the bacon under the bark,
Speaker 2: and then repeat the words ashen tree, ashen tree, pray,
Speaker 2: buy these warts of me. And then you stick a
Speaker 2: pin into the tree and then into the wart and
Speaker 2: then back into the tree, and then your wart's gone.
Speaker 2: Of course it is, And there was also so if
Speaker 2: those didn't work, there was also the option of having
Speaker 2: someone buy your wart off you. I guess there was
Speaker 2: like an open market for that, or you could treat
Speaker 2: it with anyone of the followings, so like fish heads, pigs, blood,
Speaker 2: lizard's blood, menstrual blood, doves, dung, tobacco, juice, and fasting spittle. Okay,
Speaker 2: I mean, honestly, I could go on and on with
Speaker 2: more wart remedies. Catch a long horned grasshopper and have
Speaker 2: it bite off your wart directly, so there was known
Speaker 2: as like a wart biting grasshopper or something. Of course,
Speaker 2: it's not a great solution now because the grasshopper species
Speaker 2: Decticus verucivorus is endangered, so don't do that. And then finally,
Speaker 2: spit on your wart and rub it three times in
Speaker 2: the direction of a passing funeral while saying, my wart
Speaker 2: goes with you. And when I read that, Aaron, all
Speaker 2: I could think of was my warp be with you,
Speaker 2: and also with you and with you. Yeah, so some
Speaker 2: good ones there there are many more. That's the title
Speaker 2: of the episode, my warp be with you, excellent with
Speaker 2: you anyway? Okay, I should move on though. So from
Speaker 2: ancient times to around the late eighteen hundreds, warts remained
Speaker 2: a nuisance for many people, hence these innumerable cures described,
Speaker 2: but little progress had been made in terms of understanding
Speaker 2: the transmission.
Speaker 3: Of warts or their viral cause.
Speaker 2: But it was around this time that things changed. So
Speaker 2: the development of germ theory and microscopes allowed more close
Speaker 2: examination into the contagiousness of these warts, as well as
Speaker 2: to what they looked like at a cellular level, like
Speaker 2: what was going on? And in eighteen ninety three a
Speaker 2: French dermatologist made the observation that genital warts and common
Speaker 2: skin warts might be the same thing, or caused kind
Speaker 2: of by the same thing. And other doctors successfully gave
Speaker 2: themselves warts so like they were like, oh, I'll try
Speaker 2: this out. I'll try to put some wart juice on me,
Speaker 2: and you know.
Speaker 4: Like from like, they gave themselves skin warts from someone's
Speaker 4: genitals to test it.
Speaker 2: Well, So that was mostly skin to skin. But then
Speaker 2: in nineteen o six there was a major breakthrough when
Speaker 2: an Italian doctor made an extract of genital warts and
Speaker 2: then passed it through a filter that would leave at
Speaker 2: any bacteria or fungi, and then he injected this wart
Speaker 2: juice into his skin, where wartz later developed.
Speaker 4: So some commitment right there.
Speaker 2: It is, and I mean this led to two important
Speaker 2: pieces of information. One was that warts are probably caused
Speaker 2: by a filterable transmissible agent aka virus. And it also
Speaker 2: showed that genital warts and skin warts were caused or
Speaker 2: could be caused by the same virus. Right the virus
Speaker 2: itself that caused the warts, or any human papalama virus
Speaker 2: wouldn't be discovered until nineteen fifty. Yeah, but in the meantime,
Speaker 2: there were a couple of other important developments. So I'm
Speaker 2: going to shift gears for a little bit and talk
Speaker 2: about cervical cancer.
Speaker 4: Ooh.
Speaker 2: In the early days of cancer research, it probably seemed
Speaker 2: like with every new thing you learned, you probably had
Speaker 2: ten times the amount of questions you started out with,
Speaker 2: because there didn't seem to be a single unifying cause
Speaker 2: of cancer or even predictability within the same type of cancer.
Speaker 2: New cancers were being discovered all the time, like it
Speaker 2: seems like an utterly chaotic field in.
Speaker 4: That sense, Oh man, I still feel like that.
Speaker 2: Yeah, absolutely, And then in nineteen ten, a key piece
Speaker 2: of research seemed like scientists were getting closer to at
Speaker 2: least one solid answer, because that year a pathologist named
Speaker 2: Peyton Rouse described how he was able to induce malignant
Speaker 2: tumors in healthy chickens by injecting them with a filtrate
Speaker 2: from malignant sarcomas in sick chickens. In other words, Rouse
Speaker 2: discovered the first cancer causing virus in nineteen ten, nineteen ten,
Speaker 2: nineteen ten, like. Not only was this super exciting, but
Speaker 2: it was also a very important development in our understanding
Speaker 2: the nature of viruses in cancer, and Rouse was awarded
Speaker 2: a Nobel Prize in nineteen sixty six for the finding,
Speaker 2: which I think is the longest actually delay between work
Speaker 2: and award like in Nobel Price history. After the rous
Speaker 2: sarcoma virus was discovered, many other researchers began looking into
Speaker 2: possible infectious causes of cancers, and one of these researchers
Speaker 2: was Richard Schope, whose name may sound familiar because he
Speaker 2: was one of the people who discovered the influenza A
Speaker 2: virus and linked it to the nineteen eighteen influenza.
