Sunday, May 17, 2009

Farrah Fawcett's Cancer, HPV and Gardasil

Farrah Fawcett, like Jade Goody, has focused our attention squarely on the tiny, but very real, dangers of HPV. Last night a documentary dealing with the iconic actress’ struggle with anal cancer aired to an audience of an estimated 8.9 million viewers.

In March all eyes were on reality TV star Jade Goody, who died at the appallingly young age of 27 from cervical cancer. Now Fawcett, known for her portrayal of an abused woman in The Burning Bed and for her longtime role in Charlie’s Angels, has highlighted the perils of anal cancer. In 2006 she was diagnosed with the highly curable cancer and initially was thought have beaten it; the disease, however, returned and spread to her liver.

Furious about on ongoing series of detailed leaks about her condition to the National Enquirer, and knowing that they could only come from staff at the UCLA Medical Center, 62 year-old Fawcett set a trap worthy of the French Resistance and spurred new legislation in California to safeguard patient privacy—and she’s continued to tackle her disease with equal energy, even sharing with the public what was originally supposed to be private video footage of her ordeal as a way to spread awareness.

At least those 8.9 million viewers, then, are now to some extent familiar with the disease. Anal cancer is even rarer than cervical cancer. The American Cancer Society estimates that in 2009 there will be 5, 290 new cases diagnosed in the US, mostly in people in their 60s, and about 3,190 of those will be found in women. Because anal cancer can be treated very effectively if found in time, only about 710 of those cases will die.

It’s thought that the human papillomavirus, HPV, is the cause of anal cancer. As with cervical cancer, many—even most—people will be infected with the virus at some point but it clears itself in roughly 95 percent of cases; only when an infection becomes persistent does it cause real trouble. Smoking, sleeping around, and weakening the immune system through poor diet all increase the chances of an infection becoming persistent (smoking alone can increase the chances by up to 26 times), and in the case of anal cancer, having anal sex is certainly a risk factor. Some patients, however, have no risk factors.

Symptoms can include bleeding or itching around the anus, pain in the anal area, a change in bowel habits, a lump in the anal area, swollen lymph nodes in the anal or groin area, and abnormal discharge from the anus.

Problems can usually be detected with a digital exam during a Pap test, colonoscopy, or prostate cancer screening. Anal cytology testing, a relatively new test that’s rather like an anal Pap smear, can also be performed if a patient is high risk for one reason or another. Fawcett’s battle highlights for us yet again the importance of regular screening.

The new Gardasil vaccine (in use since 2006) aims to protect against two of the most commonly cancer-causing strains of HPV, 16 and 18, as well as two that cause genital warts, although a recent study shows that 16 has for some years been losing ground to non-vaccine types. Because there are more than 100 different strains of HPV, and of those more than 40 can cause cancer, replacement diseases may well be an issue if non-vaccine types decide to fill the biological vacancy left by 16 and 18.

Two recent placebo-controlled studies showed that Gardasil decreased the risk of different types of pre-cancerous cells by 17 to 45 percent. It’s not known how long the vaccine will remain effective but a recent study showed strong protection against HPV type 16 alone for 8.5 years.

The vaccine has been associated with a number of side-effects, including Guillain-BarrĂ© Syndrome, an unusually rapid form of ALS, paralysis, and convulsions and epilepsy. No causal link has been definitively proved as yet; critics point to a high number of VAERS reports, particularly compared to Menactra, a vaccine that is aimed at a similar population. When three young girls in Spain lost consciousness and convulsed—the two we know most about have been in and out of intensive care ever since—health authorities determined that the vaccine had not caused the convulsions, but could have triggered them.

Germany and Scotland are both considering changing or ending their HPV vaccination programs because of concerns about the efficacy of the program. Many people are looking to other preventatives currently in the development pipeline, such as an ointment made with GML that would also protect against HIV.

Because of the potential side effects and less than complete protection provided by both Cervarix and Gardasil, consumers should research the pros and cons of the vaccines for themselves Regardless of your opinion about Gardasil as an HPV preventative, however, HPV is indeed an issue that we should all be aware of, and one can only be thankful to public figures like Farrah Fawcett who are willing to go very, very public to that end.

Meanwhile, my very heartfelt prayers are with her, and with her family and friends too.


Nomad said...

After seeing Farrah Fawcett's documentary I am convinced that she is an extremely genuine person; it was wonderful of her to step outside of herself to make this documentary

Anonymous said...

Overall, I was impressed with the informmation provided in this blog, as I was curious if the discussion of Farrah Fawcett's untimely and tragic demise was linked to HPV. However, when I read the next section, I was appalled: "Smoking, sleeping around, and weakening the immune system through poor diet all increase the chances of an infection becoming persistent (smoking alone can increase the chances by up to 26 times), and in the case of anal cancer, having anal sex is certainly a risk factor. Some patients, however, have no risk factors."

Indeed, sexual activity of ANY kind puts individuals at risk for HPV particularly women. I believe that this public forum on Gardasil has taken a particularly moralistic tone in saying "sleeping around...all increase the chances of an infection becoming persistent." Why not echo the dictum of the CDC, which, according to their website says that "..., even people with only one lifetime sex partner can get HPV, if their partner was infected with HPV."

It is not splitting hairs but rather maintaining that the public health discussion of HPV is about human behavior not moralizing whether someone "sleeps around." HPV is a particularly insidious opportunist: one simple sexual encounter (whether protected with barrier methods like female/male condoms or dental dams) may mean a future battle for one's life. HPV does not need but one chance to unleash its havoc in someone's life. Please consider editing that type of language from your otherwise authoritative site.


A future MPH student

Kristin said...

I appreciate your comments--well put--but had to laugh at being thought moralistic. I grew up in the 70s and 80s, pre-AIDs, post-Pill. "Nuff said.

Indeed, just one sexual encounter can give you HPV (or AIDS, or warts, or crabs, or any other unpleasant little number). What the CDC said is absolutely correct, but it is also, in my opinion, aimed at lessening the guilt/blame/fallout for women if they get HPV/cervical cancer.

There is a huge increase in the chance of getting a PERSISTENT HPV infection if you are exposed to multiple types of HPV from multiple partners. As we both know, it's the persistent infections (that don't clear themselves like 95% of HPV infections) that cause the problems. I am traveling at the moment, but when I return I will be happy to find you a study that showed this increase quite indisputably. It is particularly true of anal cancer, I believe, although I could be wrong on that.

My generation in particular, and perhaps my daughter's generation too, tend to think that if people talk about sleeping around leading to disease they are being moralistic. Actually, I remember thinking that when my mother said it to me--but she was right, dammit. This isn't about morals, it's about biological fact.

I think it is a huge disservice to people not to tell them the facts rather than the facts as they wish they were. I would love to believe that sleeping with multiple sex partners was merely a matter of morality. (Sex is fun, after all.) But that would be a lie.

If we're grown up enough to have sex, we should also be grown up enough to face biological facts and learn how to deal with them.

Anonymous said...

WELL said, Kristin. It needs to be said!