WEBVTT - Ep 67 HPV: My wart be with you 0:00:01.440 --> 0:00:05.360 My name is Stephanie. I am thirty four years old 0:00:06.080 --> 0:00:09.680 soldier with the US Army and also a government contractor. 0:00:10.520 --> 0:00:14.120 In twenty sixteen, right when I became a single mom 0:00:14.160 --> 0:00:17.080 with my two daughters, I went to get a paps mare. 0:00:17.720 --> 0:00:20.479 I had only missed two pap smears before that and 0:00:20.640 --> 0:00:24.439 didn't think anything of it. The exam itself went as 0:00:24.760 --> 0:00:28.360 normal as possibly could be. It wasn't until about two 0:00:28.360 --> 0:00:32.000 weeks later did I get a call from the gynocologist herself, 0:00:32.479 --> 0:00:35.320 urging me to come in as soon as possible. She 0:00:35.440 --> 0:00:40.600 offered to waive any co pigs and schedule me in 0:00:40.600 --> 0:00:43.440 in between clients because she said it was absolutely urgent 0:00:43.440 --> 0:00:45.880 that I went in there. So I went in the 0:00:45.960 --> 0:00:48.760 very next day and she called me into her office 0:00:49.120 --> 0:00:54.800 and sat me down, and I remember mostly how happy 0:00:55.080 --> 0:00:57.800 and cheery she was, and what I knew was going 0:00:57.840 --> 0:01:01.240 to be very bad news. She took out a paper 0:01:01.560 --> 0:01:06.800 and started with don't panic, but we found cancer cells 0:01:06.800 --> 0:01:11.319 in your cervix, and she explained that I had at 0:01:11.360 --> 0:01:16.360 no carcinoma in situ or AIS, and explained to me 0:01:16.520 --> 0:01:20.120 that although they're considered pre cancer cells, the type of 0:01:20.200 --> 0:01:24.240 cancer itself at no karcinoma tends to jump membranes quicker 0:01:24.280 --> 0:01:28.560 than the other type of cervical cancer, just squama cell carcinoma. 0:01:28.880 --> 0:01:32.520 And she told me that I needed to schedule appointment 0:01:32.840 --> 0:01:37.160 with the gynecologic oncologist at the hospital down the road, 0:01:37.480 --> 0:01:40.360 and the whole time she kept telling me not to worry, 0:01:40.600 --> 0:01:43.160 that this was good cancer and that I'm one of 0:01:43.200 --> 0:01:47.720 the lucky ones. I scheduled the appointment afterwards to go 0:01:47.840 --> 0:01:51.920 to meet the oncologist, and when I did meet him, 0:01:51.920 --> 0:01:54.520 he said the same thing. He says that I should 0:01:54.600 --> 0:01:57.720 feel very lucky. I believed that this is good cancer 0:01:57.960 --> 0:02:01.240 and that they were going to watch me for a 0:02:01.280 --> 0:02:05.840 few months and scheduled me for a cold knife conization biopsy. 0:02:06.560 --> 0:02:10.760 In those couple of months, I had to basically learn 0:02:10.840 --> 0:02:14.480 how to deal with the possibility of having good cancer 0:02:15.160 --> 0:02:20.639 as opposed to bad cancer or no cancer, and it 0:02:20.360 --> 0:02:23.600 was scary, and because it was ais, I didn't get 0:02:23.720 --> 0:02:27.960 much support from the cologists because, as he felt, there 0:02:27.960 --> 0:02:30.360 were other graver cases of cancer when he need to handle, 0:02:30.400 --> 0:02:32.640 which I did know any better, so I thought it 0:02:32.680 --> 0:02:36.680 was fine. December twenty sixteen, right before Christmas, I went 0:02:36.720 --> 0:02:40.160 in for my cold knife conization. The pre opt was 0:02:40.240 --> 0:02:42.040 way more serious than I thought it was going to 0:02:42.120 --> 0:02:46.240 be because I kept thinking good cancer, easy biopsy, and 0:02:46.280 --> 0:02:48.680 that would be out, but it was treated like a 0:02:48.680 --> 0:02:52.760 full surgery. After the surgery, I was told that my 0:02:52.840 --> 0:02:55.000 margins were clear and that I was good to go 0:02:55.080 --> 0:02:59.160 and would need no more real oncologist help outside of 0:02:59.200 --> 0:03:02.960 the follow up from that appointment. A couple weeks after that, 0:03:03.360 --> 0:03:07.640 I started getting really heavy cramping and bleeding during times 0:03:07.639 --> 0:03:10.919 that I was not on my Mestro cycle, and by 0:03:11.400 --> 0:03:14.600 April the pain became so severe that I ended up 0:03:14.600 --> 0:03:18.480 in the emergency room in the er. They ran a 0:03:18.520 --> 0:03:23.160 scan and they found a really really small mass on 0:03:23.280 --> 0:03:27.960 the cervical canal, and I had to go back to 0:03:28.120 --> 0:03:31.840 the gynocologic oncologists to see what we were going to 0:03:31.919 --> 0:03:36.440 do next. The oncologist told me, basically the best case 0:03:36.480 --> 0:03:38.840 right now I would be to have a hysterectomy, and 0:03:38.880 --> 0:03:41.680 he actually wanted to wait a couple of years to 0:03:41.720 --> 0:03:46.040 have the hysterectomy, not because the cancer wasn't serious, but 0:03:46.240 --> 0:03:49.560 because he wanted to make sure that I was done 0:03:49.600 --> 0:03:52.880 having children. I have two daughters, they were ten and 0:03:52.960 --> 0:03:57.040 four at the time, and I felt different about that 0:03:57.800 --> 0:03:59.600 he wanted to make sure that I didn't one day 0:03:59.600 --> 0:04:02.960 and wake up wanted to have a boy a son, 0:04:03.400 --> 0:04:05.920 and I kept telling him that I was done having children. 0:04:05.960 --> 0:04:07.880 So it was a really what I felt was an 0:04:07.960 --> 0:04:12.240 unfair battle I was having with my oncologists because I 0:04:12.320 --> 0:04:14.920 just wanted to get anything cancerous out of me, so 0:04:14.960 --> 0:04:16.279 I could, you know, be there for the. 0:04:16.320 --> 0:04:17.039 Children I do have. 0:04:17.960 --> 0:04:20.640 So after about a week I finally convinced him to 0:04:20.680 --> 0:04:24.360 just go ahead with the hystectomy now. And so about 0:04:24.960 --> 0:04:28.159 two weeks after that er visit, I was in the 0:04:28.200 --> 0:04:33.040 operating room again having a hysterect me. They took my cervix, 0:04:33.120 --> 0:04:36.560 my uterus, and my Philippian tubes and a little bit 0:04:36.680 --> 0:04:43.480 off the top of the vagina, and recovery was painful. 0:04:43.800 --> 0:04:47.560 I went into surgical menopause, which was miserable for that 0:04:47.680 --> 0:04:54.159 short time that I was dealing with that. And the 0:04:54.200 --> 0:04:57.599 follow up appointment he said everything was great, there was 0:04:57.640 --> 0:05:00.480 no more sign of any cancer civils or any cancer anywhere, 0:05:00.960 --> 0:05:03.719 and that I was clear to do annual pap smears 0:05:04.080 --> 0:05:07.799 for the next five years. So that was the first 0:05:07.800 --> 0:05:09.880 time that he told me that the cause of the 0:05:09.920 --> 0:05:13.919 cancer was actually uh HPV sixteen strand he had not 0:05:14.040 --> 0:05:16.120 mentioned it, and now that I did, Mike goin ofcollogies 0:05:16.160 --> 0:05:19.839 mention HPV up until that point, and I think that 0:05:19.880 --> 0:05:22.279 has to do a lot with the stigma behind HPV 0:05:22.360 --> 0:05:27.719 and circle cancer and my last PAS smear, which was 0:05:28.040 --> 0:05:31.200 I'm going to say a few months ago, my gynecologist 0:05:31.320 --> 0:05:34.320 told me that she once again found HPBE strand sixteen 0:05:34.960 --> 0:05:39.160 around my virgual cup. So right now it's just being observed, 0:05:39.440 --> 0:05:42.359 hopefully it doesn't turn into any kind of cancer again. 0:05:43.440 --> 0:05:46.960 In the Circle cancer support group that I am on Facebook, 0:05:47.520 --> 0:05:50.240 I see a lot of women who have to do 0:05:50.320 --> 0:05:53.760 a lot of radiation and they have to use dilators 0:05:53.760 --> 0:05:57.120 so that their vaginas don't seal, and they have to 0:05:57.360 --> 0:06:01.000 do chemo. And so I understand what my doctors were 0:06:01.000 --> 0:06:03.200 saying when they said I was one of the lucky ones, 0:06:03.680 --> 0:06:06.599 even though I went from thinking I was totally healthy 0:06:07.000 --> 0:06:12.640 to two surgeries, er visits, almost losing my job, losing 0:06:12.640 --> 0:06:16.640 my ability to ever have another child within seven months, 0:06:16.680 --> 0:06:17.160 I believe. 0:06:18.040 --> 0:06:19.200 So I do feel I. 0:06:19.160 --> 0:06:22.279 Do feel very lucky, even though I know that it 0:06:22.400 --> 0:06:26.039 was still a hard and traumatic event in my life. 0:06:26.480 --> 0:06:28.200 But there's you know, not a day that goes bad 0:06:28.240 --> 0:06:30.119 that I'm not thankful that I'm here, and I'm hoping 0:06:30.160 --> 0:06:34.839 that this new or old HPV doesn't bring back the 0:06:34.880 --> 0:07:00.120 cancer in any way. 0:07:19.800 --> 0:07:22.160 Wow, thank you so much for sharing your story. We 0:07:22.280 --> 0:07:23.240 really appreciate it. 0:07:23.480 --> 0:07:23.880 Thank you. 0:07:25.160 --> 0:07:25.360 Hi. 0:07:25.600 --> 0:07:29.000 I'm erin Welsh and I'm Aaron Allman Updyke and this 0:07:29.120 --> 0:07:30.640 is this podcast will kill you. 0:07:31.240 --> 0:07:35.080 Yeah, I'm very excited for today's episode. 0:07:35.560 --> 0:07:35.960 Me too. 0:07:36.400 --> 0:07:38.280 I mean, we say this every week and then we 0:07:38.320 --> 0:07:40.000 say that we say this every week. 0:07:40.520 --> 0:07:44.840 But listen, today we're talking about HPV. 0:07:45.600 --> 0:07:51.080 Yeah, so we are reasonably excited, understandably excited. This has 0:07:51.120 --> 0:07:54.560 been a long time coming. I feel like we've gotten 0:07:54.560 --> 0:07:57.239 a lot of requests about it. It's a big, juicy 0:07:57.280 --> 0:08:00.280 one in that like there's a big biology to it, 0:08:00.320 --> 0:08:03.120 there's a big history to it, and I think I 0:08:03.280 --> 0:08:09.040 might be most excited for like the current status type stuff. 0:08:09.400 --> 0:08:11.640 Yeah, because that's a whole big I feel like we're 0:08:11.640 --> 0:08:15.240 just gonna end up going on our own Aaron's public 0:08:15.240 --> 0:08:16.680 health tangents about it. 0:08:16.640 --> 0:08:20.600 All probably a bit on like a high horse or like, listen, 0:08:20.680 --> 0:08:22.720 here's the bottom line exactly. 0:08:23.600 --> 0:08:25.640 It's gonna be great. It's gonna be everything. 0:08:26.200 --> 0:08:28.480 It's gonna be everything. But before we get to the 0:08:28.640 --> 0:08:31.160 meat of the episode, we've got some business to take 0:08:31.200 --> 0:08:35.400 care of. It's quarantine any time, it is quarantiney time. 0:08:35.600 --> 0:08:37.160 What are we drinking this week? 0:08:37.480 --> 0:08:42.960 Well, of course we're drinking the pap Shmearr. I feel 0:08:43.000 --> 0:08:44.760 like I didn't say that great. 0:08:45.240 --> 0:08:47.480 So I've been not practicing. 0:08:47.520 --> 0:08:49.880 But every time I say it, I realize, am I 0:08:50.120 --> 0:08:53.160 enunciating papst purely enough? 0:08:53.520 --> 0:08:54.360 Like papst? 0:08:54.800 --> 0:08:56.480 Maybe we should just explain what's in it and then 0:08:56.520 --> 0:08:58.760 it might be easier to hear the pronunciation. 0:08:59.240 --> 0:09:06.920 It's PBR PAPST, blue ribbon and grapefruit juice and some 0:09:06.960 --> 0:09:12.600 simple syrup. Yeah, because it's like a pap smear. Get it? So? 0:09:12.760 --> 0:09:15.400 This just like cold as the Rocky Mountain. Spotted Fever 0:09:16.080 --> 0:09:18.760 was one of the Quarantini names that we came up 0:09:18.800 --> 0:09:21.280 with on the day that we came up with the 0:09:21.320 --> 0:09:22.240 podcast Severe. 0:09:22.360 --> 0:09:25.640 It was one of the like clinchers, like we have 0:09:25.720 --> 0:09:28.120 to make this podcast because it's too good of a 0:09:28.240 --> 0:09:29.920 name to let it go to waste. 0:09:30.280 --> 0:09:33.000 I still think of, like, even before recording this, I 0:09:33.000 --> 0:09:37.800 would still think of pap smear whenever I drank a PBR. 0:09:40.440 --> 0:09:42.160 I thought about every time I got a pap smear. 0:09:42.320 --> 0:09:46.800 Ao. Well, we will post the full recipe for the 0:09:46.960 --> 0:09:49.800 quarantini as well as the non alcoholic Plussy burrita on 0:09:49.800 --> 0:09:52.160 our website This podcast will Kill You dot com, as 0:09:52.160 --> 0:09:54.240 well as on all of our social media channels. 0:09:54.320 --> 0:09:57.920 Absolutely, do we have any other business before we dive 0:09:57.960 --> 0:09:59.120 into this big episode. 0:09:59.240 --> 0:10:01.040 Erin, there's usual stuff. 0:10:01.080 --> 0:10:06.600 There's fantastic, wonderful, beautiful merch. There is a bookshop dot 0:10:06.720 --> 0:10:11.160 org affiliate account, and also there is a good Reads 0:10:11.240 --> 0:10:13.160 list where we add the books that we read. And 0:10:13.200 --> 0:10:16.240 also it's like a nice community list where listeners add 0:10:16.280 --> 0:10:19.480 books that they think are of the podcast or related 0:10:19.520 --> 0:10:20.240 to the podcast. 0:10:20.559 --> 0:10:25.960 Yeah, okay, well, then let's take a quick break and 0:10:26.000 --> 0:10:27.240 then dive into this episode. 0:10:27.600 --> 0:10:28.640 Sounds great. 0:10:57.720 --> 0:11:04.560 So HPV stands for human papaloma virus. This is a 0:11:04.800 --> 0:11:09.760 double stranded DNA virus. Except it's not just a virus, right, 0:11:09.880 --> 0:11:15.040 Oh No, this is an entire family of double stranded 0:11:15.080 --> 0:11:20.800 DNA viruses, the papaloma viruses, which include I don't even 0:11:20.840 --> 0:11:25.680 know how many viruses, but viruses that infect essentially I 0:11:25.720 --> 0:11:28.600 don't know every animal ever, every mammal that we've ever 0:11:28.640 --> 0:11:33.000 looked at birds, turtle, snakes, fish, I think every animal. 