Speaker 4: That was three and a half years ago. I now
Speaker 4: remember his name well.
Speaker 2: But his name also might sound familiar because his son,
Speaker 2: Robert Schope, was a famous virologist who worked on arboviruses
Speaker 2: mostly and discovered more novel viruses than anyone else previously. Wow,
Speaker 2: Like unbelievable amount of virus like research. He was like
Speaker 2: a walking encyclopedia apparently. Wow anyway, Wikipedia rabbit hole. Speaking
Speaker 2: of rabbits. In the nineteen thirties, Shop who had collaborated
Speaker 2: with Rouse, was out hunting one day in Iowa when
Speaker 2: he noticed what looked like a wild cottontail rabbit with horns.
Speaker 2: These rabbits, these horned rabbits, were a strange thing to see,
Speaker 2: but they weren't unknown, Like there was already sort of
Speaker 2: this first of all, like everyone who was a hunter
Speaker 2: out there was like, oh, yeah, we see this all
Speaker 2: the time. Yeah. Secondly, hope. Secondly, there's a jackalobe. It's
Speaker 2: actually thought that these horned rabbits might have given rise
Speaker 2: to the jacalobe myth. Yes, very cool. So Chop trapped
Speaker 2: some of these rabbits so he could get a closer
Speaker 2: look at their horns and discovered that the horns were
Speaker 2: actually cancerous growths caused by a rabbit papalomavirus. What. Yeah,
Speaker 2: so the jackalobe is just a rabbit infected with a
Speaker 2: cancer causing papalama virus, poor jackalopees. And he was able
Speaker 2: to in the lab induce these cancers in other rabbits
Speaker 2: through like passing on the virus. Wow. And I also
Speaker 2: realized I haven't done the etymology for papaloma, which comes
Speaker 2: from a combo of Latin and Greek words that together
Speaker 2: mean a tumor resembling a nipple. There you go.
Speaker 3: I'm just gonna leave that there.
Speaker 2: And then the final big piece of news or developments
Speaker 2: happened in nineteen sixty four, which is when the discovery
Speaker 2: of the epstein bar virus and the fact that it
Speaker 2: could cause Burkitt's lymphoma showed that cancer causing viruses didn't
Speaker 2: exist solely in animals, but could also cause cancer in humans. Okay,
Speaker 2: so at this point all of the pieces were in
Speaker 2: place to link HPV to cervical cancer, but that didn't
Speaker 2: happen right away, And in order to tell that part
Speaker 2: of the story, I wanted to dive a bit into
Speaker 2: the history of cervical cancer to give a bit more context,
Speaker 2: Cervical cancer doesn't leave any marks on the skeleton, so
Speaker 2: we have to rely on early descriptions of what we
Speaker 2: might think might be cervical cancer to understand sort of
Speaker 2: the perception of the disease, as well as to guess
Speaker 2: is how long it's been around. Although given how ancient
Speaker 2: these viruses are and how like everyone is infected.
Speaker 3: With them, it's safe to assume.
Speaker 2: That cervical cancer has been in humans from day one,
Speaker 2: although it was one of the papers I read noted
Speaker 2: that the rate of cervical cancer probably increased over time,
Speaker 2: not due to human travel or increase in population density,
Speaker 2: which might have had a role to play, but due
Speaker 2: to the nature of cancer in general as a disease
Speaker 2: of longevity. So like when life expectancy was lower, people
Speaker 2: were less were more likely to die of something else
Speaker 2: before getting cervical cancer.
Speaker 4: Yeah, it's a long time period from infection to cancer
Speaker 4: for cervical cancer, so yeah, makes sense.
Speaker 2: And there are some ancient writings ancient Egyptian papyri, in
Speaker 2: some Hindu manuscripts from like the fourth century BCE, and
Speaker 2: then also in ancient Rome, there was a device uncovered
Speaker 2: that looks like an or very early speculum, which is
Speaker 2: pretty interesting to think about, like the first first century CE.
Speaker 4: I bet it's painful.
Speaker 2: Oh yeah, and it's going to get a lot more painful,
Speaker 2: I think, because early treatment for ulceration or malignant growth
Speaker 2: of the uterus or cervix was usually something along the
Speaker 2: lines of couterization or partial removal, but honestly, those things
Speaker 2: usually ended up leading to just a quicker death. By
Speaker 2: the sixteen hundreds seventeen hundreds or so, people had started
Speaker 2: to make the distinction between malignant and benign in these
Speaker 2: uterine or cervix tumors, but the distinction was pretty much
Speaker 2: useless because it generally involved the doctor just going Okay,
Speaker 2: patient is wasting away and dying, so this must be malignant,
Speaker 2: or this tumor doesn't seem to be changing at all,
Speaker 2: so the patient's probably fine. Gat Essentially, yeah, Essentially, doctors
Speaker 2: were just sitting around waiting for their patient to die
Speaker 2: or not. As you might have guessed, many doctors were
Speaker 2: not especially content with this type of hands off medicine,
Speaker 2: and so they began to explore treatments such as belladonna, hemlock,
Speaker 2: strych nine, lead mercury et cetera. Basically like any very toxic,
Speaker 2: intense compounds.
