Dr. Bruce Brockstein (NorthShore) - 11:42 AM:
Welcome. My name is Bruce Brockstein, MD . Thanks for coming on this chat. I'm a medical oncologist specializing in head and neck (mouth and throat) cancers, as well as melanoma and sarcoma. I am the medical director of our NorthShore Kellogg Cancer Centers at Evanston, Glenbrook and Highland Park Hospitals.
I am here and available to take questions and initiate discussions during this chat.
HPV infections are extremely common!. Beside the very common HPV viruses that cause common skin warts, the majority of U.S. adults at some point in their life- generally soon after initiating sexual activity, will develop an HPV infection. These are almost always silent. Later, they can cause cervical cancer, cancer of the base of the tongue or tonsil, cancer of the vagina, vulva, anus or penis or cause genital warts
HPV related cancers will hopefully become a thing of the past in years to come, once we have succeeded in vaccinating our children with the proven effective HPV vaccine.
Dr. Bruce Brockstein (NorthShore) - 11:47 AM:
(Continued)-
HPV-related cancers will hopefully become a thing of the past in years to come once we have succeeded in vaccinating our children with the proven effective HPV vaccine. Girls aged 9-26 and boys 9-21- ideally 9-13 years old, should receive the sequence of 2 (or in some cases 3) vaccine injections. This has been shown to be highly effective in preventing cervical and oral infections in those who receive the vaccine (especially prior to first sexual activity or any HPV infection), and all the science and data points towards this preventing cancer. PREVENTING cancer with a vaccine!
Education about this, as well as screening for infection and cancer, will help us to prevent suffering and death from these cancers.
Kathryn (Moderator) - 12:00 PM:
Our chat on HPV and its related cancers is now open. You can submit questions at any time during this chat.
J.J. (Mount Prospect, IL) - 12:10 PM:
Is there any standard exam or guidelines for testing for HPV in the mouth and throat?
Should everyone be tested periodically?
Dr. Bruce Brockstein (NorthShore)
Currently there is no clinically available test to be used for testing for the HPV virus in the mouth or throat. This is used for research purposes, which has been very helpful for understanding the way the virus is transmitted and prevented.
Dr. Bruce Brockstein (NorthShore) - 12:13 PM:
We do know that in adults, about 7% of the adult population at any time has an oral HPV infection. A little less than half are from the HPV type that can cause cancer. We don't know now how many of those people will eventually get cancer, and right now, we don't know how best to treat the infection before it becomes cancer. When the virus is detected to have caused changes in the cells of the cervix in a woman; however, it is treated with a minor surgical procedure.
Kathryn (Moderator) - 12:26 PM:
We apologize - we are experiencing a small delay, and will be back shortly.
J.J. (Mount Prospect, IL) - 12:27 PM:
What percentage of oral, head and neck cancers are of HPV origin?
Dr. Bruce Brockstein (NorthShore)
In the oropharynx (back of the throat), approximately 70% in the US are caused by HPV. In the rest of the mouth, it is much lower.
The other 30% in back of throat and rest of the mouth are from tobacco and alcohol, or other carcinogens.
Cathy (Arlington Heights, IL) - 12:29 PM:
I got my HPV vaccine when I was in high school. Didn't seem out of the ordinary, but others had told me they found the shot very painful (someone said they even passed out). Is a range of experiences expected with this? Is there any way to know how someone will respond?
Dr. Bruce Brockstein (NorthShore)
The shot generally causes no side effects, but some have pain and or redness/swelling. There is no way to know how a person will respond. A few people have developed lightheadedness or passed out, so it is generally recommended to sit or lie down for 15 minutes post-vaccine.
Kay (Mundelein, IL) - 12:30 PM:
What is the rate of recurrance? I had high risk HPV type SIN II and had LEEP at age 29.
Dr. Bruce Brockstein (NorthShore)
Generally low if treated surgically with LEEP, but ongoing monitoring is important as a new infection/new precancerous spot can possibly occur.
Toni (Chicago, IL) - 12:31 PM:
I have had HPV and pre-cancerous cells removed. Can they come back?
Dr. Bruce Brockstein (NorthShore)
See the answer to the last question. Usually it is cured when removed /treated surgically.
Nicole (Chicago, IL) - 12:32 PM:
I received only 1 of the HPV vaccinations due to an adverse reaction from it. Is it worth trying to get the 2nd vaccine approximately 8 years later? Am I covered from just the 1 vaccination or can I still get HPV?