0:11:33.360 --> 0:11:35.080 Fish. That's the one that really got me. 0:11:35.360 --> 0:11:40.240 It was like fish. I had an advisor who studied 0:11:40.240 --> 0:11:41.760 turtle papalomma viruses. 0:11:42.240 --> 0:11:42.760 Oh cool. 0:11:43.120 --> 0:11:48.040 Yeah, But today we're talking about the human papillomaviruses aka 0:11:48.600 --> 0:11:55.080 hp V. So for HPVs, these are a group of 0:11:55.200 --> 0:12:00.520 several hundred viruses which fall into a few large kind 0:12:00.559 --> 0:12:04.439 of subgroups. They call them alpha, which is the one 0:12:04.440 --> 0:12:07.520 that we're going to focus on the most today, as 0:12:07.520 --> 0:12:10.800 well as beta, gamma, delta. There's new, there's new, there 0:12:10.880 --> 0:12:14.359 might be a chi. There's a lot of different subgroups 0:12:14.360 --> 0:12:18.520 of these viruses, and then within each of these different subgroups, 0:12:18.559 --> 0:12:21.920 there are dozens of different types of HPV, which we're 0:12:21.960 --> 0:12:24.840 probably all familiar with. You've probably all heard at some 0:12:24.960 --> 0:12:29.240 point or another a type of HPV HPV sixteen, HPV 0:12:29.520 --> 0:12:33.560 six eleven. On top of that, and kind of within 0:12:33.679 --> 0:12:38.360 these larger subgroups, you can also bin these different HPVs 0:12:38.400 --> 0:12:41.720 based on the types of cells that they tend to infect. 0:12:42.600 --> 0:12:46.760 So all HPV viruses infect epithelial cells, which are the 0:12:46.800 --> 0:12:50.360 cells that make up our outer linings of everything in 0:12:50.400 --> 0:12:52.760 our body. But we have a lot of different types 0:12:52.760 --> 0:12:55.560 of epithelial cells on our skin, the linings of our 0:12:55.559 --> 0:12:58.480 respiratory tract or our GI tract or our genital tract. 0:12:59.080 --> 0:12:59.640 So you can. 0:12:59.559 --> 0:13:04.720 Also get these HPV types as some being more likely 0:13:04.800 --> 0:13:09.120 to affect the skin, which they sometimes call cutaneotropic like 0:13:09.440 --> 0:13:13.800 cutaneous like your skin. These are the strains or types 0:13:13.880 --> 0:13:17.600 that tend to cause warts of all different kinds. Right, 0:13:17.720 --> 0:13:23.720 everyone knows warts. But then there are also the mucosotropic types, 0:13:23.880 --> 0:13:28.840 which preferentially infect cells of our mucosal lining like the cervix, 0:13:29.200 --> 0:13:31.280 which is going to be what we talk the most 0:13:31.320 --> 0:13:36.640 about today, but also the anal canal are oorrofharynks. These 0:13:36.679 --> 0:13:40.600 can also cause warts generally of the genital tract or 0:13:40.679 --> 0:13:45.400 even in our larynx or pharynx. And so in general, 0:13:45.480 --> 0:13:48.440 it's these HPV types that we're going to focus on 0:13:48.520 --> 0:13:51.520 for this episode. All of these tend to be in 0:13:51.600 --> 0:13:56.439 the alpha HPV category. It gets a little bit more 0:13:56.440 --> 0:14:00.319 complicated because on top of that you also have high 0:14:00.440 --> 0:14:03.760 risk and low risk strains or types. 0:14:04.080 --> 0:14:06.600 I'm very excited to learn more about this. 0:14:06.720 --> 0:14:10.880 Yeah, and that's because that's the biggest story in association 0:14:11.000 --> 0:14:13.440 with HPV and that is the risk of cancer. So 0:14:13.440 --> 0:14:17.040 when we say high risk, these are HPV types that 0:14:17.520 --> 0:14:21.800 have a high risk of potentially causing cancer, and low 0:14:21.920 --> 0:14:24.560 risk means they have a very low risk of potentially 0:14:24.560 --> 0:14:28.520 causing cancer. All right, So let's talk about how these 0:14:28.600 --> 0:14:32.120 viruses are transmitted. A lot of times we think of 0:14:32.280 --> 0:14:37.760 HPV as a purely sexually transmitted disease, and many types 0:14:38.320 --> 0:14:43.400 are sexually transmitted diseases, and those cause genital wards and 0:14:43.440 --> 0:14:48.200 those types also are associated with certain cancers. But there 0:14:48.200 --> 0:14:51.640 are so many different types of HPV, and really, when 0:14:51.640 --> 0:14:54.560 it comes down to it, they're all transmitted by contact, 0:14:55.280 --> 0:14:59.600 so sexual contact. But if you have HPV on your hands, 0:14:59.800 --> 0:15:02.760 then and you can transmit it from hand to anything. 0:15:03.360 --> 0:15:06.280 If you have plantar warts, which are warts on the 0:15:06.320 --> 0:15:10.160 bottom of your feet, those actually shed so much HPV 0:15:10.320 --> 0:15:11.880 that that can end up on the floor and it 0:15:11.920 --> 0:15:13.880 can live for a really long time, and then someone 0:15:13.880 --> 0:15:17.400 else can walk along that floor and get HPV from 0:15:17.440 --> 0:15:17.840 the floor. 0:15:18.440 --> 0:15:19.720 How long is a long time? 0:15:20.280 --> 0:15:22.920 I think I read months potentially, but I don't know 0:15:23.040 --> 0:15:26.320 under what conditions that would be true. Yeah, all right, 0:15:26.600 --> 0:15:30.600 But basically, if you include all these different types, all 0:15:30.640 --> 0:15:35.760 these different subgroupings of HPV. It's really everywhere, Like this 0:15:35.920 --> 0:15:40.680 is such a ubiquitous virus family. Oh yeah, and it's 0:15:40.760 --> 0:15:47.280 quite transmissible. If we look more at sexually transmitted HPV, 0:15:47.840 --> 0:15:50.600 or if we look just specifically at sexually transmitted HPV, 0:15:51.080 --> 0:15:55.240 it's estimated that the like per sexual act transmission rate 0:15:55.440 --> 0:15:57.040 is up to sixty percent. 0:15:57.920 --> 0:16:00.840 Wow. Yeah, I mean the thing is like, by the 0:16:00.920 --> 0:16:04.120 time you're a couple of years old, you are probably 0:16:04.160 --> 0:16:07.040 infected with one HPV, right, right, What. 0:16:07.120 --> 0:16:09.960 Kid doesn't have warts at some point in their life, Like, 0:16:10.320 --> 0:16:14.280 everyone has at least a wart, right, But let's get 0:16:14.280 --> 0:16:17.800 one thing really clear right off the bat. The vast, 0:16:18.720 --> 0:16:25.080 vast majority of HPV infections are almost entirely benign, even 0:16:25.360 --> 0:16:28.760 if they present with a WART, which not all of 0:16:28.800 --> 0:16:34.720 them do. In general, over ninety percent even of genital 0:16:35.000 --> 0:16:40.240 HPV infections will be cleared completely, especially in younger age 0:16:40.240 --> 0:16:44.040 groups like teenagers and young adults. This process is not 0:16:44.160 --> 0:16:48.080 super fast. The half life of the disease, which it's 0:16:48.280 --> 0:16:50.880 interesting to talk about a disease having a half life 0:16:50.960 --> 0:16:54.000 because we don't usually do that, but that tells you 0:16:54.080 --> 0:16:56.720 just kind of how long you can end up infected 0:16:56.800 --> 0:17:00.440 with this and yet still clear it. But the half 0:17:00.480 --> 0:17:02.560 life for HPV is thought to be like eight to 0:17:02.680 --> 0:17:06.119 ten months, So almost all infections will clear in about 0:17:06.160 --> 0:17:07.160 a year or two. 0:17:08.080 --> 0:17:12.320 And so is an infection defined as like actively shedding 0:17:12.600 --> 0:17:15.880 virus or and then like at the end of that infection, 0:17:16.000 --> 0:17:18.480 the virus is cleared from your body, your immune system 0:17:18.520 --> 0:17:19.359 has taken care of it. 0:17:20.160 --> 0:17:22.960 Yes, cleared means that your immune system has taken care 0:17:23.000 --> 0:17:26.240 of it and you no longer have virus in our cells. 0:17:26.440 --> 0:17:31.520 And are you shedding that entire time or that's a good. 0:17:31.480 --> 0:17:37.320 Question as far as I believe, I believe yes, Okay, 0:17:37.560 --> 0:17:40.440 I would guess that how much virus you shed probably 0:17:40.560 --> 0:17:45.800 varies throughout that time course. Okay, But not every infection 0:17:46.200 --> 0:17:52.040 is cleared. So some types of HPV can cause a 0:17:52.119 --> 0:17:56.360 more latent infection where they essentially can stay in our 0:17:56.400 --> 0:17:59.960 cells for a longer time and over that time period 0:18:01.359 --> 0:18:07.159 end up causing cancer. HPV is associated with essentially one 0:18:07.240 --> 0:18:11.359 hundred percent of cervical cancers right as far as we 0:18:11.680 --> 0:18:16.240 can tell so far, cervical cancer. It is necessary to 0:18:16.359 --> 0:18:20.199 have an HPV infection in order to have cervical cancer. 0:18:20.240 --> 0:18:24.200 It's not the only thing, but it is a necessary 0:18:24.280 --> 0:18:29.600 part of the cervical cancer process. However, HPV infection is 0:18:29.640 --> 0:18:34.720 also associated with vaginal cancer, vulvar cancer, penile cancer, anal 0:18:34.800 --> 0:18:38.600 cancer or a pharyngeal cancers, and laryngeal cancers. So that's 0:18:38.640 --> 0:18:40.159 of the back of the throat and the throat. 0:18:40.800 --> 0:18:44.720 I think it's it's interesting because like that is not 0:18:45.000 --> 0:18:49.560 a commonly known thing or it's not something that was 0:18:49.680 --> 0:18:54.280 commonly like spread as part of the public health message. 0:18:54.680 --> 0:18:58.560 Oh arn, I. 0:18:58.600 --> 0:19:01.280 Have so many thoughts about that that we'll touch on 0:19:01.640 --> 0:19:02.840 in the current events section. 0:19:02.920 --> 0:19:05.159 All right, we'll step down from the platform like for 0:19:05.200 --> 0:19:06.440 this for the time being. 0:19:06.560 --> 0:19:10.360 For the time being, let's let's get back to our HPV. 0:19:12.000 --> 0:19:16.480 So the real question, of course, is how on earth 0:19:16.960 --> 0:19:22.240 can a virus cause cancer? Yeah? Right, And the answer 0:19:22.400 --> 0:19:26.679 is so fascinating, especially because we have talked about a 0:19:26.760 --> 0:19:31.680 virus that causes cancer previously, but in a totally different 0:19:31.800 --> 0:19:36.719 way hepsi. Hepsi. Right, this is totally different. Okay, So 0:19:37.520 --> 0:19:41.320 to understand this, we have to understand HPV and then 0:19:41.359 --> 0:19:44.080 we have to understand our epithelial cells a little bit. 0:19:44.160 --> 0:19:47.679 So let's get into it. We know that because this 0:19:47.760 --> 0:19:51.000 is a virus, it has to infect our cells in 0:19:51.119 --> 0:19:54.560 order to replicate, since viruses use our cellular machinery in 0:19:54.640 --> 0:19:59.600 order to replicate, so HPV enters into our tissue via 0:19:59.680 --> 0:20:02.960 little microabrasions, So you have to have small, tiny little 0:20:03.000 --> 0:20:06.000 cuts on your skin or mucosal membranes in order for 0:20:06.200 --> 0:20:09.960 HPV to get in. And then it infects a very 0:20:10.040 --> 0:20:15.080 specific set of our epithelial cells. It infects the basal layer. 0:20:15.119 --> 0:20:18.440 That's the bottom layer of our epithelial cells. So think 0:20:18.480 --> 0:20:20.440 of this as like if you look at a cross 0:20:20.440 --> 0:20:22.880 section of your skin. You have all the dead skin 0:20:22.960 --> 0:20:25.880 cells on top that like slough off when you wipe 0:20:26.359 --> 0:20:29.359 or wash or whatever. And then you have other layers 0:20:29.400 --> 0:20:32.160 of cells that are like differentiated and they're doing their thing. 0:20:32.440 --> 0:20:35.960 And then at the bottom what we have here are 0:20:36.240 --> 0:20:39.439 these kind of stem cells. These basal cells are the 0:20:39.440 --> 0:20:43.160 ones that replicate over and over and then produce all 0:20:43.200 --> 0:20:46.480 of these top layers. They kind of like pooshe themselves up, 0:20:46.760 --> 0:20:51.199 if that makes sense. Yeah, So that bottom layer is 0:20:51.240 --> 0:20:58.040 where HPV infects. Interesting once they're there. Once HPV is 0:20:58.080 --> 0:21:02.200 in those cells, first, that virus will use our cell 0:21:02.280 --> 0:21:05.000 machinery to replicate a few times, just so there's like 0:21:05.119 --> 0:21:07.920 a nice group of them in each cell, like maybe 0:21:07.920 --> 0:21:13.719 fifty to one hundred, okay, And then these viruses have 0:21:13.800 --> 0:21:18.640 a couple of proteins that act to help stimulate our 0:21:18.960 --> 0:21:23.800 cells to replicate. So epithelial cells, like our skin cells, 0:21:23.840 --> 0:21:27.239 they generally replicate pretty rapidly already compared to a lot 0:21:27.280 --> 0:21:30.720 of cells in our body. But this HPV infection is like, hey, 0:21:30.800 --> 0:21:34.200 let's let's kind of do this even more because every 0:21:34.240 --> 0:21:37.000 time that a cell replicates, it's going to replicate all 0:21:37.040 --> 0:21:38.800 that viral DNA as well. 0:21:39.480 --> 0:21:44.520 That's an interesting strategy instead of like because usually we 0:21:44.560 --> 0:21:48.440 see viruses invading, replicating in this cell and then bursting 0:21:48.480 --> 0:21:52.119 the cell, killing it, and then infecting another cell and 0:21:52.160 --> 0:21:53.880 another set and another cell and doing the same thing. 0:21:53.920 --> 0:21:57.280 But this is like contained replications. 0:21:56.920 --> 0:22:00.680 Herein You're right, isn't it exciting? 0:22:01.040 --> 0:22:02.399 This is very interesting. 