Speaker 4: All kinds of things that can kill you.
Speaker 2: And of course nothing worked, and the birth of the
Speaker 2: field of gynecology didn't exactly help things either. Right away,
Speaker 2: gynecology began to be recognized as a separate, distinct medical
Speaker 2: field around the seventeen hundreds and eighteen hundreds, but not
Speaker 2: to gather knowledge that would improve the health of women everywhere,
Speaker 2: but rather to detect sexually transmitted diseases in sex workers. Basically,
Speaker 2: a big part of the push for gynecology was to
Speaker 2: protect the male clients of sex workers, like you were
Speaker 2: given a clean.
Speaker 3: Bill of health and allowed to.
Speaker 2: Work, or you were held in the hospital until you
Speaker 2: got better against your will. In this burgeoning field of gynecology,
Speaker 2: tools to help assess vaginal or cervical health were needed,
Speaker 2: and so they were developed. For instance, the Duckbill speculum,
Speaker 2: which is very close, if not the exact thing that
Speaker 2: we used today, That was developed by James mary and Simms,
Speaker 2: who was the so called father of modern gynecology and
Speaker 2: also one of the most unethical people I have read
Speaker 2: about while working on the podcast.
Speaker 4: Not surprised about that.
Speaker 2: Oh no, he operated almost exclusively unenslaved black women and
Speaker 2: never with anesthesia, conducted all sorts of medicalized torture, as
Speaker 2: well as perpetuated a lot of misinformation. Please read the
Speaker 2: book Medical Bondage by Deirdre Cooper Owens for more info
Speaker 2: about him. It's so good, Okay. Anyway back to cervical cancer.
Speaker 2: So what these new and improved speculums did was allowed
Speaker 2: doctors to visualize these different lesions and record their observations,
Speaker 2: so that ultimately the link between cervical lesions or cauliflower
Speaker 2: growths and later developing advanced cancer of the womb was made.
Speaker 2: And this visibility or observability of two of the most
Speaker 2: common cancers to affect women so like breast cancer and
Speaker 2: cervical cancer, led to cancer's overall being seen as a
Speaker 2: quote female ailment, usually attributed to some part of the
Speaker 2: woman's reproductive tract. So like, oh, you know, like hysteria,
Speaker 2: right like it must be from an overactive beaterus, right like,
Speaker 2: as if anyone knew what that meant? Wow, a wandering uterus,
Speaker 2: a wandering uterus. So and then second book recommendation here
Speaker 2: illness is a metaphor by Susan Sontag Okay. So, once
Speaker 2: doctors had made the link between these lesions and cancer,
Speaker 2: they started to try to treat these ulcers to prevent
Speaker 2: their spread again cauterization or treatment with corrosive chemicals, or
Speaker 2: simply removal of the affected areas, so like full on
Speaker 2: trying to remove a cervix or uterus. These were the
Speaker 2: pretty much like the options that they that they chose,
Speaker 2: and in these days, these more drastic options were nearly
Speaker 2: almost always fatal and in the days before anesesia unbelievably excruciating.
Speaker 2: Even after surgical practices and diagnostic tools improved, focus turned
Speaker 2: towards ways to detect cancers early and prevent them from spreading.
Speaker 2: Enter the pap smear. The pap smear was developed by
Speaker 2: none other than doctor George Papa Niki Lau in the
Speaker 2: nineteen twenties.
Speaker 4: The nineteen twenties, Yeah, I didn't realize it was not
Speaker 4: long ago.
Speaker 2: Yeah, So he had started work on mice to develop
Speaker 2: a lab test to show how changing levels of estrogen
Speaker 2: could be detected in changes in the vaginal lining. And
Speaker 2: he was like, well, I really want to like translate
Speaker 2: this research into humans. I could use it to stimulate
Speaker 2: menstruation or treatment fertility. But then he was like, I
Speaker 2: actually have no idea what a normal vaginal smear looks like,
Speaker 2: Like what's the baseline? And so once he started looking
Speaker 2: for that baseline, he began observing that some of the
Speaker 2: smears had irregular looking cells, and subsequent gynecological examination revealed
Speaker 2: that they had early cancer of the cervix.
Speaker 3: And his article that described.
Speaker 2: This finding didn't really gain a lot of traction, and
Speaker 2: many doctors remained skeptical for a number of years. But
Speaker 2: over time this use for vaginal smears grew, and they
Speaker 2: were then named the papiniko lao or pap smear in
Speaker 2: his honor, doctor George Papp. The pap smear, especially the
Speaker 2: simplified version of the test, which was developed by doctor
Speaker 2: Anna Marion Hilliard in the fifties, I think did a
Speaker 2: lot to advance knowledge in terms of what proportion of
Speaker 2: lesions were likely to remain localized and which were likely
Speaker 2: to advance to invasive malignancies. In the nineteen sixties and
Speaker 2: seventies continued with this trend of early detection and lesion removal,
Speaker 2: with fewer and fewer hysterectomies performed instead being replaced by
Speaker 2: less invasive surgical procedures, and so this was a great
Speaker 2: improvement from the early days of cervical cancer. Early detection
Speaker 2: methods had been developed, and physicians realized that precancerous lesions
Speaker 2: were pretty fragile, meaning that their removal often meant that
Speaker 2: the cancer itself was gone, but issues remained. These cervical biopsies,
Speaker 2: which were described as as minor surgical procedures, not only
Speaker 2: still had and have risks associated with them, but they
Speaker 2: could also be very painful and associated with uncomfortable side effects,
Speaker 2: and a positive diagnosis itself could be quite terrifying since
Speaker 2: it usually meant additional diagnostic tests, which can be distressing,
Speaker 2: especially because there often was an adequate communication, and that
Speaker 2: problem lingers today about what exactly the tests are for
Speaker 2: or what the finding is. The consensus, of course, and
Speaker 2: I know you'll talk more about this, is that regular
Speaker 2: screening helps detect and effectively treat cervical cancers, but that
Speaker 2: in many places clear guidelines didn't exist or were being
Speaker 2: developed at a slow pace for how frequently someone should
Speaker 2: be tested or the age group that should be tested.
