• 5/28/2007
  • New York, NY
  • Wendy Anne Epstein, M.D
  • new York News (www.nynews.com)

In a May 22 Community View (“HPV vaccine: Pressure leaves parents confused”), Bob Moffitt gives merit to the argument that mandatory vaccination with the HPV vaccine will encourage “reckless behavior such as sexual promiscuity.” Implicit in this argument is that once vaccinated an individual would feel freer to engage in sexual behavior because they felt immune to contracting cancer-causing HPV.

However, human papilloma virus is only one sexually transmitted disease. There is no vaccine for herpes, Hepatitis C, HIV. Implicit in this argument is that sexual contact is necessary to become infected with the cancer-causing strains of HPV, and by avoiding sexual contact one is guaranteed not to contract HPV. Unfortunately, sexual contact is not necessary for the transmission of cancer-causing HPV. Abstinence will not guarantee that your children are protected against developing cervical cancer.

Hand-to-hand contact can transmit cancer-causing HPV. After all, that’s how most people get ordinary warts caused by HPV. Most warts do not cause cancer, because most warts on the hands and fingers are caused by non-cancer-associated HPVs. However, cancer-causing strains of HPV, including strains 16 and 18, can also be found on the hands and fingers. Squamous cell carcinoma of the finger is almost exclusively caused by HPV strains 16 and 18, the same cause of 70 percent of cervical cancer. These cancers are potentially very aggressive and can reoccur or even metastasize if not adequately treated.

I have treated several patients that had persistent warts on their hands or fingers caused by cancer-causing strains of HPV. I have seen several women with cancer-causing strains of HPV warts on the fingers that also had atypical Pap smears of the cervix. Since most warts on the hands and fingers are treated without biopsies or special testing to see which HPV strain caused the warts, we don’t know what percentage of “ordinary”-appearing warts on the hands are caused by cancer-causing strains of HPV.

Human papilloma virus is the major cause of cervical cancer. Worldwide, cancer of the cervix is the No. 1 cause of cancer death in women. The vaccine, Gardasil, can prevent infection with the two most common cancer-causing strains of the virus.

Perhaps it is unfortunate that Gardasil is marketed solely as a prevention of cervical cancer. HPV strains 16 and 18 cause several other forms of cancers in males and females. HPV strains 16 and 18 can cause cancer of the esophagus, mouth, throat, larynx, tongue, tonsils, rectum, uncircumcised penis and skin.

It is my opinion that our culture continues its basic disdain for female sexual behavior. While the portrayal and consumption of female sexuality is in utmost demand, females engaging in sexual behavior are still morally devalued. Insidiously, under the guise of morality, female sexual behavior is to continue to be punishable by cervical cancer.

Abstinence alone does not guarantee that your children are protected against developing cervical cancer, because sexual contact is not necessary to become infected with cancer causing strains of HPV.

Vaccination with Gardasil should not lull anyone into a false sense of security because it will not immunize against all strains of cancer causing HPVs. One should try to avoid touching another person’s HPV-infected skin, be it on their genitals or fingers. The problem is that there is no way to know if someone is infected with cancer-causing HPV unless they know and tell you. Not all HPV-infected skin produces a visible wart. Vaccination therefore is important because it can prevent an infection that you or the person you are touching is unaware that they have.

While practicing dermatology for more than two decades, both in private practice and as a New York University School of Medicine faculty member teaching at Bellevue Hospital, I have witnessed how conservative cultural ideals conflict with actual human behavior. Viruses are apolitical, and so must we be in preventing the cancers they cause.

It is my opinion that all non-infected human beings, irrespective of sex or age, be offered vaccination against certain strains of HPV to prevent cancer.

The writer is a dermatologist, a faculty member of New York University School of Medicine and health officer of the village of Grand View.