0:22:02.640 --> 0:22:06.440 So if this happens on our skin or on some 0:22:06.480 --> 0:22:10.720 of our meucosal surfaces, with most of these HPV types, 0:22:10.760 --> 0:22:15.320 it might manifest as warts. Right, So warts are basically 0:22:15.400 --> 0:22:18.880 just keratinocytes our skin cells that kind of grow, they 0:22:18.920 --> 0:22:23.680 get like extra keratinized, and then as those cells slough off, 0:22:23.960 --> 0:22:27.000 that's when the virus explodes. Out and is able to 0:22:27.040 --> 0:22:28.600 go on and infect other cells. 0:22:29.640 --> 0:22:33.920 That is really interesting, yes, but that. 0:22:33.840 --> 0:22:37.560 Doesn't tell us what about cancer. That that's not cancer, 0:22:38.200 --> 0:22:43.080 that's worts. So there's another thing that certain types of 0:22:43.119 --> 0:22:48.240 this virus have that allow them to be even sneakier. 0:22:49.720 --> 0:22:53.560 So the high risk subtypes have a few extra tricks. 0:22:54.400 --> 0:22:59.840 One is that they can actually integrate into our genome directly. 0:23:01.560 --> 0:23:04.320 That's spooky, Yeah, it happens. 0:23:05.320 --> 0:23:05.920 I love it. 0:23:07.320 --> 0:23:09.879 So that means that they can do an even better 0:23:10.040 --> 0:23:14.840 job of disrupting our normal cell functioning because they actually 0:23:14.840 --> 0:23:19.479 can insert themselves inside our genome, like in between our DNA. 0:23:19.680 --> 0:23:25.159 It's like human human HPV HPV human human. Right on 0:23:25.240 --> 0:23:28.680 top of that, the high risk subtypes have a couple 0:23:28.680 --> 0:23:32.040 of extra proteins. One that's called E six, one that's 0:23:32.080 --> 0:23:35.879 called E seven, maybe also E five. And what these 0:23:35.920 --> 0:23:39.440 proteins do, so we already know that HPV has these 0:23:39.480 --> 0:23:44.040 proteins that like tell our cells, hey, replicate more than 0:23:44.080 --> 0:23:48.120 you want to. These other proteins, on top of that, 0:23:48.720 --> 0:23:52.800 function to suppress a couple of genes that we have 0:23:52.920 --> 0:23:55.840 in our bodies, which are called P fifty three and 0:23:55.960 --> 0:24:00.919 p RB or P retinoblastoma which in our normal human 0:24:01.000 --> 0:24:05.960 cells or what are called tumor suppressor genes. These genes 0:24:06.000 --> 0:24:09.919 are responsible for doing like a double check whenever our 0:24:10.000 --> 0:24:14.120 cells replicate DNA these proteins, the proteins that are encoded 0:24:14.119 --> 0:24:16.920 for by these genes, They're like, hey, hey, let's take 0:24:16.960 --> 0:24:19.520 a minute real quick. You guys, you made a mistake here. 0:24:19.960 --> 0:24:22.399 This isn't right. You can't do that. This needs to 0:24:22.400 --> 0:24:26.359 either be fixed or I'm gonna kill you. So it 0:24:26.440 --> 0:24:31.040 either stops DNA replication or they try and fix it. 0:24:31.160 --> 0:24:33.679 And if they can't do that, then they just do 0:24:33.800 --> 0:24:37.119 apoptosis and they're like, scratch this whole operation. This cells 0:24:37.119 --> 0:24:41.439 out of commission, right, So, these tumor suppressor genes are 0:24:41.480 --> 0:24:45.240 what prevent our cells from replicating out of control and 0:24:45.760 --> 0:24:50.600 what prevents our cells from replicating incorrect faulty DNA sequences. 0:24:52.320 --> 0:24:57.800 High risk HPV turns this function off. So not only 0:24:58.000 --> 0:25:01.160 is HPV convincing our cells to rep implicate more rapidly, 0:25:01.440 --> 0:25:05.639 but as they do so, they replicate incorrect and messed 0:25:05.680 --> 0:25:09.080 up DNA, which can lead to eventually, you know how 0:25:09.119 --> 0:25:12.040 these cells are in the basal layer, the bottom layer 0:25:12.160 --> 0:25:15.639 of our skin yeah, and normally skin cells replicate up 0:25:15.760 --> 0:25:21.480 up up. This uncontrolled, incorrect division can allow them to 0:25:21.600 --> 0:25:25.640 invade beyond the basement membrane, which is the layer underneath 0:25:25.680 --> 0:25:30.560 those basil cells, and invade deeper structures. That's cancer. 0:25:31.280 --> 0:25:36.639 And is that primarily in the mucosal or only mucosal? 0:25:36.920 --> 0:25:40.359 Yeah, so this is what happens in the high risk 0:25:40.640 --> 0:25:44.560 HPV subtypes, which tend to infect mucosal surfaces. 0:25:46.240 --> 0:25:50.080 This is It's so interesting to me because like from 0:25:50.119 --> 0:25:53.439 a virus's point of view, this seems like an excellent strategy. 0:25:53.760 --> 0:25:55.160 Yeah, so it's. 0:25:55.000 --> 0:25:58.880 Such a good strategy, Like, why don't we see this more? 0:25:59.200 --> 0:26:02.919 I guess I think it's very very complicated, So it 0:26:03.040 --> 0:26:08.040 must be, Yeah, because this is it's not just that 0:26:08.200 --> 0:26:13.360 this virus itself is growing really rapidly, Like this virus 0:26:13.400 --> 0:26:16.720 has to have a very intimate relationship with our genome, 0:26:17.280 --> 0:26:20.280 so it has to have evolved with us for a 0:26:20.400 --> 0:26:22.760 very long time. I would guess I actually didn't look 0:26:22.800 --> 0:26:24.720 into that. You're going to talk a little bit about it, 0:26:24.760 --> 0:26:25.080 I think. 0:26:25.160 --> 0:26:27.360 But I'm thrilled. This is so great. I love when 0:26:27.359 --> 0:26:27.840 this happened. 0:26:27.920 --> 0:26:32.040 Yes, but yeah, I mean that's what that would suggest, right, 0:26:32.119 --> 0:26:35.800 because it has such an intimate relationship with our genes. 0:26:35.840 --> 0:26:38.959 It specifically is turning off these tumor suppressor genes. And 0:26:39.000 --> 0:26:40.959 like you said, it's a great strategy because now this 0:26:41.080 --> 0:26:45.520 virus can invade our whole body, cancer can go anywhere 0:26:45.560 --> 0:26:47.520 at once once it starts going. 0:26:48.920 --> 0:26:50.720 How does it disrupt p. 0:26:50.800 --> 0:26:51.320 Fifty three? 0:26:52.040 --> 0:26:58.800 Oh gosh, Aaron, don't ask me that, Okay, it just does. Yeah, 0:26:59.760 --> 0:27:02.880 that's that's what I have for the path of physiology 0:27:02.920 --> 0:27:04.320 of this disease. 0:27:05.240 --> 0:27:12.480 It's very fascinating and it's like, it's very scary. Cervical 0:27:12.520 --> 0:27:15.040 cancer is the one that we hear the most about. 0:27:15.240 --> 0:27:16.760 Yeah, why is that? 0:27:16.800 --> 0:27:19.840 Well, first of all, why are those areas so much 0:27:19.920 --> 0:27:27.879 more susceptible to cancer caused by HPVs? And why cervical 0:27:27.920 --> 0:27:30.359 cancer most of all? Or is it just that we 0:27:30.440 --> 0:27:31.800 hear more about it. 0:27:31.800 --> 0:27:34.439 It's a good question. I think in part, we do 0:27:34.600 --> 0:27:37.840 hear more about it, and we'll talk about kind of 0:27:37.880 --> 0:27:39.840 why that is. And part of that's because we can 0:27:39.880 --> 0:27:44.120 screen for it, which is great. It's also I think 0:27:44.160 --> 0:27:49.080 because other cancers that are associated with HPV also have 0:27:49.520 --> 0:27:53.120 other risk factors or other things that can cause them 0:27:53.160 --> 0:27:58.520 without necessarily having HPV, whereas cervical cancer, it seems that 0:27:58.720 --> 0:28:03.359 HPV is a necessary precursor. Like if there's not HPV, 0:28:03.600 --> 0:28:06.160 the cervix is never going to become cancerous. 0:28:07.119 --> 0:28:10.879 Okay, if that makes sense, Yes, that is interesting. 0:28:11.160 --> 0:28:11.600 Yeah. 0:28:12.080 --> 0:28:16.240 The cervix, by the way, is the bottom part of 0:28:16.280 --> 0:28:18.280 the uterus. Some people might not know that. 0:28:18.600 --> 0:28:19.399 It's very true. 0:28:19.600 --> 0:28:23.480 Yeah, it's the bottom part of the uterus. It looks so. 0:28:23.720 --> 0:28:25.600 I guess we'll talk about this so that we can 0:28:25.720 --> 0:28:29.600 understand why we're able to screen for cervical cancer. And 0:28:29.640 --> 0:28:31.520 I think aarin you'll talk a little bit more too, 0:28:31.560 --> 0:28:35.920 about like how someone came up with this. Oh yeah, yeah, 0:28:36.200 --> 0:28:38.719 So it's the bottom part of the uterus, which is 0:28:38.920 --> 0:28:41.600 also if you are looking into the vagina, it's the 0:28:41.680 --> 0:28:44.920 very top part of what you'd see at the vaginal canal. 0:28:45.080 --> 0:28:47.920 It looks like a little doughnut. It's kind of cute, 0:28:48.960 --> 0:28:52.120 with a little hole in the middle. That little hole 0:28:52.160 --> 0:28:56.400 in the middle goes up like through that hole would 0:28:56.400 --> 0:29:00.560 go up into the uterus. And at that zone right 0:29:00.600 --> 0:29:04.080 in the middle of that hole is where the outside 0:29:04.120 --> 0:29:08.320 body meets the inside body, and there's a transition zone 0:29:08.640 --> 0:29:14.400 in there where our cells change type that transition zone 0:29:14.720 --> 0:29:20.160 is also very susceptible to HPV infection. Huh, the same 0:29:20.280 --> 0:29:23.160 is true. We think of the transition zone because there's 0:29:23.160 --> 0:29:25.920 a similar transition zone in the anal canal where we 0:29:25.960 --> 0:29:27.800 go from outside of the body to the inside of 0:29:27.840 --> 0:29:31.160 the body, and that transition zone in the anal canal 0:29:31.240 --> 0:29:33.360 is also very susceptible to HPV infection. 0:29:33.840 --> 0:29:36.880 So the transition zone where you so you have cells 0:29:37.800 --> 0:29:41.160 turning into different kinds, like that's what the border. Yes, 0:29:41.280 --> 0:29:44.880 and does that have something to do with it? Just 0:29:44.920 --> 0:29:47.440 the fact that there are like different instructions and so 0:29:47.520 --> 0:29:50.440 like a different type of cell might not receive the 0:29:50.440 --> 0:29:52.480 same amount of like scrutiny. 0:29:53.080 --> 0:29:56.720 Yeah, it's possible. So I think from what I have read, 0:29:56.760 --> 0:30:02.640 we don't fully understand exactly that process, but it is 0:30:02.680 --> 0:30:05.560 thought that, yes, something about that transition zone and the 0:30:05.640 --> 0:30:08.920 kind of what's called metaplasia or cell type change that 0:30:09.040 --> 0:30:13.880 happens there might have something to do with why this why. 0:30:13.680 --> 0:30:15.640 The cervix interesting? 0:30:16.080 --> 0:30:16.560 Interesting? 0:30:17.200 --> 0:30:21.840 But the good news when it comes to cervical cancer 0:30:21.920 --> 0:30:27.440 at least is that it's a really preventable type of cancer. 0:30:27.560 --> 0:30:30.640 It's at this day and age, it's a very preventable 0:30:30.680 --> 0:30:33.800 type of cancer, at least in theory. We can prevent 0:30:33.840 --> 0:30:37.640 it in a number of different ways. One is by 0:30:37.920 --> 0:30:39.520 This is kind of fun because we can talk about 0:30:39.520 --> 0:30:44.360 the types of prevention, right, Yeah, So in public health 0:30:44.400 --> 0:30:48.040 we have a lot of different types of prevention, and 0:30:48.160 --> 0:30:52.040 one is called secondary prevention, and that's what screening is. 0:30:52.520 --> 0:30:55.640 So that means we're trying to find precursors of something 0:30:55.720 --> 0:30:58.959 like cancer or very very early cancer that we can 0:30:59.000 --> 0:31:04.200 treat before its severe disease. So screening like breast cancer 0:31:04.240 --> 0:31:08.520 screenings or cervical cancer screenings are secondary prevention. And we 0:31:08.600 --> 0:31:12.520 can do that. We can scrape off cells at that 0:31:12.640 --> 0:31:16.200 transition zone from the inside of the cervix and then 0:31:16.240 --> 0:31:19.600 look at them under a microscope and look for pre 0:31:19.720 --> 0:31:24.040 cancerous changes, and that can tell us, hey, you're at 0:31:24.160 --> 0:31:28.440 risk of having cancer. And then you can go one 0:31:28.480 --> 0:31:30.960 step further and do a second test where you basically 0:31:31.120 --> 0:31:35.280 put acetic acid on the cervix and look with another 0:31:35.400 --> 0:31:39.040 type of special lens to see if there are any 0:31:39.160 --> 0:31:42.360 changes and then remove those as well before they become 0:31:42.360 --> 0:31:47.240 cancer or before they become invasive cancer. So that's one 0:31:47.280 --> 0:31:50.160 type of screening, and that's the PAP smear combined with 0:31:50.240 --> 0:31:56.120 what's called kolposcopy, which is the more invasive test. Nowadays, 0:31:56.200 --> 0:31:59.960 we have another type of screening which I get rare 0:32:00.080 --> 0:32:03.680 very excited about because it's a lot less invasive, it 0:32:03.720 --> 0:32:06.960 doesn't have to be done as often, and it's as good, 0:32:07.160 --> 0:32:12.040 if not better, and that is direct HPV testing. So 0:32:13.200 --> 0:32:17.800 because cervical cancer necessarily has HPV infection, you can test 0:32:18.360 --> 0:32:21.440 cervical cells really like just a vaginal swab. It doesn't 0:32:21.480 --> 0:32:23.880 have to be all the way jamming into the cervix, 0:32:24.000 --> 0:32:27.720 which is a lot more painful, and you can just 0:32:27.800 --> 0:32:31.960 test for the presence of certain types of high risk 0:32:32.200 --> 0:32:35.280 HPV and then if you see it, then you go 0:32:35.360 --> 0:32:37.280 from there in terms of like what you do about it. 0:32:38.600 --> 0:32:42.680 So that's really exciting because that's secondary prevention that's possible. 