Speaker 2: I could get.
Speaker 4: Literally so excited talking about guidance.
Speaker 2: Oh yes, and I think that often, like one of
Speaker 2: the biggest problems is just like, once again, we always
Speaker 2: come back to this communication, right, so like not just
Speaker 2: in public health campaigns, which like those were pushed really
Speaker 2: hard in the sixties and seventies, but also between physician
Speaker 2: and patient, right like open communication, clear communication, ask as
Speaker 2: many questions.
Speaker 4: As you want.
Speaker 2: I will be as you know, direct and informative as possible. Whatever.
Speaker 2: So anyway, but the bottom line is that for the
Speaker 2: most part, effective treatment is no substitute for complete prevention,
Speaker 2: and the only way to do that was to understand
Speaker 2: what caused these cancers. This was not a new question.
Speaker 2: Even before cancer, like the big C cancer was defined
Speaker 2: medically or cellularly, people had wondered about the causes of
Speaker 2: various cancers, including cervical cancer, and there was quite a
Speaker 2: long list in the case of cervical cancer of suspected
Speaker 2: causes masturbation, excessive sexual activity, sexual abstinence, sterility, syphilis, and
Speaker 2: other STIs, great sadness.
Speaker 4: Dangers of great sadness.
Speaker 3: Great sadness, dangers.
Speaker 2: Of urban life, fright, childbirth, abortion, and menopause. Literally anything, yeah,
Speaker 2: anything that happens near the cervix YEP. Then the field
Speaker 2: of medical or health statistics finally shed some light on
Speaker 2: the issue in the mid eighteen hundreds when Italian surgeon
Speaker 2: Domenico Rigoni Stern published his findings that nuns had a
Speaker 2: much lower rate of uterine cancer and a higher rate
Speaker 2: of breast cancer than married women, and this did not
Speaker 2: distinguish between like like.
Speaker 4: True uterine versus cervical right versus true urine.
Speaker 2: This research not only hinted at a potential sexual link
Speaker 2: to cervical cancer, but it also suggested that different cancers
Speaker 2: might have different causes, which is pus like a pretty.
Speaker 4: Big that's a huge Yeah, that's in the eighteen hundreds.
Speaker 2: Yeah, wow yeah. Other research from around the same time
Speaker 2: supported the sexual link. In one hundred and twenty cases
Speaker 2: of uterine cancer, five point eight three percent were from
Speaker 2: single women, eighty six point six were married, and seven
Speaker 2: point five were widows. Later, when cervical cancer was distinguished
Speaker 2: from cancer of the uterine body, the link between sex
Speaker 2: and cervical cancer remained, and additional evidence like how cervical
Speaker 2: cancer was lower in groups that practiced male circumcision and
Speaker 2: how sexually active but unmarried women experienced similar rates of
Speaker 2: cervical cancer as married women. These things further supported this link.
Speaker 2: It seems seemed so clear that cervical cancer was tied
Speaker 2: to sexual activity that by the nineteen seventies there were
Speaker 2: articles in scientific journals asking if cervical cancer was a
Speaker 2: sexually transmitted infection. I mean, and it certainly seemed to be.
Speaker 2: But which one? Which one was it? Was it syphilis
Speaker 2: trickamonis donnerrhea? Or how about the great boogeyman of the
Speaker 2: sexual revolution herpe simplex two? HERB must have been herb
Speaker 2: And this last one HSV two I keep like, I
Speaker 2: was like, hpvhs Yeah, this last one Herpe's simplex virus too.
Speaker 2: This emerged as the favorite partially because it did have
Speaker 2: some support from epidemiological studies, but at least one researcher
Speaker 2: wasn't so sure. Doctor Harold Zerhausen, who is a German virologist,
Speaker 2: could not find Herpe's simplex virus too reliably in the
Speaker 2: many cervical cancer by he screened, and so he came
Speaker 2: to the conclusion that it wasn't the cause, and he
Speaker 2: presented his findings at the nineteen seventy two Get a
Speaker 2: load of this name International Conference on Herpes virus and
Speaker 2: Cervical cancer. So, like what it was very pretty much
Speaker 2: accepted in that like, there was a whole conference about it.
