Dr. Desiree Hooi has been leading a significant research project on the prevalence and prevention of the spread of HPV Human Papillomavirus with Fundashon Prevenshon in Willemstad, Curaçao.
We are back with Part 2 of a previous interview with Dr. Hooi you can read PART 1 here.
CF: What is HPV?
• HPV stands for Human Papillomavirus and is a double stranded DNA virus.
• HPV is the number one most common STD.
• 80 to 84% of the population was once in contact with this virus.
Fortunately the body takes care to eliminate the virus and it may take 1 to 2 years for the immune system to get rid of the virus. HPV knows approximately 160 genotypes from which can be subdivided in cutaneous and mucosa. This virus is known for in some occasions depending which genotype causing the so-called genital and some cutaneous (skin) warts. HPV is divided in low risk (lr HPV) and high risk (hr HPV). The last subdivision is important because the hr HPV is known to cause cancer and is an oncovirus. HPV 16 & 18 are the most prevalent in causing Cervical Cancer.
The HPV genotypes known for causing cancer do not give any symptoms.
CF: So is HPV a Public Health issue?
Dr. Hooi: Indeed; HPV is considered a Public Health issue due to findings of cancer caused by a very
contagious sexual transmitted virus in the cervix (feminine organ) and also in other tissues in women and men e.g. vulva, vagina, anus, oral cavity and throat in women. There are reports of HPV in men with cancer of the penis, anus, oral and throat cavity.
CF: Is this a preventable cancer?
Dr. Hooi: Yes. Besides the fact that young children can be vaccinated this cancer develops slowly. One must become infected with HPV to develop cervical cancer.
This virus causes changes in the human DNA structure and provokes a pre-cancer lesion which most of the time will take 10-15 years to turn into cancer. During this period, the pre-cancer lesion can be detected and treated on time if you have a screening (Pap smear) done regularly.
CF:Why do you think this is important in the Caribbean?
The cervical cancer mortality rate is high in the Caribbean region and it is the 2nd place most prevalent cancer among women between ages 15 to 44.
It is noticed that in developed countries screening programs have reduced the incidence of cancer and mortality rate. More data is needed to analyze the situation in the Caribbean. Guidelines must be adapted on the basis of the results within the culture and ethnicity of the medical community in the specific Caribbean area.
The results of the studies can be applied to other islands where the necessary adjustments are aimed in specific medical standards and cultures.
CF: What is your estimated result of this HPV study?
I estimate a high % positivity in the upcoming 1000 tests given. The results of the study held among 253 women on Curaçao in 2013 had a high prevalence (20.2%) in the specific age group 45-75 years.
The prevalence by country is:
Europe is 6%,
The United States 13%,
Latin America 18%
We expect a higher prevalence from the upcoming 1000 samples since the age group <40 years will be representative in this survey. Among this age group of individuals less than 40 years, HPV prevalence is the highest according to literature. Regarding our study on paraffin embedded tissue; we can mention that the HPV 16+18 was not that prevalent compared with the rest of the world.
This may have important significance for the introduction of vaccine considering the fact that other HPV genotypes are playing a role in causing cancer in our population. What type of role still needs to be discussed.
A study performed among sex workers in our community revealed no significant differences between this group and the results from the pilot in volunteered participants. We have to wait for results of the population in this specific age group <40 years that represented the sex workers in order to compare and do analysis on these findings. We can preliminarily say that it will not make an important difference since the virus is very contagious and promiscuity or multiple sex partners does not only happen amongst sex workers.
The oral cavity study it is still ongoing with results pending this year. We think that the results will not differ from the rest of the world. Regarding the women with hysterectomies with intact cervix I think there might be a large number with no cervical cancer screening afterwards because they are:
1. Not aware of the relevance of having the cervix intact and the need to perform a Pap-smear.
2. This group will be considered the non-responders to well established cervical cancer screening programs in some countries.
This fact maybe underestimated.