0:32:43.400 --> 0:32:47.320 But even better than secondary prevention is primary prevention. 0:32:47.920 --> 0:32:48.440 Oh yeah. 0:32:48.600 --> 0:32:52.560 Primary prevention means preventing somebody from ever getting a disease 0:32:52.760 --> 0:32:58.000 in the first place, and for cancer, we often can't 0:32:58.000 --> 0:33:03.560 do that. So for cancer, secondary prevention is often kind 0:33:03.600 --> 0:33:06.600 of like the mainstay of public health prevention. That's usually 0:33:06.640 --> 0:33:08.320 all that we can do is try and find it 0:33:08.400 --> 0:33:12.280 early and do something about it. But for cervical cancer, 0:33:13.200 --> 0:33:17.040 we can prevent it because we have a vaccine. 0:33:17.480 --> 0:33:18.160 It's amazing. 0:33:19.240 --> 0:33:22.400 We have a cancer preventing vaccine. 0:33:22.920 --> 0:33:26.920 I know, it's we're living in the future. We really are. 0:33:27.760 --> 0:33:31.880 So there are three different types of HPV vaccines that 0:33:31.960 --> 0:33:38.800 are currently licensed. One covers four types of HPV, two 0:33:38.880 --> 0:33:42.520 that are high risk, which are sixteen and eighteen. Those 0:33:42.600 --> 0:33:46.360 cover seventy percent of all cervical cancer in the world, 0:33:47.640 --> 0:33:51.160 as well as six and eleven, which cause about ninety 0:33:51.160 --> 0:33:56.280 percent of genital warts, which is awesome. Yeah, there's another 0:33:56.320 --> 0:33:59.000 one that was licensed a couple years later that only 0:33:59.040 --> 0:34:02.720 covers sixteen in eighteen, so it doesn't protect against genital warts, 0:34:02.920 --> 0:34:06.720 but it does protect against seventy percent of cervical cancers. 0:34:07.720 --> 0:34:10.760 But recently, in the last couple of years, there's another 0:34:10.840 --> 0:34:16.839 one that covers nine strains, including sixteen and eighteen, which 0:34:16.840 --> 0:34:21.000 are the most common causes of cancer, but also thirty one, 0:34:21.080 --> 0:34:24.160 thirty three, forty five, fifty two, fifty eight, which are 0:34:24.200 --> 0:34:28.360 all high risk types that all together account for ninety 0:34:28.440 --> 0:34:30.440 percent of all cervical cancers. 0:34:30.800 --> 0:34:31.680 That's amazing. 0:34:31.800 --> 0:34:35.720 And then it also covers genital warts. We'll talk about 0:34:35.719 --> 0:34:38.800 all of the pitfalls with this vaccine and with screening 0:34:38.920 --> 0:34:42.719 in general. A little bit more later on in this episode, 0:34:43.160 --> 0:34:48.359 But first, Aaron, ooh, where did we? How did we? 0:34:48.719 --> 0:34:52.120 What is this virus? Is cancer virus? 0:34:52.120 --> 0:34:52.560 Like what? 0:34:53.239 --> 0:34:56.160 I know? I know, I'm very excited to talk about it. 0:34:56.320 --> 0:35:30.640 Let's take a quick break first. So first off, to 0:35:30.800 --> 0:35:36.840 say that papollomaviruses in general, papollomaviruses have been around since 0:35:36.920 --> 0:35:41.160 humans became human, would be a bit of an understatement, 0:35:42.880 --> 0:35:47.600 kind of an enormous understatement actually, because papalomaviruses are thought 0:35:47.640 --> 0:35:51.080 to be hundreds of millions. 0:35:50.440 --> 0:35:51.240 Of years old. 0:35:51.680 --> 0:35:54.120 Have they been around since viruses were viruses? 0:35:54.560 --> 0:35:59.759 I mean not far off? The number in diversity of 0:35:59.760 --> 0:36:05.200 hope that they infect, like you mentioned, Aaron, fish, birds, mammals, reptiles, 0:36:05.200 --> 0:36:10.239 et cetera. And also their diversity within the host species. 0:36:10.840 --> 0:36:15.000 It just like highlights how ancient this group of viruses is. 0:36:16.040 --> 0:36:18.600 All Right, So I found one paper that puts the 0:36:18.719 --> 0:36:22.280 root of the papilloma virus tree back to four hundred 0:36:22.280 --> 0:36:26.960 and twenty four million years ago. What like this is 0:36:27.080 --> 0:36:30.960 beyond what anything that we've talked about in terms of 0:36:31.000 --> 0:36:33.360 like ancientness. 0:36:33.760 --> 0:36:34.320 Wow. 0:36:34.880 --> 0:36:38.960 Yeah, And then the first big divergence was around one 0:36:39.040 --> 0:36:41.680 hundred and eighty four million years ago, and that was 0:36:41.760 --> 0:36:45.920 during the period when mammal evolution and diversification led to 0:36:45.960 --> 0:36:49.240 the development of a whole lot of new real estate 0:36:49.360 --> 0:36:55.560 for these viruses, specifically some of the mammalian skin characteristics 0:36:55.600 --> 0:36:59.640 like hairs, sweat glands, sebaceous glands, milk glands, et cetera. 0:37:00.640 --> 0:37:04.560 So this is just like open space to occupy tons 0:37:04.719 --> 0:37:08.560 new territory, absolutely, and so from that point there are 0:37:08.640 --> 0:37:13.080 several other additional diversification events or periods where the Papaloma 0:37:13.120 --> 0:37:16.680 virus diversity kind of like fanned out even further. But 0:37:16.840 --> 0:37:18.959 I'm just gonna leave it at that because it gets 0:37:19.000 --> 0:37:22.640 sort of like and then, and then and then. Basically, 0:37:23.000 --> 0:37:26.799 the bottom line is that papalomaviruses are incredibly old and 0:37:26.960 --> 0:37:31.480 have evolved with their hosts, and that the cancer causing 0:37:31.560 --> 0:37:36.560 genes in papaloma viruses are not specific to human papalamaviruses, 0:37:37.440 --> 0:37:41.600 and so those genes it's likely that those genes evolved 0:37:41.680 --> 0:37:48.000 before humans did. What, so like, those genes are likely 0:37:48.040 --> 0:37:51.759 similar across all of the like in different animal viruses. 0:37:51.920 --> 0:37:55.680 Honestly, that makes sense. Because P. Fifty three is highly conserved. 0:37:55.440 --> 0:37:58.560 Exactly exactly, so it's probably not like convergent evolution, I 0:37:58.600 --> 0:38:06.080 would guess anyway, also because complexity, but whatever, And because 0:38:06.120 --> 0:38:09.520 of how old and widespread these viruses are, it probably 0:38:09.520 --> 0:38:12.160 doesn't surprise you to learn that there are lots and 0:38:12.200 --> 0:38:16.200 lots of ancient writings about them, or at least about 0:38:16.239 --> 0:38:21.360 the things that they caused, like warts. Genital warts, for instance, 0:38:21.400 --> 0:38:24.319 have been written about since at least the time of Hippocrates, 0:38:24.480 --> 0:38:27.200 so like for one hundred and sixty to three hundred 0:38:27.200 --> 0:38:33.080 and seventy BCE. And the medical term for them, condolomata acuminata, 0:38:34.320 --> 0:38:38.560 comes from the ancient Greek and Latin condoloma meaning knob 0:38:38.680 --> 0:38:42.400 or round tumor, and acuminata from the Latin for sharp points. 0:38:43.040 --> 0:38:47.840 And a term for plannar warts mirror mesia mirror mechia 0:38:48.560 --> 0:38:50.600 comes from the Greek word for ant hill. 0:38:51.960 --> 0:38:52.680 I can see that. 0:38:53.200 --> 0:38:56.200 And in ancient Rome, genital warts were called pycus or 0:38:56.280 --> 0:38:59.920 thymus because apparently they looked like an open fig or 0:39:00.000 --> 0:39:05.240 resembled the leaves of the time plant. Yeah, and besides 0:39:05.280 --> 0:39:08.880 just writings about warts, there was also a toe wart 0:39:09.000 --> 0:39:12.040 found on the embalmed body of an ancient Egyptian worker 0:39:12.239 --> 0:39:15.279 from like thousands of years ago. But you know, like 0:39:16.080 --> 0:39:20.120 all types of warts, the warts common on fingers, genital warts, 0:39:20.239 --> 0:39:23.440 planter warts, they all made appearances in ancient Roman and 0:39:23.480 --> 0:39:27.640 Greek medical texts, and it was commonly assumed that sexual activity, 0:39:27.719 --> 0:39:32.880 particularly excessive sexual activity, was the cause of genital warts. 0:39:33.320 --> 0:39:37.200 The causes of other warts, like those commonly found on fingers, 0:39:37.440 --> 0:39:42.080 were often chocked up to females addicted to solitary habits 0:39:42.560 --> 0:39:47.279 in quotes aka, do you know what I mean by that? 0:39:47.600 --> 0:39:48.799 Oh? I know what you mean by that? 0:39:49.320 --> 0:39:55.640 Okay? And or also those that like regularly were hen testers, 0:39:55.680 --> 0:39:58.440 so they would stick their finger up the cloaca of 0:39:58.480 --> 0:40:00.479 a hen to see how close it was to laying 0:40:00.520 --> 0:40:00.879 an egg. 0:40:01.160 --> 0:40:05.600 Oh my god, I have never thought about a finger 0:40:05.680 --> 0:40:08.799 going up a cloaca. I don't like the thought of it. 0:40:13.960 --> 0:40:15.880 I hope that won't become an intrusive thought for you. 0:40:16.160 --> 0:40:16.799 I think it might. 0:40:17.160 --> 0:40:24.760 Yeah, well, you know, there are worse things. So anyway, 0:40:25.640 --> 0:40:29.319 the precise cause of wartz was not known, like the 0:40:29.360 --> 0:40:32.200 fact that they were viral, but they were recognized to 0:40:32.239 --> 0:40:36.960 be contagious. But for the most part, this early focus 0:40:37.000 --> 0:40:40.520 on warts wasn't so much on uncovering the cause of wartz, 0:40:40.719 --> 0:40:44.239 but rather how to treat them or get rid of them, 0:40:44.280 --> 0:40:47.520 which brings me to one of my favorite things, which 0:40:47.560 --> 0:40:49.080 is old timey cures. 0:40:49.360 --> 0:40:51.719 Oh, I feel like it's been a very long time 0:40:51.760 --> 0:40:54.080 since we've discussed old timey cures. 0:40:54.000 --> 0:40:57.040 Well, and I feel the same way. And so because 0:40:57.080 --> 0:41:00.719 of that, I have like quite a big section on 0:41:00.840 --> 0:41:06.600 this because I was like, oh, let me find my 0:41:06.719 --> 0:41:10.320 favorites and I'll put them in here, and I just 0:41:10.400 --> 0:41:13.759 kept adding more so and I'll link to papers that 0:41:13.800 --> 0:41:16.960 have even more. So this is like specifically old timey 0:41:16.960 --> 0:41:19.239 folklore of Europe in terms of how to get rid 0:41:19.239 --> 0:41:20.000 of warts. 0:41:20.120 --> 0:41:22.640 Okay, worts or just or genital worts. 0:41:23.520 --> 0:41:25.839 Some of them didn't specify, but for the most part 0:41:25.880 --> 0:41:30.839 it seemed like skin warts, like finger toe whatever, all right, 0:41:31.280 --> 0:41:33.359 because I mean some of them, you will it's very 0:41:33.400 --> 0:41:38.400 clear that it's not genital warts, okay, but yeah, oh dear, okay. 0:41:38.440 --> 0:41:41.800 So these can be grouped into the following categories. One 0:41:42.239 --> 0:41:45.359 was transference, so like transferring your wart to somebody else 0:41:45.480 --> 0:41:50.600 or something else. Number two was animal, plant or mineral remedies. 0:41:51.600 --> 0:41:56.359 Number three was prayers or incantations, and number four was 0:41:56.520 --> 0:42:00.720 miscellaneous that things like crossroads, moon phase, funeral, et cetera. 0:42:01.760 --> 0:42:04.600 What okay, yeah, I'll get there. Okay, So a couple 0:42:04.760 --> 0:42:09.319 examples of transference. You should rub the warts against a 0:42:09.360 --> 0:42:12.480 man who is the father of an illegitimate child without 0:42:12.520 --> 0:42:17.960 his knowledge. So that one you'd probably just want to 0:42:18.000 --> 0:42:22.120 do with hand warts, right, like, I don't think you 0:42:22.160 --> 0:42:23.240 could do genital warts. 0:42:24.560 --> 0:42:27.160 Yeah, no, nope, not without his knowledge. 0:42:28.080 --> 0:42:32.040 And then quote, if a bag containing as many small 0:42:32.080 --> 0:42:34.800 pebbles as a person has warts be tossed over the 0:42:34.880 --> 0:42:37.840 left shoulder, it will transfer the warts to whoever is 0:42:37.960 --> 0:42:44.120 unfortunate enough to pick up the bag. Another one quote, 0:42:44.280 --> 0:42:46.640 take one of the large black snails which are to 0:42:46.680 --> 0:42:49.719 be found during summer, rub it over the wart, and 0:42:49.760 --> 0:42:52.399 then hang it on a thorn. This must be done 0:42:52.680 --> 0:42:55.800 nine nights consecutively, at the end of which the wart 0:42:55.800 --> 0:43:00.719 will completely disappear. You could also rub your wort with 0:43:00.760 --> 0:43:03.160 a piece of bacon. Cut a slit in the bark 0:43:03.200 --> 0:43:06.040 of an ash tree, and slip the bacon under the bark, 0:43:06.200 --> 0:43:10.480 and then repeat the words ashen tree, ashen tree, pray, 0:43:10.680 --> 0:43:13.719 buy these warts of me. And then you stick a 0:43:13.760 --> 0:43:15.640 pin into the tree and then into the wart and 0:43:15.680 --> 0:43:19.600 then back into the tree, and then your wart's gone. 0:43:19.760 --> 0:43:22.880 Of course it is, And there was also so if 0:43:22.920 --> 0:43:26.320 those didn't work, there was also the option of having 0:43:26.360 --> 0:43:30.120 someone buy your wart off you. I guess there was 0:43:30.160 --> 0:43:33.399 like an open market for that, or you could treat 0:43:33.400 --> 0:43:36.680 it with anyone of the followings, so like fish heads, pigs, blood, 0:43:36.760 --> 0:43:42.240 lizard's blood, menstrual blood, doves, dung, tobacco, juice, and fasting spittle. Okay, 0:43:43.320 --> 0:43:46.839 I mean, honestly, I could go on and on with 0:43:46.920 --> 0:43:50.160 more wart remedies. Catch a long horned grasshopper and have 0:43:50.239 --> 0:43:52.440 it bite off your wart directly, so there was known 0:43:52.480 --> 0:43:55.200 as like a wart biting grasshopper or something. Of course, 0:43:55.440 --> 0:43:59.040 it's not a great solution now because the grasshopper species 0:44:00.120 --> 0:44:09.080 Decticus verucivorus is endangered, so don't do that. And then finally, 0:44:09.640 --> 0:44:12.120 spit on your wart and rub it three times in 0:44:12.160 --> 0:44:15.680 the direction of a passing funeral while saying, my wart 0:44:15.800 --> 0:44:20.080 goes with you. And when I read that, Aaron, all 0:44:20.080 --> 0:44:22.759 I could think of was my warp be with you, 0:44:23.120 --> 0:44:31.040 and also with you and with you. Yeah, so some 0:44:31.080 --> 0:44:35.120 good ones there there are many more. That's the title 0:44:35.160 --> 0:44:39.520 of the episode, my warp be with you, excellent with 0:44:39.600 --> 0:44:46.960 you anyway? Okay, I should move on though. So from 0:44:47.000 --> 0:44:50.280 ancient times to around the late eighteen hundreds, warts remained 0:44:50.320 --> 0:44:54.920 a nuisance for many people, hence these innumerable cures described, 0:44:55.320 --> 0:44:58.239 but little progress had been made in terms of understanding 0:44:58.280 --> 0:44:59.600 the transmission. 