Speaker 2: So when he presented his findings, he was met with
Speaker 2: quote stony silence, which he later felt to be quote
Speaker 2: the low point of his career, which is really depressing,
Speaker 2: poor guy. But he wasn't discouraged and he continued his
Speaker 2: work on HPV, which he thought was a much better
Speaker 2: candidate for cervical cancer than herpes.
Speaker 4: So that was the low point, because things went up
Speaker 4: from there.
Speaker 3: Things went way up.
Speaker 2: He published his hypothesis in nineteen seventy six, and that
Speaker 2: was a year before his lab group discovered that yes,
Speaker 2: there were actually multiple types of HPV, and the final
Speaker 2: breakthrough came in nineteen eighty two and his research fellow
Speaker 2: Mattiah Durst, isolated a new HPV type, HPV sixteen from
Speaker 2: a cervical cancer biopsy. He came up with the naming system,
Speaker 2: by the way, or like the numbering system. HPV eighteen,
Speaker 2: another cancer causing type, was found shortly after, and nearly
Speaker 2: all of the lab specimens of cervical cancer biopsies contained
Speaker 2: one of these viruses, and to Zerhausen, the link was clear,
Speaker 2: as was the path forward. In nineteen eighty four, he
Speaker 2: approached pharmaceutical companies to start working on a vaccine, but
Speaker 2: they all turned him down, saying, yeah, that's not going
Speaker 2: to be profitable. There are more urgent problems to solve,
Speaker 2: I know. And the scientific community was like almost as
Speaker 2: dismissive of his findings for the most part. Like, it
Speaker 2: wasn't really until the mid nineties and after extensive demiological
Speaker 2: work that there was wide consensus on HPV's role in
Speaker 2: cervical cancer. And the landmark study that erased all doubt
Speaker 2: was published in nineteen ninety five and involved over one
Speaker 2: thousand cervical tumors from twenty two countries and it showed
Speaker 2: that ninety nine point seven percent of the tumors were
Speaker 2: HPV positive. So then eleven years after this study, in
Speaker 2: two thousand and six, the HPV vaccine Gardissel, the first
Speaker 2: HPV vaccine, was approved by the FDA to considerable controversy.
Speaker 3: Oh yeah, which I think.
Speaker 2: You'll go into. And since then many other countries have
Speaker 2: approved its use and incorporated it into recommended vaccination programs.
Speaker 2: Two varying degrees of effectiveness and also with some very
Speaker 2: interesting messaging. I also want a note real quick that
Speaker 2: Zerhausen was awarded a Nobel Prize I believe in two
Speaker 2: thousand and eight for this for making this link.
Speaker 4: I just want to go back to the fact that
Speaker 4: this link wasn't cemented in scientific consensus until the mid nineties.
Speaker 2: That was sort of like the final like I think
Speaker 2: that there had been steady growth of acceptance of this. Yeah,
Speaker 2: but oh my, yeah, it's an interesting timeline that.
Speaker 4: It's fascinating that timeline Erin so Erin, Oh.
Speaker 2: I'm hoping you're about to tell me more about some
Speaker 2: of these vaccine controversies, in particular how the vaccine was
Speaker 2: targeted to certain groups or certain people, and how much
Speaker 2: of an impact we can see now fifteen years after
Speaker 2: it was first introduced.
Speaker 4: I can't wait. We'll get into it right after this break.
Speaker 4: I want to get into all of that juicy vaccine
Speaker 4: info and cervical cancer statistics and everything, and also just
Speaker 4: like a lot of Aaron and Aaron's hot takes. How
Speaker 4: about that, But first, let's bring it all the way
Speaker 4: back to HPV for a minute, because I really want
Speaker 4: to stress just how prevalent this virus is, and this
Speaker 4: is specifically for genital HPV, so we're not even going
Speaker 4: to account for the fact that every child probably has
Speaker 4: a wart and a lot of adults do too at
Speaker 4: some point on their skin. When we're talking about genital
Speaker 4: HPV point prevalence. So overall, if you just at any
Speaker 4: given time took a sample of random adults, anywhere from
Speaker 4: three to forty five percent of them would be positive
Speaker 4: for HPV, even without any symptoms.
Speaker 2: That's I mean, that's a very high percentage.
Speaker 4: And that's just point prevalence. If you look at lifetime risk,
Speaker 4: which means because most people who get this infection will
Speaker 4: clear it, so they might have had it, but when
Speaker 4: you sample them, they come up negative. So if you
Speaker 4: look at lifetime risk, we're talking eighty percent of people
Speaker 4: are likely to be infected with HPV at some point
Speaker 4: in their lives.
Speaker 5: It's almost an inevitability. It's almost an inevitability. But that's
Speaker 5: just HPV. Let's now focus on cervical cancer because we
Speaker 5: have the most data for cervical cancer, so worldwide today
Speaker 5: well twenty eighteen data, cervical cancer causes an estimated five
Speaker 5: hundred and seventy thousand new cases every year.
Speaker 3: With five hundred and seventy thousand, five.
Speaker 4: Hundred and seventy thousand new cases and over three hundred
Speaker 4: and eleven thousand deaths due to cervical cancer every year,
Speaker 4: every year, HPV worldwide is the fourth leading cause of
Speaker 4: cancer in people with a cervix. The fourth leading cause
Speaker 4: of cancer in people with a cervix worldwide.
