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The Virus That Owns the WorldDung Hoang

The Virus That Owns the World (continued)

These days, most of the attention-grabbing headlines associated with HPV have to do with the fact that head and neck cancer is rising dramatically, especially among men, and is now as common in the U.S. as cervical cancer is among women. Each accounts for about 10,000 new cases annually.

Shah protégé Maura Gillison, MD, PhD ’01, established herself early on as an intellectual leader in a new field that straddled epidemiology, oncology and otolaryngology. Now, she and her students continue to push the frontiers of that field.

She demonstrated that HPV infection causes a distinct molecular, clinical and pathological subset of head and neck squamous cell carcinomas. An individual’s HPV status is the single most important prognostic factor in terms of whether someone will die from the disease, she says, even more important than how far along cancer has progressed. HPV-positive status is a strong predictor of survival. In fact, about 75 percent of HPV-related head and neck cancers are curable compared to 25 percent related to smoking. Also, there’s growing evidence that HPV-associated head and neck cancers require less aggressive and invasive treatment than head and neck cancers not caused by HPV. Gillison’s latest data reveal that the proportion of oropharynx cancers that were HPV-positive in the U.S. rose dramatically in the past couple of decades, from 16 percent during 1984–1989 to 73 percent during 2000–2004.

It was during an “intense three-year mentorship” beginning in 1996 that Keerti Shah taught her about science—and life, says Gillison, now at The Ohio State University

She recalls Shah’s attempts to temper her exacting nature by reminding her that “sometimes the perfect is the enemy of the excellent.” He chided her for not taking time to celebrate successes—like when their team in 2000 published the first strong evidence that HPV causes head and neck cancer in humans.

At the time, Gillison shared a lab with Gravitt. Both shared their mentor’s passion for making public health impacts with scientific findings. On Gillison’s list to complete in the summer of 2003 was a case-control study designed to definitively prove that the same human papillomavirus that causes cervical cancer also causes tonsillar cancer. Enter Gypsyamber D’Souza, a grad student who, under Gillison’s tutelage, promptly published key research in the New England Journal of Medicine.

It served D’Souza well, training with successive generations of HPV heavyweights. (So too did growing up in a household where the discussion of sex was not taboo, she says.) D’Souza, PhD ’06,

MPH, is focusing on HPV in high-risk groups, namely young adults, HIV-infected individuals, and men having sex with men. By studying patients with the disease and exploring infection in high-risk populations, the associate professor in Epidemiology aims to find out why infection leads to disease in some people but not others.

Her research necessitates a candor and nonchalance about conditions and behaviors, which some clinicians—especially those whose expertise is confined to the head and neck—might find hard to broach with patients. Although dentists generally perform quick look-see exams for cancer, HPV-related oropharynx cancers occur so deep in the throat they aren’t detected until a late stage.

“Given the lack of reliable screening, prevention is key,” D’Souza says, referring to the HPV vaccine and stressing the importance of outreach and education. To that end, she’s been producing webinars to train providers how to talk to vaccine-hesitant parents, as well as presenting at meetings and writing articles for practitioners of oral medicine

Lately, companies have gotten aggressive with their marketing of saliva HPV tests to dentists, D’Souza reports. “But once dentists tell their patients they have HPV in their mouths, what does that even mean? Essentially, we don’t know. A single, oral HPV DNA test in a healthy person is not likely to be a good predictor of cancer risk,” she says.

 In the cervix, it’s only when the infection causes a precancerous lesion or if cancer cells are detected by Pap screening that treatment is warranted.

“HPV-causing cancer really wasn’t understood outside of the cervix until these past few years,” D’Souza says. “Health care providers are just now learning what they need to tell people.”

Although more and more doctors are insisting that adolescent girls and boys should be immunized with the HPV vaccine prior to sexual debut, parents in the U.S. aren’t listening. An April 2013 Pediatrics article reveals that the number of parents who worry about the safety of the HPV vaccine and don’t intend to get their teens vaccinated rose dramatically (from 4.5 percent to 16.4 percent) from 2008 to 2010. In fact, only about 30 percent of teens have been immunized with the HPV vaccine, according to the American Cancer Society

“It’s a tragedy the rates in the U.S. are so low,” D’Souza says, citing countries such as Australia and England where school-based vaccination programs have resulted in compliance rates as high as 90 percent. “It’s going to protect the younger generation [from cancer] if we can improve our uptake of the vaccine.”

“HPV-causing cancer really wasn’t understood outside of the cervix until these past few years.”—Gypsyamber D'Souza

Comments

  • Mukund

    Staten Island 06/06/2013 11:15:46 PM

    Keertimama, You are my hero, my mama and my scientist.

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Lessons From the Master

Lessons From the Master

Patti Gravitt reflects on the science and life lessons she learned from Keerti Shah during the decades they’ve spent investigating human papillomavirus.

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