0:44:59.040 --> 0:45:00.760 Of warts or their viral cause. 0:45:01.520 --> 0:45:05.000 But it was around this time that things changed. So 0:45:05.040 --> 0:45:08.560 the development of germ theory and microscopes allowed more close 0:45:08.600 --> 0:45:12.839 examination into the contagiousness of these warts, as well as 0:45:12.880 --> 0:45:15.279 to what they looked like at a cellular level, like 0:45:15.320 --> 0:45:19.080 what was going on? And in eighteen ninety three a 0:45:19.120 --> 0:45:22.920 French dermatologist made the observation that genital warts and common 0:45:22.920 --> 0:45:26.640 skin warts might be the same thing, or caused kind 0:45:26.640 --> 0:45:30.200 of by the same thing. And other doctors successfully gave 0:45:30.320 --> 0:45:34.360 themselves warts so like they were like, oh, I'll try 0:45:34.400 --> 0:45:36.560 this out. I'll try to put some wart juice on me, 0:45:36.680 --> 0:45:38.120 and you know. 0:45:38.640 --> 0:45:42.760 Like from like, they gave themselves skin warts from someone's 0:45:42.760 --> 0:45:44.040 genitals to test it. 0:45:44.600 --> 0:45:48.640 Well, So that was mostly skin to skin. But then 0:45:48.840 --> 0:45:51.640 in nineteen o six there was a major breakthrough when 0:45:51.640 --> 0:45:55.440 an Italian doctor made an extract of genital warts and 0:45:55.480 --> 0:45:58.080 then passed it through a filter that would leave at 0:45:58.080 --> 0:46:01.760 any bacteria or fungi, and then he injected this wart 0:46:01.800 --> 0:46:04.840 juice into his skin, where wartz later developed. 0:46:05.600 --> 0:46:08.200 So some commitment right there. 0:46:08.640 --> 0:46:13.040 It is, and I mean this led to two important 0:46:13.040 --> 0:46:16.560 pieces of information. One was that warts are probably caused 0:46:16.560 --> 0:46:21.440 by a filterable transmissible agent aka virus. And it also 0:46:21.520 --> 0:46:24.640 showed that genital warts and skin warts were caused or 0:46:24.680 --> 0:46:28.600 could be caused by the same virus. Right the virus 0:46:28.640 --> 0:46:31.880 itself that caused the warts, or any human papalama virus 0:46:31.920 --> 0:46:37.680 wouldn't be discovered until nineteen fifty. Yeah, but in the meantime, 0:46:37.960 --> 0:46:41.120 there were a couple of other important developments. So I'm 0:46:41.120 --> 0:46:43.879 going to shift gears for a little bit and talk 0:46:43.920 --> 0:46:45.160 about cervical cancer. 0:46:45.560 --> 0:46:46.440 Ooh. 0:46:46.719 --> 0:46:50.360 In the early days of cancer research, it probably seemed 0:46:50.719 --> 0:46:53.520 like with every new thing you learned, you probably had 0:46:53.600 --> 0:46:55.960 ten times the amount of questions you started out with, 0:46:56.520 --> 0:46:59.400 because there didn't seem to be a single unifying cause 0:46:59.400 --> 0:47:03.360 of cancer or even predictability within the same type of cancer. 0:47:03.920 --> 0:47:06.920 New cancers were being discovered all the time, like it 0:47:07.040 --> 0:47:10.279 seems like an utterly chaotic field in. 0:47:10.239 --> 0:47:12.600 That sense, Oh man, I still feel like that. 0:47:13.120 --> 0:47:17.680 Yeah, absolutely, And then in nineteen ten, a key piece 0:47:17.719 --> 0:47:21.080 of research seemed like scientists were getting closer to at 0:47:21.160 --> 0:47:25.479 least one solid answer, because that year a pathologist named 0:47:25.520 --> 0:47:29.560 Peyton Rouse described how he was able to induce malignant 0:47:29.560 --> 0:47:33.680 tumors in healthy chickens by injecting them with a filtrate 0:47:33.800 --> 0:47:38.840 from malignant sarcomas in sick chickens. In other words, Rouse 0:47:38.840 --> 0:47:44.640 discovered the first cancer causing virus in nineteen ten, nineteen ten, 0:47:45.280 --> 0:47:48.400 nineteen ten, like. Not only was this super exciting, but 0:47:48.440 --> 0:47:51.520 it was also a very important development in our understanding 0:47:51.640 --> 0:47:56.400 the nature of viruses in cancer, and Rouse was awarded 0:47:56.440 --> 0:47:59.320 a Nobel Prize in nineteen sixty six for the finding, 0:47:59.400 --> 0:48:03.200 which I think is the longest actually delay between work 0:48:03.320 --> 0:48:08.440 and award like in Nobel Price history. After the rous 0:48:08.440 --> 0:48:12.319 sarcoma virus was discovered, many other researchers began looking into 0:48:12.360 --> 0:48:16.879 possible infectious causes of cancers, and one of these researchers 0:48:17.080 --> 0:48:21.759 was Richard Schope, whose name may sound familiar because he 0:48:21.960 --> 0:48:24.160 was one of the people who discovered the influenza A 0:48:24.280 --> 0:48:28.120 virus and linked it to the nineteen eighteen influenza. 0:48:27.880 --> 0:48:31.160 That was three and a half years ago. I now 0:48:31.200 --> 0:48:32.520 remember his name well. 0:48:32.520 --> 0:48:35.160 But his name also might sound familiar because his son, 0:48:35.480 --> 0:48:40.640 Robert Schope, was a famous virologist who worked on arboviruses 0:48:40.680 --> 0:48:46.719 mostly and discovered more novel viruses than anyone else previously. Wow, 0:48:46.840 --> 0:48:50.480 Like unbelievable amount of virus like research. He was like 0:48:50.520 --> 0:48:58.320 a walking encyclopedia apparently. Wow anyway, Wikipedia rabbit hole. Speaking 0:48:58.320 --> 0:49:03.799 of rabbits. In the nineteen thirties, Shop who had collaborated 0:49:03.840 --> 0:49:07.319 with Rouse, was out hunting one day in Iowa when 0:49:07.360 --> 0:49:11.239 he noticed what looked like a wild cottontail rabbit with horns. 0:49:12.640 --> 0:49:17.000 These rabbits, these horned rabbits, were a strange thing to see, 0:49:17.280 --> 0:49:21.960 but they weren't unknown, Like there was already sort of 0:49:22.000 --> 0:49:24.800 this first of all, like everyone who was a hunter 0:49:24.840 --> 0:49:26.160 out there was like, oh, yeah, we see this all 0:49:26.200 --> 0:49:30.520 the time. Yeah. Secondly, hope. Secondly, there's a jackalobe. It's 0:49:30.560 --> 0:49:33.359 actually thought that these horned rabbits might have given rise 0:49:33.440 --> 0:49:39.520 to the jacalobe myth. Yes, very cool. So Chop trapped 0:49:39.520 --> 0:49:41.200 some of these rabbits so he could get a closer 0:49:41.239 --> 0:49:44.480 look at their horns and discovered that the horns were 0:49:44.520 --> 0:49:51.720 actually cancerous growths caused by a rabbit papalomavirus. What. Yeah, 0:49:51.760 --> 0:49:56.239 so the jackalobe is just a rabbit infected with a 0:49:56.280 --> 0:50:02.080 cancer causing papalama virus, poor jackalopees. And he was able 0:50:02.120 --> 0:50:06.080 to in the lab induce these cancers in other rabbits 0:50:06.120 --> 0:50:10.440 through like passing on the virus. Wow. And I also 0:50:10.480 --> 0:50:14.480 realized I haven't done the etymology for papaloma, which comes 0:50:14.520 --> 0:50:17.440 from a combo of Latin and Greek words that together 0:50:17.520 --> 0:50:21.839 mean a tumor resembling a nipple. There you go. 0:50:23.000 --> 0:50:24.400 I'm just gonna leave that there. 0:50:26.400 --> 0:50:31.160 And then the final big piece of news or developments 0:50:32.200 --> 0:50:35.759 happened in nineteen sixty four, which is when the discovery 0:50:35.800 --> 0:50:38.560 of the epstein bar virus and the fact that it 0:50:38.600 --> 0:50:43.200 could cause Burkitt's lymphoma showed that cancer causing viruses didn't 0:50:43.239 --> 0:50:49.400 exist solely in animals, but could also cause cancer in humans. Okay, 0:50:49.400 --> 0:50:52.080 so at this point all of the pieces were in 0:50:52.160 --> 0:50:55.600 place to link HPV to cervical cancer, but that didn't 0:50:55.680 --> 0:50:59.040 happen right away, And in order to tell that part 0:50:59.080 --> 0:51:01.000 of the story, I wanted to dive a bit into 0:51:01.000 --> 0:51:04.480 the history of cervical cancer to give a bit more context, 0:51:05.120 --> 0:51:07.600 Cervical cancer doesn't leave any marks on the skeleton, so 0:51:07.640 --> 0:51:10.360 we have to rely on early descriptions of what we 0:51:10.480 --> 0:51:13.480 might think might be cervical cancer to understand sort of 0:51:13.480 --> 0:51:16.480 the perception of the disease, as well as to guess 0:51:16.520 --> 0:51:20.400 is how long it's been around. Although given how ancient 0:51:20.480 --> 0:51:24.240 these viruses are and how like everyone is infected. 0:51:23.920 --> 0:51:26.120 With them, it's safe to assume. 0:51:25.800 --> 0:51:29.919 That cervical cancer has been in humans from day one, 0:51:30.239 --> 0:51:33.200 although it was one of the papers I read noted 0:51:33.239 --> 0:51:36.760 that the rate of cervical cancer probably increased over time, 0:51:37.080 --> 0:51:40.440 not due to human travel or increase in population density, 0:51:40.920 --> 0:51:43.520 which might have had a role to play, but due 0:51:43.520 --> 0:51:46.640 to the nature of cancer in general as a disease 0:51:46.640 --> 0:51:49.840 of longevity. So like when life expectancy was lower, people 0:51:50.160 --> 0:51:52.359 were less were more likely to die of something else 0:51:52.400 --> 0:51:53.840 before getting cervical cancer. 0:51:54.160 --> 0:51:58.360 Yeah, it's a long time period from infection to cancer 0:51:58.560 --> 0:52:01.200 for cervical cancer, so yeah, makes sense. 0:52:01.920 --> 0:52:06.160 And there are some ancient writings ancient Egyptian papyri, in 0:52:06.200 --> 0:52:10.080 some Hindu manuscripts from like the fourth century BCE, and 0:52:10.120 --> 0:52:13.719 then also in ancient Rome, there was a device uncovered 0:52:13.760 --> 0:52:18.160 that looks like an or very early speculum, which is 0:52:18.560 --> 0:52:23.040 pretty interesting to think about, like the first first century CE. 0:52:23.760 --> 0:52:24.880 I bet it's painful. 0:52:25.400 --> 0:52:27.840 Oh yeah, and it's going to get a lot more painful, 0:52:27.880 --> 0:52:33.319 I think, because early treatment for ulceration or malignant growth 0:52:33.360 --> 0:52:36.400 of the uterus or cervix was usually something along the 0:52:36.440 --> 0:52:42.200 lines of couterization or partial removal, but honestly, those things 0:52:42.280 --> 0:52:45.680 usually ended up leading to just a quicker death. By 0:52:45.719 --> 0:52:49.720 the sixteen hundreds seventeen hundreds or so, people had started 0:52:49.760 --> 0:52:52.799 to make the distinction between malignant and benign in these 0:52:52.920 --> 0:52:56.480 uterine or cervix tumors, but the distinction was pretty much 0:52:56.560 --> 0:52:59.800 useless because it generally involved the doctor just going Okay, 0:53:00.160 --> 0:53:02.920 patient is wasting away and dying, so this must be malignant, 0:53:03.440 --> 0:53:05.399 or this tumor doesn't seem to be changing at all, 0:53:06.040 --> 0:53:12.760 so the patient's probably fine. Gat Essentially, yeah, Essentially, doctors 0:53:13.080 --> 0:53:15.160 were just sitting around waiting for their patient to die 0:53:15.239 --> 0:53:18.279 or not. As you might have guessed, many doctors were 0:53:18.280 --> 0:53:22.520 not especially content with this type of hands off medicine, 0:53:22.560 --> 0:53:26.480 and so they began to explore treatments such as belladonna, hemlock, 0:53:26.640 --> 0:53:32.280 strych nine, lead mercury et cetera. Basically like any very toxic, 0:53:32.480 --> 0:53:34.520 intense compounds. 0:53:33.840 --> 0:53:35.560 All kinds of things that can kill you. 0:53:38.040 --> 0:53:42.000 And of course nothing worked, and the birth of the 0:53:42.040 --> 0:53:48.480 field of gynecology didn't exactly help things either. Right away, 0:53:49.880 --> 0:53:54.440 gynecology began to be recognized as a separate, distinct medical 0:53:54.480 --> 0:53:58.680 field around the seventeen hundreds and eighteen hundreds, but not 0:53:58.840 --> 0:54:03.200 to gather knowledge that would improve the health of women everywhere, 0:54:03.680 --> 0:54:09.279 but rather to detect sexually transmitted diseases in sex workers. Basically, 0:54:09.320 --> 0:54:11.839 a big part of the push for gynecology was to 0:54:11.880 --> 0:54:17.279 protect the male clients of sex workers, like you were 0:54:17.320 --> 0:54:18.719 given a clean. 