Speaker 2: It's so interesting to me, the lack of visibility between
Speaker 2: something like breast cancer, lung cancer, and then cervical cancer.
Speaker 4: Well, here's part of it. The vast majority of these
Speaker 4: new cases and deaths that are due to cervical cancer
Speaker 4: are in low and middle income countries where access to
Speaker 4: screenings and vaccines is very limited, if it's even existent
Speaker 4: at all. If we look briefly at data in the US,
Speaker 4: there is an estimated thirty six thousand new cases of
Speaker 4: HPV associated cancers every year. That's all HPV associated cancers. Okay,
Speaker 4: So in the US that includes about fourteen thousand cases
Speaker 4: of oropharyngeal or throat cancer, eleven thousand cases of cervical cancer,
Speaker 4: six thousand cases of anal cancer, and over three thousand
Speaker 4: cases of vaginal or vulgar cancer and a thousand cases
Speaker 4: of penile cancer. Dang, that's a lot of humans.
Speaker 3: That's a lot of humans worldwide.
Speaker 4: And I do kind of want to focus on this
Speaker 4: for a second because it's so under represented, Like talk
Speaker 4: about cervical cancer being underrepresented. Eighty five percent of anal
Speaker 4: cancers are associated with HPV, eighty five percent, forty six
Speaker 4: percent of penal cancers HPV, anywhere from thirty three to
Speaker 4: seventy two percent of oropharyngeal HPV. It's a lot of cancers.
Speaker 2: Yeah.
Speaker 4: And while we have screening programs in a lot of
Speaker 4: places that can detect cervical cancer, which is incredible because
Speaker 4: it's very effective. The pap smer is a screening tool
Speaker 4: that can detect pre cancerous changes that can then be
Speaker 4: treated so that it never becomes cancer.
Speaker 2: If we had something equivalent to a pap smere for
Speaker 2: like other kinds of cancers, I mean, it would be incredible.
Speaker 4: Act I think it's incredible.
Speaker 2: It's hard to wrap your brain around just how amazing
Speaker 2: it is to be able to be like there is
Speaker 2: cancer developing or pre cancer developing, we can do something
Speaker 2: about it.
Speaker 3: It's the other.
Speaker 4: Thing, too, is that the way that you can then
Speaker 4: treat those pre cancerous changes that you might detect on
Speaker 4: a pap smear is also not nearly as invasive as
Speaker 4: the way that you would need to treat pre cancerost
Speaker 4: changes if you could even detect those other places. So
Speaker 4: not only are we able to detect pre cancer before
Speaker 4: it becomes cancer, but we can then also treat it
Speaker 4: before it becomes cancer. It's really similar to the way
Speaker 4: that we can do colon cancer screenings. That's really the
Speaker 4: only other one that we can do in the same
Speaker 4: way where if we see a poll up, we can
Speaker 4: remove it and we treated your cancer before it became cancer.
Speaker 2: Gotcha.
Speaker 4: Yeah, And that's incredible, but it isn't perfect. PAP smears
Speaker 4: are an invasive test, they're uncomfortable. A lot of people
Speaker 4: might not be comfortable even getting them, even in places
Speaker 4: where they are easily accessible. They're also both operator and
Speaker 4: reader dependent, and so it requires a lot of infrastructure
Speaker 4: that in low and middle income countries just might not
Speaker 4: exist at all. And in some cases, because they are
Speaker 4: so dependent on the reader and the operator, they can
Speaker 4: be overread and then potentially lead to unnecessary procedures that
Speaker 4: do have risks associated with them. So they are not
Speaker 4: a perfect thing, but on top of that, they are
Speaker 4: specific to cervical cancer, and HPV causes a lot more
Speaker 4: than just cervical cancer. So the fact that we have
Speaker 4: a vaccine is beyond incredible. Yeah, because this is a
Speaker 4: vaccine that can prevent all of these types of cancer.
Speaker 4: Not one hundred percent of all of these types of cancer,
Speaker 4: but one hundred percent of cervical cancers and a lot
Speaker 4: of the proportion of all of these other cancers. So
Speaker 4: the question is, why do we even still have cervical
Speaker 4: cancer fifteen years out from this vaccine?
Speaker 2: Well, a lot of different answers there.
Speaker 4: It's a lot of different answers, like you said, erin,
Speaker 4: a lot of it in certain countries like the US,
Speaker 4: has to do with how this vaccine was marketed at
Speaker 4: the beginning. In most places where it was rolled out,
Speaker 4: it was only recommended for people with a cervix except
Speaker 4: it was marketed as give this STI prevention vaccine to
Speaker 4: your young girls, and so that was interpreted by a
Speaker 4: lot of people as a vaccine to promote sexual promiscuity,
Speaker 4: which we all know is not allowed in our culture.
Speaker 2: And also like that's not what this vaccine does.
Speaker 4: Not in the slightest, but that is absolutely how it
Speaker 4: was perceived. Yeah, so the marketing failures were really immense.
Speaker 4: But on top of that, this was a very expensive vaccine,
Speaker 4: especially when it first came out.
Speaker 2: Holy cow.
