HIV, HPV AND CANCER RISK. Joanne Lindsay PWN-Summit 2016 Fort Walton Beach, Florida September 2016

Transcription

1 HIV, HPV AND CANCER RISK Joanne Lindsay PWN-Summit 2016 Fort Walton Beach, Florida September 2016

2 HPV: What is it? HPV = Human Papillomavirus Common, but highly contagious virus Amongst sexually ackve people, eskmates are 75 95% have had HPV at least once (globally, based on numerous citakons, educated guess) There are more than 100 types of HPV At least 40 of these HPV types are sexually transmived, but not all can cause harm.

3 HPV: What is it? Two HPV types cause genital warts (HPV- 6 & 11) For 13 of all the HPV types, there is strong evidence of being carcinogenic to humans, which means that they may cause cancer in humans HPV - 16 is the worst offender in terms of total numbers of cancers caused, followed by HPV - 18

4 Genital Warts Ugly growths that may look like cauliflowers Can be red or white Can cause itching or burning Found on or inside sex organs of men or women Rarely develop into cancer

5 Cancers caused by HPV Women: cervix, vulva, vagina Men: penis Both : anus, head, neck (mouth & throat)

6 Who can get HPV? Anyone who is sexually ackve Almost 8 out of 10 Canadians will get HPV in their lifekmes HPV infeckons ocen have no signs or symptoms You may not be able to tell if you or your partner are infected with HPV, or even if you or your partner have ever had HPV

7 Why are there no symptoms of HPV? Most infeckons caused by HPV don t lead to lesions visible to the naked eye Even warts might be in a place that no one would ever see, such as inside a vagina, a rectum, or on a cervix

8 Can HPV be cured? No Genital warts can be treated Cell changes caused by HPV can be treated The immune system in many people may clear the virus, especially for HIV- people who are under 30 HIV+ people who get HPV are ocen unable to clear the virus

9 ProtecKon against HPV Using condoms helps but does not provide full proteckon HPV can be spread by skin-toskin contact, as penetrakon is not required VaccinaKon is effeckve at prevenkng many HPV types, such as those that can cause genital warts and HPV related cancers.

10 VaccinaKon In Canada, vaccinakon is approved for females aged 9-45 and for males aged 9-26 VaccinaKon works best before you become sexually ackve, before you get exposed to those types of HPV that cause cancer If you are already sexually ackve or already have HPV, vaccinakon may skll be effeckve in prevenkng further complicakons of an exiskng HPV infeckon

11 TesKng for HPV In Canada, teskng for HPV in women under 30 is not suggested, especially for those who are HIV- HPV is very common for those who are under 30 and sexually ackve, and many of the infeckons will clear on their own, without treatment TesKng is also not recommended for HIV+ women (or HIV+ men) as this may lead to too may posikve tests, all being followed up with colposcopy (screening for cervical infeckon) or anoscopy (screening for anal infeckon) ScienKsts ankcipate that too many of these follow-up tests, for cancer screening, would come back negakve; Research scienksts are currently working on clinical studies to determine which teskng tools are best for anal cancer screening, in order to minimize HPV tests that would lead to too many people having to go through anal anoscopy when there is no chance of them being posikvely diagnosed with anal pre-cancer

12 Anal Cancer Anal Cancer starts in the anus, the opening at the lower end of the inteskne The anus (also called the anal canal) is a short tube, about 1.5 inches long, at the end of the rectum Stool leaves the body through this tube, moving through the anal canal from the rectum

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14 What is Anal Dysplasia? Anal dysplasia is abnormal cells (or a lesion) in the lining (skin) of the anal canal Anal dysplasia is caused by HPV Some low-grade (mild) lesions can become high-grade (moderate to severe), but some may even disappear High-grade lesions can progress to cancer

15 Signs or Symptoms? While there are no specific symptoms of anal dysplasia or cancer, these may be present: Bleeding from anus or rectum A lump or mass at anal opening Pain or pressure in anal area Itching or discharge (mucus, pus) Change in bowel habits (more or fewer bowel movements, or increased straining during BM) Swollen lymph nodes (glands) in anal or groin area

16 Increased risk of genng anal cancer: Being HIV+ Being over 50 years old Being a woman, especially one with a history of cervical or vulvar dysplasia or cancer Having many sexual partners Having recepkve anal sex Smoking cigareves History of anal warts or of other sexually transmived infeckons (STIs) Not using condoms regularly

17 Screening for people at high risk Screening = looking for cancer when there are no symptoms Goal of screening = find cancer at an early stage, when treatment is most successful Screening = anal Pap test or anal Pap smear, where the anal lining is swabbed for cells that are then looked at under a microscope

18 PosiKve anal Pap test? If an anal Pap test is posikve, a biopsy should be done, where a sample of the Kssue is sniped for closer examinakon under a microscope If AIN (anal dysplasia) is found in the biopsy, and is high-grade (most likely to become cancer) treatment is advised: laser (Infra- Red CoagulaKon - IRC) or TrichloroaceKc Acid (TCA) wash

19 Sources 1. The Society of Obstetricians and Gynaecologists of Canada, hvp://hpvinfo.ca/wp-content/uploads/ 2015/04/HPVPamphlet2015E-2.pdf 2. Elizabeth SKer, M.D. and Helen H. Mu, 2011, No BuVs About It: Anal Dysplasia and Cancer 3. American Cancer Society, 2016, Anal Cancer, hvp:// analcancer/detailedguide/anal-cancerwhat-is-anal-cancer 4. Dr. Ann Burchell, personal supervision and correspondence, 2016