0:54:18.440 --> 0:54:19.799 Bill of health and allowed to. 0:54:19.800 --> 0:54:22.360 Work, or you were held in the hospital until you 0:54:22.440 --> 0:54:27.360 got better against your will. In this burgeoning field of gynecology, 0:54:27.600 --> 0:54:31.480 tools to help assess vaginal or cervical health were needed, 0:54:31.520 --> 0:54:35.160 and so they were developed. For instance, the Duckbill speculum, 0:54:35.440 --> 0:54:38.759 which is very close, if not the exact thing that 0:54:38.800 --> 0:54:42.800 we used today, That was developed by James mary and Simms, 0:54:42.840 --> 0:54:46.759 who was the so called father of modern gynecology and 0:54:46.840 --> 0:54:49.319 also one of the most unethical people I have read 0:54:49.360 --> 0:54:51.440 about while working on the podcast. 0:54:52.160 --> 0:54:53.439 Not surprised about that. 0:54:53.760 --> 0:54:58.200 Oh no, he operated almost exclusively unenslaved black women and 0:54:58.239 --> 0:55:02.120 never with anesthesia, conducted all sorts of medicalized torture, as 0:55:02.160 --> 0:55:06.680 well as perpetuated a lot of misinformation. Please read the 0:55:06.719 --> 0:55:11.320 book Medical Bondage by Deirdre Cooper Owens for more info 0:55:11.360 --> 0:55:15.400 about him. It's so good, Okay. Anyway back to cervical cancer. 0:55:15.800 --> 0:55:18.280 So what these new and improved speculums did was allowed 0:55:18.360 --> 0:55:22.520 doctors to visualize these different lesions and record their observations, 0:55:23.040 --> 0:55:27.279 so that ultimately the link between cervical lesions or cauliflower 0:55:27.320 --> 0:55:32.480 growths and later developing advanced cancer of the womb was made. 0:55:32.680 --> 0:55:36.920 And this visibility or observability of two of the most 0:55:36.960 --> 0:55:40.000 common cancers to affect women so like breast cancer and 0:55:40.040 --> 0:55:44.640 cervical cancer, led to cancer's overall being seen as a 0:55:44.760 --> 0:55:49.200 quote female ailment, usually attributed to some part of the 0:55:49.200 --> 0:55:53.839 woman's reproductive tract. So like, oh, you know, like hysteria, 0:55:54.000 --> 0:55:59.200 right like it must be from an overactive beaterus, right like, 0:55:59.239 --> 0:56:03.960 as if anyone knew what that meant? Wow, a wandering uterus, 0:56:04.000 --> 0:56:08.719 a wandering uterus. So and then second book recommendation here 0:56:08.800 --> 0:56:14.520 illness is a metaphor by Susan Sontag Okay. So, once 0:56:14.600 --> 0:56:17.320 doctors had made the link between these lesions and cancer, 0:56:17.400 --> 0:56:20.160 they started to try to treat these ulcers to prevent 0:56:20.200 --> 0:56:25.400 their spread again cauterization or treatment with corrosive chemicals, or 0:56:25.520 --> 0:56:29.400 simply removal of the affected areas, so like full on 0:56:29.480 --> 0:56:34.160 trying to remove a cervix or uterus. These were the 0:56:34.320 --> 0:56:37.360 pretty much like the options that they that they chose, 0:56:38.280 --> 0:56:42.640 and in these days, these more drastic options were nearly 0:56:42.800 --> 0:56:50.040 almost always fatal and in the days before anesesia unbelievably excruciating. 0:56:51.800 --> 0:56:56.560 Even after surgical practices and diagnostic tools improved, focus turned 0:56:56.560 --> 0:57:00.000 towards ways to detect cancers early and prevent them from spreading. 0:57:01.320 --> 0:57:07.480 Enter the pap smear. The pap smear was developed by 0:57:07.480 --> 0:57:11.160 none other than doctor George Papa Niki Lau in the 0:57:11.239 --> 0:57:12.400 nineteen twenties. 0:57:13.719 --> 0:57:16.960 The nineteen twenties, Yeah, I didn't realize it was not 0:57:17.080 --> 0:57:17.520 long ago. 0:57:18.120 --> 0:57:22.280 Yeah, So he had started work on mice to develop 0:57:22.280 --> 0:57:25.160 a lab test to show how changing levels of estrogen 0:57:25.200 --> 0:57:29.800 could be detected in changes in the vaginal lining. And 0:57:29.880 --> 0:57:31.880 he was like, well, I really want to like translate 0:57:31.920 --> 0:57:35.520 this research into humans. I could use it to stimulate 0:57:35.560 --> 0:57:39.400 menstruation or treatment fertility. But then he was like, I 0:57:39.440 --> 0:57:44.240 actually have no idea what a normal vaginal smear looks like, 0:57:44.240 --> 0:57:48.680 Like what's the baseline? And so once he started looking 0:57:48.760 --> 0:57:51.720 for that baseline, he began observing that some of the 0:57:51.760 --> 0:57:57.440 smears had irregular looking cells, and subsequent gynecological examination revealed 0:57:57.440 --> 0:57:59.440 that they had early cancer of the cervix. 0:58:00.800 --> 0:58:02.560 And his article that described. 0:58:02.120 --> 0:58:04.600 This finding didn't really gain a lot of traction, and 0:58:04.640 --> 0:58:07.480 many doctors remained skeptical for a number of years. But 0:58:07.760 --> 0:58:11.680 over time this use for vaginal smears grew, and they 0:58:11.680 --> 0:58:16.080 were then named the papiniko lao or pap smear in 0:58:16.160 --> 0:58:22.080 his honor, doctor George Papp. The pap smear, especially the 0:58:22.120 --> 0:58:25.320 simplified version of the test, which was developed by doctor 0:58:25.400 --> 0:58:29.840 Anna Marion Hilliard in the fifties, I think did a 0:58:29.880 --> 0:58:32.680 lot to advance knowledge in terms of what proportion of 0:58:32.760 --> 0:58:36.120 lesions were likely to remain localized and which were likely 0:58:36.160 --> 0:58:40.640 to advance to invasive malignancies. In the nineteen sixties and 0:58:40.640 --> 0:58:44.680 seventies continued with this trend of early detection and lesion removal, 0:58:44.840 --> 0:58:49.040 with fewer and fewer hysterectomies performed instead being replaced by 0:58:49.120 --> 0:58:52.720 less invasive surgical procedures, and so this was a great 0:58:52.760 --> 0:58:57.200 improvement from the early days of cervical cancer. Early detection 0:58:57.320 --> 0:59:01.320 methods had been developed, and physicians realized that precancerous lesions 0:59:01.360 --> 0:59:05.080 were pretty fragile, meaning that their removal often meant that 0:59:05.120 --> 0:59:11.800 the cancer itself was gone, but issues remained. These cervical biopsies, 0:59:12.160 --> 0:59:16.760 which were described as as minor surgical procedures, not only 0:59:16.800 --> 0:59:20.680 still had and have risks associated with them, but they 0:59:20.680 --> 0:59:26.160 could also be very painful and associated with uncomfortable side effects, 0:59:27.120 --> 0:59:31.080 and a positive diagnosis itself could be quite terrifying since 0:59:31.120 --> 0:59:35.000 it usually meant additional diagnostic tests, which can be distressing, 0:59:35.240 --> 0:59:40.200 especially because there often was an adequate communication, and that 0:59:40.360 --> 0:59:43.959 problem lingers today about what exactly the tests are for 0:59:44.280 --> 0:59:47.920 or what the finding is. The consensus, of course, and 0:59:47.920 --> 0:59:50.000 I know you'll talk more about this, is that regular 0:59:50.040 --> 0:59:54.280 screening helps detect and effectively treat cervical cancers, but that 0:59:54.360 --> 0:59:58.240 in many places clear guidelines didn't exist or were being 0:59:58.280 --> 1:00:01.200 developed at a slow pace for how frequently someone should 1:00:01.240 --> 1:00:03.880 be tested or the age group that should be tested. 1:00:06.000 --> 1:00:06.920 I could get. 1:00:07.320 --> 1:00:09.520 Literally so excited talking about guidance. 1:00:10.080 --> 1:00:13.880 Oh yes, and I think that often, like one of 1:00:13.880 --> 1:00:17.240 the biggest problems is just like, once again, we always 1:00:17.280 --> 1:00:19.960 come back to this communication, right, so like not just 1:00:20.640 --> 1:00:23.400 in public health campaigns, which like those were pushed really 1:00:23.400 --> 1:00:26.600 hard in the sixties and seventies, but also between physician 1:00:26.800 --> 1:00:30.880 and patient, right like open communication, clear communication, ask as 1:00:30.880 --> 1:00:31.760 many questions. 1:00:31.480 --> 1:00:31.959 As you want. 1:00:32.040 --> 1:00:36.520 I will be as you know, direct and informative as possible. Whatever. 1:00:36.680 --> 1:00:40.720 So anyway, but the bottom line is that for the 1:00:40.760 --> 1:00:45.320 most part, effective treatment is no substitute for complete prevention, 1:00:46.560 --> 1:00:49.240 and the only way to do that was to understand 1:00:49.280 --> 1:00:53.480 what caused these cancers. This was not a new question. 1:00:54.360 --> 1:00:58.360 Even before cancer, like the big C cancer was defined 1:00:58.400 --> 1:01:02.240 medically or cellularly, people had wondered about the causes of 1:01:02.320 --> 1:01:06.680 various cancers, including cervical cancer, and there was quite a 1:01:06.720 --> 1:01:09.920 long list in the case of cervical cancer of suspected 1:01:09.960 --> 1:01:16.720 causes masturbation, excessive sexual activity, sexual abstinence, sterility, syphilis, and 1:01:16.760 --> 1:01:19.520 other STIs, great sadness. 1:01:19.640 --> 1:01:22.720 Dangers of great sadness. 1:01:22.320 --> 1:01:25.280 Great sadness, dangers. 1:01:24.800 --> 1:01:34.320 Of urban life, fright, childbirth, abortion, and menopause. Literally anything, yeah, 1:01:34.400 --> 1:01:39.840 anything that happens near the cervix YEP. Then the field 1:01:39.920 --> 1:01:42.920 of medical or health statistics finally shed some light on 1:01:42.960 --> 1:01:46.800 the issue in the mid eighteen hundreds when Italian surgeon 1:01:46.880 --> 1:01:51.120 Domenico Rigoni Stern published his findings that nuns had a 1:01:51.320 --> 1:01:55.200 much lower rate of uterine cancer and a higher rate 1:01:55.240 --> 1:01:57.960 of breast cancer than married women, and this did not 1:01:58.080 --> 1:02:00.360 distinguish between like like. 1:02:00.360 --> 1:02:04.480 True uterine versus cervical right versus true urine. 1:02:04.520 --> 1:02:07.439 This research not only hinted at a potential sexual link 1:02:07.440 --> 1:02:11.160 to cervical cancer, but it also suggested that different cancers 1:02:11.280 --> 1:02:15.040 might have different causes, which is pus like a pretty. 1:02:14.760 --> 1:02:19.200 Big that's a huge Yeah, that's in the eighteen hundreds. 1:02:19.920 --> 1:02:24.000 Yeah, wow yeah. Other research from around the same time 1:02:24.160 --> 1:02:27.200 supported the sexual link. In one hundred and twenty cases 1:02:27.240 --> 1:02:30.920 of uterine cancer, five point eight three percent were from 1:02:30.960 --> 1:02:34.240 single women, eighty six point six were married, and seven 1:02:34.280 --> 1:02:38.640 point five were widows. Later, when cervical cancer was distinguished 1:02:38.640 --> 1:02:42.120 from cancer of the uterine body, the link between sex 1:02:42.160 --> 1:02:46.960 and cervical cancer remained, and additional evidence like how cervical 1:02:47.000 --> 1:02:50.840 cancer was lower in groups that practiced male circumcision and 1:02:50.880 --> 1:02:54.480 how sexually active but unmarried women experienced similar rates of 1:02:54.520 --> 1:02:58.600 cervical cancer as married women. These things further supported this link. 1:02:59.600 --> 1:03:02.800 It seems seemed so clear that cervical cancer was tied 1:03:02.800 --> 1:03:06.520 to sexual activity that by the nineteen seventies there were 1:03:06.600 --> 1:03:10.320 articles in scientific journals asking if cervical cancer was a 1:03:10.400 --> 1:03:14.800 sexually transmitted infection. I mean, and it certainly seemed to be. 1:03:15.840 --> 1:03:19.840 But which one? Which one was it? Was it syphilis 1:03:19.920 --> 1:03:24.320 trickamonis donnerrhea? Or how about the great boogeyman of the 1:03:24.320 --> 1:03:30.120 sexual revolution herpe simplex two? HERB must have been herb 1:03:31.240 --> 1:03:34.640 And this last one HSV two I keep like, I 1:03:34.720 --> 1:03:39.720 was like, hpvhs Yeah, this last one Herpe's simplex virus too. 1:03:40.280 --> 1:03:43.440 This emerged as the favorite partially because it did have 1:03:43.560 --> 1:03:48.480 some support from epidemiological studies, but at least one researcher 1:03:48.680 --> 1:03:54.720 wasn't so sure. Doctor Harold Zerhausen, who is a German virologist, 1:03:55.320 --> 1:03:58.600 could not find Herpe's simplex virus too reliably in the 1:03:58.640 --> 1:04:02.280 many cervical cancer by he screened, and so he came 1:04:02.320 --> 1:04:05.560 to the conclusion that it wasn't the cause, and he 1:04:05.640 --> 1:04:09.640 presented his findings at the nineteen seventy two Get a 1:04:09.680 --> 1:04:12.720 load of this name International Conference on Herpes virus and 1:04:12.760 --> 1:04:17.080 Cervical cancer. So, like what it was very pretty much 1:04:17.080 --> 1:04:20.120 accepted in that like, there was a whole conference about it. 1:04:20.840 --> 1:04:23.240 So when he presented his findings, he was met with 1:04:23.400 --> 1:04:27.440 quote stony silence, which he later felt to be quote 1:04:27.560 --> 1:04:31.200 the low point of his career, which is really depressing, 1:04:31.480 --> 1:04:35.280 poor guy. But he wasn't discouraged and he continued his 1:04:35.320 --> 1:04:38.400 work on HPV, which he thought was a much better 1:04:38.440 --> 1:04:40.720 candidate for cervical cancer than herpes. 1:04:40.840 --> 1:04:42.800 So that was the low point, because things went up 1:04:42.800 --> 1:04:43.560 from there. 