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Stalking a silent killer

"Stalking a silent killer" Continued...

Issue: "Autumn books," Oct. 7, 2006

Emily Wyse, a cervical cancer survivor, is still searching for answers since undergoing chemotherapy, radiation, and a hysterectomy a year ago. Before her diagnosis in 2005, Wyse had annual gynecological exams and Pap tests, all of which showed normal cervical cells. When she found out she had cancer, Wyse, 31, had been married for eight years and had two children. Her youngest child was 1 year old.

Wyse had never heard of HPV before her cancer diagnosis, but she soon had read everything she could find about it. She had never been tested for HPV, but she assumed she had it.

"We do not routinely test the cancers for HPV because it does not affect treatment and they are all positive," said Liz Swisher, a gynecological oncologist at the University of Washington, where Wyse was treated. After treatment, Wyse tested negative for HPV.

"There is a possibility that maybe I had the virus, but I was never tested for the virus, and now it's gone," she said.

With her cancer treatment a year behind her, Wyse considers herself an advocate for cervical cancer screening. She took a job as a program assistant at the Seattle Cancer Care Alliance, where she has chances to support other women who are going through cancer treatment. She still wants to reconcile her own story with the facts about cervical cancer and its links to HPV.

Wyse plans to have specimens from some of her old Pap tests checked for HPV. She believes what Swisher and other doctors say about the cause of cervical cancer, but she also wants to understand exactly what happened to her body.

"I'm kind of in limbo at this point. I want to know for sure," Wyse said. She also wants other women to know for sure, which is why she thinks the HPV test should be given more often.

"Women need to ask to be screened for this potentially life-threatening virus before it is too late," she said.

"If there's this virus and I do have it or did have it, why didn't I know about it? They basically test you for everything when you get pregnant."

FDA approval of the HPV vaccine Gardasil, which provides immunity from two kinds of HPV that cause 70 percent of cervical cancer, has sparked increased interest in the virus from women and the media. The vaccine's maker, pharmaceutical company Merck, has started a national ad campaign to promote HPV awareness. Commercials show women talking about "cancer caused by a virus" and direct viewers to the website www.

tell-someone.com. The women in the commercial appear surprised, just like Wyse, to hear that HPV causes cervical cancer.

Mao has studied HPV for almost 10 years and treated the disease for much longer. She pointed out that while doctors have had an inexpensive test for cervical cancer, the Pap test, since the 1940s, they did not have a reliable test for HPV until the last decade.

"HPV has been very elusive," Mao said. "It was one of more difficult viruses to look at in the lab." In 2000, the FDA approved an HPV DNA test, but only as a diagnosis tool for women who had abnormal Pap test results. Even though the regulations relaxed a little in 2003, Mao said most doctors still use the HPV DNA test only to diagnose abnormal Pap results. That explains why, until the release of the vaccine, many women knew about cervical cancer, but few people had heard about HPV unless they were diagnosed with it.

Even in the absence of routine HPV screening, the Pap test helped doctors in the United States bring cervical cancer rates under control. Between 1955 and 1992, the number of U.S. cervical cancer deaths dropped by 74 percent, according to the American Cancer Society. Dr. Anna Giuliano, a researcher at the H. Lee Moffitt Cancer Center and Research Institute in Florida, has studied HPV and cervical cancer since completing her Ph.D. in 1990.

"Ultimately, as long as people participate in a Pap smear screening program, their risk for cancer is going to be very low," Giuliano said.

Cervical cancer ranks 11th on the list of common cancers in American women, according to the American Social Health Association. But worldwide, it is the second deadliest cancer, next to breast cancer, in women because developing countries lack Pap test screening programs.

The World Health Organization reports that 80 percent of the world's cervical cancers occur in developing countries in Asia, Africa, and Central America. In Central America and the Caribbean, cervical cancer is more common than breast cancer.

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