Speaker 4: Yeah, it was one hundred and twenty dollars a dose,
Speaker 4: which compared to most childhood vaccines, is immense. You can
Speaker 4: imagine that in low and middle income countries. That is
Speaker 4: absolutely an unattainable cost even for most people in the US.
Speaker 4: One hundred and twenty dollars a dose for a vaccine
Speaker 4: that needs two to three doses. That's a lot of money.
Speaker 2: And is it one hundred and twenty dollars a dose
Speaker 2: in other countries as well? Or is it just the
Speaker 2: US has artificially inflated the price because that's just what
Speaker 2: the US does.
Speaker 4: So I couldn't get a great answer to that. It
Speaker 4: varies a lot. But today, because of a lot of
Speaker 4: different institutes that help subsidize the funding, it can be
Speaker 4: available in a lot of countries as low as in
Speaker 4: theory twenty cents or four to fifty a dose. Since
Speaker 4: two thousand and eight, which is just two years after
Speaker 4: it was introduced. PAHO, which is the Pan American Health
Speaker 4: Organization and has been subsidizing HPV vaccines at eight dollars
Speaker 4: and fifty cents per dose. So Latin America and the
Speaker 4: Caribbean actually have the highest proportion of countries that have
Speaker 4: national programs if you look at all the different regions,
Speaker 4: but overall, not a very impressive percentage of countries have
Speaker 4: instituted national HPV vaccine campaigns. As of late twenty seventeen,
Speaker 4: only about forty percent of countries had instituted national HPV
Speaker 4: vaccine programs, and you can imagine that the percentage varies
Speaker 4: greatly based on income. So seventy seven percent of high
Speaker 4: income countries have vaccination programs, but only seven percent of
Speaker 4: low income countries have vaccination programs. So this vaccine is
Speaker 4: not being evenly distributed across the globe, which is why
Speaker 4: we still have cervical cancer deaths happening every day across
Speaker 4: the globe.
Speaker 3: It is so frustrating, it really is.
Speaker 4: The World Health Organization has a lot of different goals
Speaker 4: to try and address this. Their current goals are to
Speaker 4: vaccinate ninety percent of people with a cervix by age
Speaker 4: fifteen and screen seventy percent of people with a cervix
Speaker 4: at least twice between the ages of thirty five and
Speaker 4: forty five, because again, screening is still really important, but
Speaker 4: we are no like nowhere, nowhere near those goals.
Speaker 2: And I understand that you have to have reasonable goals
Speaker 2: or at least like benchmarks, but like, why is it
Speaker 2: still just people with a cervix? Why is it not everyone?
Speaker 2: When everyone can become infected, everyone can develop some kind
Speaker 2: of cancer, and everyone can transmit it to somebody else.
Speaker 4: And saying it that's like the biggest I Okay, I
Speaker 4: get so intense when I think about that, and I
Speaker 4: honestly be because in the US, now finally the recommendation
Speaker 4: is everyone, all adolescents should be vaccinated starting at age
Speaker 4: eleven twelve. It can be as early as nine. I
Speaker 4: have issue big issue with the fact that the US
Speaker 4: still doesn't make this a mandatory vaccine for school entry.
Speaker 4: It's absolutely absurd in my errand's personal opinion, because detap
Speaker 4: is required, meningitis is required, Hepatitis B is required, and
Speaker 4: that's not roaming around schools, so like, come on. But anyways, globally,
Speaker 4: you're right, the recommendation still isn't for everyone to get
Speaker 4: this vaccine, even though we know that not only do
Speaker 4: can people with a cervix get HPV from people without
Speaker 4: a cervix? So if you're not vaccinating everyone, then you
Speaker 4: just have a bunch of people that are harboring HPV
Speaker 4: to then be spread to everyone else. But also, yeah,
Speaker 4: then we're not preventing penile cancer or anal cancer in
Speaker 4: people without a cervix, or oroferyngeal cancer like they're This
Speaker 4: is a lot bigger than just cervical cancer. This is
Speaker 4: a vaccine that can prevent a lot of different types
Speaker 4: of cancer. Everyone deserves access to it.
Speaker 2: They do, I am. It's endlessly frustrating, lessly frustrating. My
Speaker 2: big question is part of the controversy around the HPV
Speaker 2: vaccine when it first was released was that, well, we
Speaker 2: don't know whether it's going to prevent cancer.
Speaker 3: Oh yeah, aarin Right, So now.
Speaker 2: It's been fifteen years, we should have seen the effects
Speaker 2: right in the generation the first cohort that was vaccinated. Yes, Well,
Speaker 2: first of all, I have a question about the average
Speaker 2: age of onset for cervical cancer.
Speaker 4: Oh, it's fifty nine. Is the average age of death
Speaker 4: due to cervical cancer?
Speaker 3: Okay?
Speaker 2: But it could happen earlier.
Speaker 4: Absolutely, And it's one of the most common causes of
Speaker 4: cancer in people with the cervix underage forty, So it
Speaker 4: can definitely happen in younger people as well, because this
Speaker 4: is a sexual transmitted infection that has kind of highest
Speaker 4: incidents at younger ages, but usually takes ten to twenty
Speaker 4: years to then cause cancer. Okay, and then younger people
Speaker 4: are also more likely to clear the infection, so it's
Speaker 4: kind of yeah.