1:04:43.560 --> 1:04:44.920 Things went way up. 1:04:45.800 --> 1:04:49.160 He published his hypothesis in nineteen seventy six, and that 1:04:49.320 --> 1:04:52.040 was a year before his lab group discovered that yes, 1:04:52.720 --> 1:04:57.200 there were actually multiple types of HPV, and the final 1:04:57.200 --> 1:05:01.240 breakthrough came in nineteen eighty two and his research fellow 1:05:01.760 --> 1:05:07.760 Mattiah Durst, isolated a new HPV type, HPV sixteen from 1:05:07.800 --> 1:05:11.040 a cervical cancer biopsy. He came up with the naming system, 1:05:11.040 --> 1:05:15.000 by the way, or like the numbering system. HPV eighteen, 1:05:15.160 --> 1:05:19.720 another cancer causing type, was found shortly after, and nearly 1:05:19.880 --> 1:05:24.080 all of the lab specimens of cervical cancer biopsies contained 1:05:24.160 --> 1:05:28.280 one of these viruses, and to Zerhausen, the link was clear, 1:05:28.880 --> 1:05:33.480 as was the path forward. In nineteen eighty four, he 1:05:33.600 --> 1:05:37.920 approached pharmaceutical companies to start working on a vaccine, but 1:05:38.040 --> 1:05:43.360 they all turned him down, saying, yeah, that's not going 1:05:43.440 --> 1:05:46.200 to be profitable. There are more urgent problems to solve, 1:05:48.440 --> 1:05:53.000 I know. And the scientific community was like almost as 1:05:53.080 --> 1:05:56.280 dismissive of his findings for the most part. Like, it 1:05:56.440 --> 1:06:00.880 wasn't really until the mid nineties and after extensive demiological 1:06:00.920 --> 1:06:04.360 work that there was wide consensus on HPV's role in 1:06:04.360 --> 1:06:08.800 cervical cancer. And the landmark study that erased all doubt 1:06:09.000 --> 1:06:11.680 was published in nineteen ninety five and involved over one 1:06:11.680 --> 1:06:15.360 thousand cervical tumors from twenty two countries and it showed 1:06:15.360 --> 1:06:18.240 that ninety nine point seven percent of the tumors were 1:06:18.440 --> 1:06:23.560 HPV positive. So then eleven years after this study, in 1:06:23.560 --> 1:06:27.600 two thousand and six, the HPV vaccine Gardissel, the first 1:06:27.760 --> 1:06:34.040 HPV vaccine, was approved by the FDA to considerable controversy. 1:06:34.240 --> 1:06:35.680 Oh yeah, which I think. 1:06:35.560 --> 1:06:39.800 You'll go into. And since then many other countries have 1:06:39.880 --> 1:06:44.800 approved its use and incorporated it into recommended vaccination programs. 1:06:44.920 --> 1:06:49.240 Two varying degrees of effectiveness and also with some very 1:06:49.240 --> 1:06:53.240 interesting messaging. I also want a note real quick that 1:06:53.520 --> 1:06:56.800 Zerhausen was awarded a Nobel Prize I believe in two 1:06:56.800 --> 1:06:59.240 thousand and eight for this for making this link. 1:07:00.280 --> 1:07:02.040 I just want to go back to the fact that 1:07:02.240 --> 1:07:09.840 this link wasn't cemented in scientific consensus until the mid nineties. 1:07:11.760 --> 1:07:13.960 That was sort of like the final like I think 1:07:13.960 --> 1:07:17.720 that there had been steady growth of acceptance of this. Yeah, 1:07:18.040 --> 1:07:23.560 but oh my, yeah, it's an interesting timeline that. 1:07:23.680 --> 1:07:30.680 It's fascinating that timeline Erin so Erin, Oh. 1:07:29.440 --> 1:07:33.160 I'm hoping you're about to tell me more about some 1:07:33.240 --> 1:07:37.360 of these vaccine controversies, in particular how the vaccine was 1:07:37.400 --> 1:07:41.760 targeted to certain groups or certain people, and how much 1:07:41.840 --> 1:07:45.800 of an impact we can see now fifteen years after 1:07:45.840 --> 1:07:47.160 it was first introduced. 1:07:47.920 --> 1:07:51.320 I can't wait. We'll get into it right after this break. 1:08:22.600 --> 1:08:26.160 I want to get into all of that juicy vaccine 1:08:26.200 --> 1:08:32.040 info and cervical cancer statistics and everything, and also just 1:08:32.080 --> 1:08:34.680 like a lot of Aaron and Aaron's hot takes. How 1:08:34.680 --> 1:08:39.920 about that, But first, let's bring it all the way 1:08:39.960 --> 1:08:43.840 back to HPV for a minute, because I really want 1:08:43.880 --> 1:08:50.160 to stress just how prevalent this virus is, and this 1:08:50.240 --> 1:08:54.599 is specifically for genital HPV, so we're not even going 1:08:54.640 --> 1:08:57.960 to account for the fact that every child probably has 1:08:58.000 --> 1:09:00.479 a wart and a lot of adults do too at 1:09:00.479 --> 1:09:03.880 some point on their skin. When we're talking about genital 1:09:04.160 --> 1:09:08.720 HPV point prevalence. So overall, if you just at any 1:09:08.760 --> 1:09:11.960 given time took a sample of random adults, anywhere from 1:09:12.080 --> 1:09:16.599 three to forty five percent of them would be positive 1:09:16.600 --> 1:09:19.160 for HPV, even without any symptoms. 1:09:19.800 --> 1:09:21.880 That's I mean, that's a very high percentage. 1:09:21.920 --> 1:09:26.280 And that's just point prevalence. If you look at lifetime risk, 1:09:27.400 --> 1:09:31.920 which means because most people who get this infection will 1:09:32.000 --> 1:09:34.280 clear it, so they might have had it, but when 1:09:34.320 --> 1:09:36.680 you sample them, they come up negative. So if you 1:09:36.720 --> 1:09:40.799 look at lifetime risk, we're talking eighty percent of people 1:09:41.280 --> 1:09:43.800 are likely to be infected with HPV at some point 1:09:43.840 --> 1:09:44.640 in their lives. 1:09:44.920 --> 1:09:50.280 It's almost an inevitability. It's almost an inevitability. But that's 1:09:50.400 --> 1:09:55.040 just HPV. Let's now focus on cervical cancer because we 1:09:55.160 --> 1:09:59.759 have the most data for cervical cancer, so worldwide today 1:10:00.160 --> 1:10:06.400 well twenty eighteen data, cervical cancer causes an estimated five 1:10:06.479 --> 1:10:09.840 hundred and seventy thousand new cases every year. 1:10:10.479 --> 1:10:13.200 With five hundred and seventy thousand, five. 1:10:13.080 --> 1:10:17.160 Hundred and seventy thousand new cases and over three hundred 1:10:17.240 --> 1:10:21.920 and eleven thousand deaths due to cervical cancer every year, 1:10:22.280 --> 1:10:29.240 every year, HPV worldwide is the fourth leading cause of 1:10:29.360 --> 1:10:33.679 cancer in people with a cervix. The fourth leading cause 1:10:33.720 --> 1:10:36.479 of cancer in people with a cervix worldwide. 1:10:36.760 --> 1:10:40.240 It's so interesting to me, the lack of visibility between 1:10:40.360 --> 1:10:44.080 something like breast cancer, lung cancer, and then cervical cancer. 1:10:46.200 --> 1:10:50.519 Well, here's part of it. The vast majority of these 1:10:50.560 --> 1:10:54.639 new cases and deaths that are due to cervical cancer 1:10:54.720 --> 1:10:58.439 are in low and middle income countries where access to 1:10:58.600 --> 1:11:04.639 screenings and vaccines is very limited, if it's even existent 1:11:04.960 --> 1:11:09.960 at all. If we look briefly at data in the US, 1:11:10.640 --> 1:11:15.280 there is an estimated thirty six thousand new cases of 1:11:15.560 --> 1:11:21.639 HPV associated cancers every year. That's all HPV associated cancers. Okay, 1:11:21.920 --> 1:11:26.080 So in the US that includes about fourteen thousand cases 1:11:26.120 --> 1:11:31.639 of oropharyngeal or throat cancer, eleven thousand cases of cervical cancer, 1:11:32.640 --> 1:11:36.639 six thousand cases of anal cancer, and over three thousand 1:11:36.640 --> 1:11:41.120 cases of vaginal or vulgar cancer and a thousand cases 1:11:41.120 --> 1:11:45.640 of penile cancer. Dang, that's a lot of humans. 1:11:45.920 --> 1:11:48.000 That's a lot of humans worldwide. 1:11:48.000 --> 1:11:49.840 And I do kind of want to focus on this 1:11:49.880 --> 1:11:55.000 for a second because it's so under represented, Like talk 1:11:55.040 --> 1:11:59.320 about cervical cancer being underrepresented. Eighty five percent of anal 1:11:59.360 --> 1:12:05.679 cancers are associated with HPV, eighty five percent, forty six 1:12:05.760 --> 1:12:10.439 percent of penal cancers HPV, anywhere from thirty three to 1:12:10.560 --> 1:12:17.840 seventy two percent of oropharyngeal HPV. It's a lot of cancers. 1:12:18.160 --> 1:12:19.080 Yeah. 1:12:19.160 --> 1:12:22.840 And while we have screening programs in a lot of 1:12:22.880 --> 1:12:28.080 places that can detect cervical cancer, which is incredible because 1:12:28.479 --> 1:12:33.400 it's very effective. The pap smer is a screening tool 1:12:33.600 --> 1:12:37.519 that can detect pre cancerous changes that can then be 1:12:37.680 --> 1:12:40.639 treated so that it never becomes cancer. 1:12:41.640 --> 1:12:44.320 If we had something equivalent to a pap smere for 1:12:44.439 --> 1:12:47.800 like other kinds of cancers, I mean, it would be incredible. 1:12:47.960 --> 1:12:49.160 Act I think it's incredible. 1:12:49.280 --> 1:12:51.760 It's hard to wrap your brain around just how amazing 1:12:51.880 --> 1:12:54.320 it is to be able to be like there is 1:12:54.400 --> 1:12:57.719 cancer developing or pre cancer developing, we can do something 1:12:57.760 --> 1:12:58.320 about it. 1:12:58.320 --> 1:12:59.439 It's the other. 1:12:59.320 --> 1:13:02.280 Thing, too, is that the way that you can then 1:13:02.760 --> 1:13:06.160 treat those pre cancerous changes that you might detect on 1:13:06.200 --> 1:13:10.240 a pap smear is also not nearly as invasive as 1:13:10.240 --> 1:13:12.280 the way that you would need to treat pre cancerost 1:13:12.320 --> 1:13:15.240 changes if you could even detect those other places. So 1:13:15.360 --> 1:13:18.839 not only are we able to detect pre cancer before 1:13:18.960 --> 1:13:21.920 it becomes cancer, but we can then also treat it 1:13:22.400 --> 1:13:25.679 before it becomes cancer. It's really similar to the way 1:13:25.680 --> 1:13:27.960 that we can do colon cancer screenings. That's really the 1:13:27.960 --> 1:13:30.280 only other one that we can do in the same 1:13:30.320 --> 1:13:31.840 way where if we see a poll up, we can 1:13:31.880 --> 1:13:35.120 remove it and we treated your cancer before it became cancer. 1:13:35.520 --> 1:13:35.960 Gotcha. 1:13:36.160 --> 1:13:44.639 Yeah, And that's incredible, but it isn't perfect. PAP smears 1:13:44.640 --> 1:13:47.800 are an invasive test, they're uncomfortable. A lot of people 1:13:47.920 --> 1:13:50.799 might not be comfortable even getting them, even in places 1:13:50.840 --> 1:13:56.960 where they are easily accessible. They're also both operator and 1:13:57.160 --> 1:14:01.240 reader dependent, and so it requires a lot of infrastructure 1:14:02.000 --> 1:14:04.439 that in low and middle income countries just might not 1:14:04.600 --> 1:14:08.840 exist at all. And in some cases, because they are 1:14:08.840 --> 1:14:13.759 so dependent on the reader and the operator, they can 1:14:14.240 --> 1:14:18.880 be overread and then potentially lead to unnecessary procedures that 1:14:18.920 --> 1:14:22.640 do have risks associated with them. So they are not 1:14:22.720 --> 1:14:28.200 a perfect thing, but on top of that, they are 1:14:28.240 --> 1:14:33.519 specific to cervical cancer, and HPV causes a lot more 1:14:33.600 --> 1:14:38.080 than just cervical cancer. So the fact that we have 1:14:38.360 --> 1:14:45.120 a vaccine is beyond incredible. Yeah, because this is a 1:14:45.200 --> 1:14:50.719 vaccine that can prevent all of these types of cancer. 1:14:51.439 --> 1:14:54.120 Not one hundred percent of all of these types of cancer, 1:14:54.680 --> 1:14:58.200 but one hundred percent of cervical cancers and a lot 1:14:58.479 --> 1:15:01.040 of the proportion of all of these other cancers. So 1:15:01.080 --> 1:15:04.320 the question is, why do we even still have cervical 1:15:04.360 --> 1:15:07.679 cancer fifteen years out from this vaccine? 1:15:07.880 --> 1:15:11.559 Well, a lot of different answers there. 1:15:11.760 --> 1:15:13.880 It's a lot of different answers, like you said, erin, 1:15:14.760 --> 1:15:17.360 a lot of it in certain countries like the US, 1:15:17.880 --> 1:15:20.120 has to do with how this vaccine was marketed at 1:15:20.160 --> 1:15:23.320 the beginning. In most places where it was rolled out, 1:15:23.360 --> 1:15:27.960 it was only recommended for people with a cervix except 1:15:27.960 --> 1:15:32.680 it was marketed as give this STI prevention vaccine to 1:15:32.760 --> 1:15:37.600 your young girls, and so that was interpreted by a 1:15:37.640 --> 1:15:41.920 lot of people as a vaccine to promote sexual promiscuity, 1:15:41.960 --> 1:15:45.120 which we all know is not allowed in our culture. 1:15:45.880 --> 1:15:50.400 And also like that's not what this vaccine does. 1:15:50.040 --> 1:15:53.000 Not in the slightest, but that is absolutely how it 1:15:53.080 --> 1:15:59.040 was perceived. Yeah, so the marketing failures were really immense. 1:15:59.640 --> 1:16:04.200 But on top of that, this was a very expensive vaccine, 1:16:04.320 --> 1:16:06.160 especially when it first came out. 1:16:06.680 --> 1:16:07.200 Holy cow. 1:16:07.360 --> 1:16:10.439 Yeah, it was one hundred and twenty dollars a dose, 1:16:11.400 --> 1:16:15.960 which compared to most childhood vaccines, is immense. You can 1:16:16.000 --> 1:16:18.360 imagine that in low and middle income countries. That is 1:16:18.479 --> 1:16:23.160 absolutely an unattainable cost even for most people in the US. 1:16:23.280 --> 1:16:26.040 One hundred and twenty dollars a dose for a vaccine 1:16:26.040 --> 1:16:28.880 that needs two to three doses. That's a lot of money. 1:16:29.720 --> 1:16:32.160 And is it one hundred and twenty dollars a dose 1:16:32.160 --> 1:16:33.720 in other countries as well? Or is it just the 1:16:33.840 --> 1:16:36.200 US has artificially inflated the price because that's just what 1:16:36.240 --> 1:16:36.920 the US does. 1:16:37.080 --> 1:16:40.040 So I couldn't get a great answer to that. It 1:16:40.200 --> 1:16:43.600 varies a lot. But today, because of a lot of 1:16:43.600 --> 1:16:47.320 different institutes that help subsidize the funding, it can be 1:16:47.439 --> 1:16:50.800 available in a lot of countries as low as in 1:16:50.880 --> 1:16:54.639 theory twenty cents or four to fifty a dose. Since 1:16:54.680 --> 1:16:56.800 two thousand and eight, which is just two years after 1:16:56.840 --> 1:16:59.400 it was introduced. PAHO, which is the Pan American Health 1:16:59.479 --> 1:17:03.120 Organization and has been subsidizing HPV vaccines at eight dollars 1:17:03.200 --> 1:17:05.960 and fifty cents per dose. So Latin America and the 1:17:06.000 --> 1:17:08.600 Caribbean actually have the highest proportion of countries that have 1:17:08.720 --> 1:17:12.320 national programs if you look at all the different regions, 1:17:12.680 --> 1:17:17.080 but overall, not a very impressive percentage of countries have 1:17:17.200 --> 1:17:23.240 instituted national HPV vaccine campaigns. As of late twenty seventeen, 1:17:23.640 --> 1:17:29.160 only about forty percent of countries had instituted national HPV 1:17:29.240 --> 1:17:33.880 vaccine programs, and you can imagine that the percentage varies 1:17:33.920 --> 1:17:38.400 greatly based on income. So seventy seven percent of high 1:17:38.439 --> 1:17:42.960 income countries have vaccination programs, but only seven percent of 1:17:43.000 --> 1:17:48.200 low income countries have vaccination programs. So this vaccine is 1:17:48.280 --> 1:17:51.240 not being evenly distributed across the globe, which is why 1:17:51.320 --> 1:17:55.360 we still have cervical cancer deaths happening every day across 1:17:55.360 --> 1:17:56.919 the globe. 1:17:57.080 --> 1:18:00.920 It is so frustrating, it really is. 1:18:01.880 --> 1:18:05.080 The World Health Organization has a lot of different goals 1:18:05.439 --> 1:18:07.880 to try and address this. Their current goals are to 1:18:08.040 --> 1:18:11.160 vaccinate ninety percent of people with a cervix by age 1:18:11.200 --> 1:18:16.719 fifteen and screen seventy percent of people with a cervix 1:18:16.760 --> 1:18:19.280 at least twice between the ages of thirty five and 1:18:19.320 --> 1:18:24.040 forty five, because again, screening is still really important, but 1:18:24.120 --> 1:18:28.000 we are no like nowhere, nowhere near those goals. 1:18:28.520 --> 1:18:32.120 And I understand that you have to have reasonable goals 1:18:32.200 --> 1:18:34.880 or at least like benchmarks, but like, why is it 1:18:34.960 --> 1:18:38.760 still just people with a cervix? Why is it not everyone? 1:18:38.880 --> 1:18:42.559 When everyone can become infected, everyone can develop some kind 1:18:42.600 --> 1:18:46.080 of cancer, and everyone can transmit it to somebody else. 1:18:46.160 --> 1:18:53.360 And saying it that's like the biggest I Okay, I 1:18:53.439 --> 1:18:59.280 get so intense when I think about that, and I 1:18:59.360 --> 1:19:03.000 honestly be because in the US, now finally the recommendation 1:19:03.120 --> 1:19:08.400 is everyone, all adolescents should be vaccinated starting at age 1:19:08.400 --> 1:19:11.120 eleven twelve. It can be as early as nine. I 1:19:11.240 --> 1:19:14.000 have issue big issue with the fact that the US 1:19:14.240 --> 1:19:18.880 still doesn't make this a mandatory vaccine for school entry. 1:19:18.920 --> 1:19:25.120 It's absolutely absurd in my errand's personal opinion, because detap 1:19:25.200 --> 1:19:28.720 is required, meningitis is required, Hepatitis B is required, and 1:19:28.760 --> 1:19:34.400 that's not roaming around schools, so like, come on. But anyways, globally, 1:19:34.560 --> 1:19:37.760 you're right, the recommendation still isn't for everyone to get 1:19:37.760 --> 1:19:40.160 this vaccine, even though we know that not only do 1:19:40.520 --> 1:19:43.240 can people with a cervix get HPV from people without 1:19:43.240 --> 1:19:46.120 a cervix? So if you're not vaccinating everyone, then you 1:19:46.240 --> 1:19:48.719 just have a bunch of people that are harboring HPV 1:19:49.000 --> 1:19:52.679 to then be spread to everyone else. But also, yeah, 1:19:52.680 --> 1:19:56.000 then we're not preventing penile cancer or anal cancer in 1:19:56.400 --> 1:20:00.280 people without a cervix, or oroferyngeal cancer like they're This 1:20:00.400 --> 1:20:04.240 is a lot bigger than just cervical cancer. This is 1:20:04.280 --> 1:20:07.719 a vaccine that can prevent a lot of different types 1:20:07.760 --> 1:20:11.519 of cancer. Everyone deserves access to it. 1:20:12.720 --> 1:20:17.920 They do, I am. It's endlessly frustrating, lessly frustrating. My 1:20:18.040 --> 1:20:22.599 big question is part of the controversy around the HPV 1:20:22.720 --> 1:20:25.240 vaccine when it first was released was that, well, we 1:20:25.280 --> 1:20:27.599 don't know whether it's going to prevent cancer. 1:20:27.840 --> 1:20:30.760 Oh yeah, aarin Right, So now. 1:20:30.880 --> 1:20:33.519 It's been fifteen years, we should have seen the effects 1:20:33.560 --> 1:20:38.160 right in the generation the first cohort that was vaccinated. Yes, Well, 1:20:38.160 --> 1:20:40.080 first of all, I have a question about the average 1:20:40.080 --> 1:20:42.040 age of onset for cervical cancer. 1:20:42.080 --> 1:20:44.639 Oh, it's fifty nine. Is the average age of death 1:20:44.720 --> 1:20:45.879 due to cervical cancer? 1:20:46.280 --> 1:20:46.960 Okay? 1:20:47.360 --> 1:20:49.080 But it could happen earlier. 1:20:48.760 --> 1:20:51.000 Absolutely, And it's one of the most common causes of 1:20:51.040 --> 1:20:54.679 cancer in people with the cervix underage forty, So it 1:20:54.720 --> 1:20:59.000 can definitely happen in younger people as well, because this 1:20:59.160 --> 1:21:03.759 is a sexual transmitted infection that has kind of highest 1:21:03.840 --> 1:21:09.479 incidents at younger ages, but usually takes ten to twenty 1:21:09.560 --> 1:21:13.000 years to then cause cancer. Okay, and then younger people 1:21:13.000 --> 1:21:15.479 are also more likely to clear the infection, so it's 1:21:15.560 --> 1:21:16.679 kind of yeah. 1:21:17.280 --> 1:21:21.280 Another question about the vaccine's durability, Uh huh, how long 1:21:21.680 --> 1:21:22.400 are you protected? 1:21:22.840 --> 1:21:27.040 Well, that's a very good question. We know for sure 1:21:27.120 --> 1:21:31.599 at least eight years. It's likely even longer than that. Okay, yeah, 1:21:31.920 --> 1:21:34.919 it's likely pretty long term. And there's some cross protection 1:21:35.120 --> 1:21:38.599 as well. So even though even the sort of broadest 1:21:38.640 --> 1:21:42.360 vaccine that we have covers nine subtypes, there's thought to 1:21:42.400 --> 1:21:44.960 be at least some cross protection to protect you against 1:21:45.160 --> 1:21:48.120 further types as well. Gotcha, if that makes sense. But 1:21:48.160 --> 1:21:52.360 you have full protection against either two, four or nine subtypes, 1:21:52.400 --> 1:21:55.960 depending on which vaccine you get. But you asked, Aarin, 1:21:56.400 --> 1:21:59.240 do we have any data to say this actually prevents 1:21:59.280 --> 1:22:02.559 cervical cancer? Because you're right. When this vaccine first came out, 1:22:02.600 --> 1:22:06.640 everyone was like, well, it protect against HPV infection and 1:22:06.880 --> 1:22:09.639 maybe like pre cancer, but we can't say for sure 1:22:09.680 --> 1:22:15.280 that it protects the cancer. Like give me strength, I know, 1:22:15.479 --> 1:22:18.160 I know it does. The answer that we have now 1:22:18.360 --> 1:22:22.200 is without a doubt, it absolutely does. If you'd like 1:22:22.320 --> 1:22:25.240 some hard data on it, there's a beautiful study out 1:22:25.240 --> 1:22:29.760 of Sweden where they implemented a school based vaccination program 1:22:30.200 --> 1:22:34.639 and studied over a million people with a cervix, about 1:22:34.680 --> 1:22:38.120 half of whom received the vaccine, and over the time 1:22:38.160 --> 1:22:42.479 period studied, only nineteen people who had received at least 1:22:42.600 --> 1:22:46.400 one dose of the vaccine were diagnosed with cervical cancer, 1:22:46.680 --> 1:22:52.120 while over five hundred who hadn't were diagnosed with cervical cancer. 1:22:52.360 --> 1:22:53.280 That's pretty clear. 1:22:53.880 --> 1:22:57.479 What's even more clear is that the protective effects were 1:22:57.560 --> 1:23:01.800 far stronger for people who were vaccinated before for age seventeen. 1:23:02.520 --> 1:23:05.759 So the earlier that people get the vaccine, the better 1:23:05.880 --> 1:23:09.519 it works. Not only because it seems to work better 1:23:09.800 --> 1:23:13.719 in younger people, but you have to get this vaccine 1:23:14.120 --> 1:23:20.440 before you are exposed to HPV. HPV is a sexually 1:23:20.479 --> 1:23:23.480 transmitted disease, which means you need to get the vaccine 1:23:23.520 --> 1:23:27.160 before you ever have sexual activity for it to be 1:23:27.240 --> 1:23:28.440 the most effective. 1:23:29.040 --> 1:23:32.960 And so you mean any HPV or you mean just 1:23:33.040 --> 1:23:35.920 the sexually transmitted HPVs. 1:23:35.479 --> 1:23:41.280 Sexually transmitted HPVs. Okay, yeah, So that's why the recommended 1:23:41.400 --> 1:23:46.200 age is eleven to twelve or even as young as nine, 1:23:46.600 --> 1:23:49.720 because the idea is to give it to people who 1:23:49.760 --> 1:23:54.360 have not yet engaged in sexual activity, like well before, 1:23:55.280 --> 1:23:58.880 so that you're really preventing this. Now, that doesn't mean 1:23:58.920 --> 1:24:01.639 that you can't get it if you have already had 1:24:01.920 --> 1:24:05.760 sexual activity or if you're over age twelve. It's recommended 1:24:05.800 --> 1:24:08.320 as like a catch up up to age twenty six, 1:24:08.880 --> 1:24:12.800 and now it's approved all the way up to age forty. Huh. 1:24:12.840 --> 1:24:16.679 So that's HPV guys and cervical cancer. 1:24:17.240 --> 1:24:18.240 It's so interesting. 1:24:21.080 --> 1:24:21.960 This is a big one. 1:24:22.360 --> 1:24:24.040 Oh my gosh, it's way bigger than I thought. I 1:24:24.080 --> 1:24:26.040 feel like I talked for seven years. 1:24:27.120 --> 1:24:28.360 There's a lot to talk about. 1:24:29.439 --> 1:24:32.320 I mean, I'm sure that I missed a lot of things. Also, 1:24:32.680 --> 1:24:35.559 so why don't we talk about our sources so that 1:24:35.560 --> 1:24:38.200 people can do a lot more reading and learn all 1:24:38.240 --> 1:24:39.679 the things that we probably forgot. 1:24:40.040 --> 1:24:43.759 Sounds great, So I will shout out just a couple 1:24:43.760 --> 1:24:47.080 of things. One is a book called A Woman's Disease, 1:24:47.160 --> 1:24:52.280 The History of cervical cancer by Elana Lowie. Then also 1:24:53.320 --> 1:24:57.360 a paper by onan at all history of human papillama 1:24:57.400 --> 1:25:03.519 virus'es Warts and Cancer Van Doorslayer twenty thirteen, Evolution of 1:25:03.520 --> 1:25:10.040 the Papalamaveri Day, and finally a great paper by Burns 1:25:10.120 --> 1:25:13.640 nineteen ninety two Warts and All the history and folklore 1:25:13.680 --> 1:25:14.200 of warts. 1:25:14.560 --> 1:25:22.840 I love it. I have a lot of different papers 1:25:23.200 --> 1:25:26.360 ranging from everything from a lot more detail on the 1:25:26.360 --> 1:25:30.680 path of physiology and natural history of HPV infection and 1:25:30.720 --> 1:25:34.400 the specific mechanisms on how it causes cancer, all the 1:25:34.400 --> 1:25:38.680 way up to the global distribution and the effects of 1:25:38.720 --> 1:25:41.040 the vaccine and all of that kind of stuff. You 1:25:41.040 --> 1:25:43.560 can find a list of our sources from this episode 1:25:43.560 --> 1:25:46.200 and every single one of our episodes on our website, 1:25:46.200 --> 1:25:48.920 This Podcast will Kill You dot Com under the episodes tab. 1:25:50.200 --> 1:25:52.960 Thank you to Bloodmobile for providing the music for this 1:25:53.040 --> 1:25:54.840 episode and all of our episodes. 1:25:55.680 --> 1:25:58.880 Thank you to Exactly Right Network, of whom we are 1:25:59.400 --> 1:26:02.160 very proud to be a member, And. 1:26:02.160 --> 1:26:05.880 Thank you to you listeners for listening and for suggesting 1:26:05.920 --> 1:26:09.960 this episode so many times. We're so excited to finally 1:26:10.120 --> 1:26:12.040 give it to you and hopefully. 1:26:11.720 --> 1:26:14.839 You take it. I learned a lot about the history 1:26:15.040 --> 1:26:18.320 of HPV and cervical cancer, which is exciting. 1:26:18.800 --> 1:26:22.800 Yeah. I learned a lot about the biology. 1:26:22.360 --> 1:26:23.960 And the current events. 1:26:25.880 --> 1:26:30.800 My gosh, wow how about that. Well, until next time, 1:26:31.320 --> 1:26:33.640 wash your hands, you filthy animals.