Speaker 2: Another question about the vaccine's durability, Uh huh, how long
Speaker 2: are you protected?
Speaker 4: Well, that's a very good question. We know for sure
Speaker 4: at least eight years. It's likely even longer than that. Okay, yeah,
Speaker 4: it's likely pretty long term. And there's some cross protection
Speaker 4: as well. So even though even the sort of broadest
Speaker 4: vaccine that we have covers nine subtypes, there's thought to
Speaker 4: be at least some cross protection to protect you against
Speaker 4: further types as well. Gotcha, if that makes sense. But
Speaker 4: you have full protection against either two, four or nine subtypes,
Speaker 4: depending on which vaccine you get. But you asked, Aarin,
Speaker 4: do we have any data to say this actually prevents
Speaker 4: cervical cancer? Because you're right. When this vaccine first came out,
Speaker 4: everyone was like, well, it protect against HPV infection and
Speaker 4: maybe like pre cancer, but we can't say for sure
Speaker 4: that it protects the cancer. Like give me strength, I know,
Speaker 4: I know it does. The answer that we have now
Speaker 4: is without a doubt, it absolutely does. If you'd like
Speaker 4: some hard data on it, there's a beautiful study out
Speaker 4: of Sweden where they implemented a school based vaccination program
Speaker 4: and studied over a million people with a cervix, about
Speaker 4: half of whom received the vaccine, and over the time
Speaker 4: period studied, only nineteen people who had received at least
Speaker 4: one dose of the vaccine were diagnosed with cervical cancer,
Speaker 4: while over five hundred who hadn't were diagnosed with cervical cancer.
Speaker 3: That's pretty clear.
Speaker 4: What's even more clear is that the protective effects were
Speaker 4: far stronger for people who were vaccinated before for age seventeen.
Speaker 4: So the earlier that people get the vaccine, the better
Speaker 4: it works. Not only because it seems to work better
Speaker 4: in younger people, but you have to get this vaccine
Speaker 4: before you are exposed to HPV. HPV is a sexually
Speaker 4: transmitted disease, which means you need to get the vaccine
Speaker 4: before you ever have sexual activity for it to be
Speaker 4: the most effective.
Speaker 2: And so you mean any HPV or you mean just
Speaker 2: the sexually transmitted HPVs.
Speaker 4: Sexually transmitted HPVs. Okay, yeah, So that's why the recommended
Speaker 4: age is eleven to twelve or even as young as nine,
Speaker 4: because the idea is to give it to people who
Speaker 4: have not yet engaged in sexual activity, like well before,
Speaker 4: so that you're really preventing this. Now, that doesn't mean
Speaker 4: that you can't get it if you have already had
Speaker 4: sexual activity or if you're over age twelve. It's recommended
Speaker 4: as like a catch up up to age twenty six,
Speaker 4: and now it's approved all the way up to age forty. Huh.
Speaker 4: So that's HPV guys and cervical cancer.
Speaker 2: It's so interesting.
Speaker 3: This is a big one.
Speaker 4: Oh my gosh, it's way bigger than I thought. I
Speaker 4: feel like I talked for seven years.
Speaker 2: There's a lot to talk about.
Speaker 4: I mean, I'm sure that I missed a lot of things. Also,
Speaker 4: so why don't we talk about our sources so that
Speaker 4: people can do a lot more reading and learn all
Speaker 4: the things that we probably forgot.
Speaker 2: Sounds great, So I will shout out just a couple
Speaker 2: of things. One is a book called A Woman's Disease,
Speaker 2: The History of cervical cancer by Elana Lowie. Then also
Speaker 2: a paper by onan at all history of human papillama
Speaker 2: virus'es Warts and Cancer Van Doorslayer twenty thirteen, Evolution of
Speaker 2: the Papalamaveri Day, and finally a great paper by Burns
Speaker 2: nineteen ninety two Warts and All the history and folklore
Speaker 2: of warts.
Speaker 4: I love it. I have a lot of different papers
Speaker 4: ranging from everything from a lot more detail on the
Speaker 4: path of physiology and natural history of HPV infection and
Speaker 4: the specific mechanisms on how it causes cancer, all the
Speaker 4: way up to the global distribution and the effects of
Speaker 4: the vaccine and all of that kind of stuff. You
Speaker 4: can find a list of our sources from this episode
Speaker 4: and every single one of our episodes on our website,
Speaker 4: This Podcast will Kill You dot Com under the episodes tab.
Speaker 2: Thank you to Bloodmobile for providing the music for this
Speaker 2: episode and all of our episodes.
Speaker 4: Thank you to Exactly Right Network, of whom we are
Speaker 4: very proud to be a member, And.
Speaker 2: Thank you to you listeners for listening and for suggesting
Speaker 2: this episode so many times. We're so excited to finally
Speaker 2: give it to you and hopefully.
Speaker 4: You take it. I learned a lot about the history
Speaker 4: of HPV and cervical cancer, which is exciting.
Speaker 2: Yeah. I learned a lot about the biology.
Speaker 3: And the current events.
Speaker 4: My gosh, wow how about that. Well, until next time,
Speaker 4: wash your hands, you filthy animals.