Dr. Bruce Brockstein (NorthShore)
Depending on the age you were at the time, your current age and the reaction you had, it may be worthwhile. However, if you are over 26, have initiated sexual activity or had a severe reaction, it may be best not to get the vaccine. Even 1 injection does give some protection though.
Steven (Chicago, IL) - 12:35 PM:
Hi Dr. Brockstein. I received the vaccination; however, it was after I first showed signs of genital warts. Is there any chance the vaccination will help me in the future?
Dr. Bruce Brockstein (NorthShore)
Yes - genital warts are caused by HPV types 6 and 11. The vaccine covers 9 types, so it is possible that you've not yet had the the other "high risk" HPV type infections and that the vaccine helped prevent it.
Binana (Skokie, IL) - 12:37 PM:
My pediatrician has not recommended the HPV vaccine yet for my eleven year old daughter. How can I start the talk? Why do only 60% of kids get the HPV vaccine compared to other vaccines? How can we educate others?
Dr. Bruce Brockstein (NorthShore)
Thanks for asking--this is a complicated and IMPORTANT question.
Some parents and even some health practitioners are uncomfortable with raising the issue of a vaccine for a sexually-transmitted disease for a variety of reasons that turn out generally to be unfounded (fear the child will then freely engage in sex, get other STDs, uncomfortable talking about it in the office with kid, etc).
My advice is to let your child know she/he will be getting a shot (can explain details depending on your comfort; however, very few parents or physicians explain measles, mumps, polio, hepatitis, etc), and if your physician doesn't raise it, let her/him know it is TIME for the HPV vaccine too. If they say no, move on to another physician.
Julia (Glenview,IL) - 12:40 PM:
If a 40+ yr old female tests negative for HPV, should/can they still receive the HPV vaccine?
Dr. Bruce Brockstein (NorthShore)
The recommendation is up to age 26.
From a PRACTICAL standpoint, it won't be covered by insurance and will cost several hundred dollars.
From a clinical standpoint, once sexual activity has started, the effectiveness, at least in populations, goes down because an HPV infection is so common. Well over 50% of adults get silent HPV infections, even those with few or even only 1 partner in their lifetime (more common with more partners).
So overall recommendation is no.
Mary Ann (Northbrook, IL) - 12:43 PM:
What symptoms come up that would indicate that you have reason to think you might have or had HPV?
Dr. Bruce Brockstein (NorthShore)
There are no symptoms at all from the infection.
Years later, there may be symptoms from the cancer or warts (warty bumps) - cancer the in cervix may cause bleeding, pain, etc. In the throat, symptoms generally occur decades after infection (average age is 50s). The symptoms may be a lump in the neck, sore throat, difficulty swallowing, etc.
Pat (Highland Park, IL) - 12:47 PM:
Are there any long-term issues that arise from getting the HPV vaccine? I read that there are now reports of ovarian failure as a result of the vaccine - since they started administering about 10 years ago.
Dr. Bruce Brockstein (NorthShore)
None that are clearly correlated.
Overall, the vaccine should eventually save 10-20,000 of our children per year from dying of cancer and more from suffering the side effects of treatment.
If ultimately a few people do get late side effects, that will be very unfortunate, but there would still be a huge net benefit and that shouldn't discourage us from vaccination.
Mia (Chicago, IL) - 12:50 PM:
Is getting a pap every 3 years instead of once a year reducing the effectiveness of finding and removing abnormal HPV test results? Wouldn't this result in higher risk of getting cancer? I have had SIN II and LEEP procedure. What is the recurrence rate and how often does it become cancer?
Dr. Bruce Brockstein (NorthShore)
3 years is the recommendation under normal circumstances. This is based on research optimizing the best way to detect with fewest tests. Based on the specifics of your case, your doctor (gynecologist or gynecological oncologist) may recommend more frequent screenings. The cure rate is very high.
Carly - 12:52 PM:
Is there anything those who have already been infected with the high risk strains 16 & 18 can do for prevention or treatment?
Dr. Bruce Brockstein (NorthShore)
An additional vaccine is not thought to be helpful. Your gynecologist may recommend more frequent screenings to catch any pre-cancerous changes early.
Jen (Evanston, IL) - 12:53 PM:
Should young men also be given the HPV vaccine? If so, at what age is this appropriate?
Dr. Bruce Brockstein (NorthShore)
YES, YES, YES!!!
Ages 9-12 is best but 13-21 is still good if they haven't had it.
Boys can develop cancer of the throat, penis or anus, or can pass HPV that can cause cancer.
Once all girls AND boys are vaccinated, we will probably eliminate most cervical and throat cancers just like we eliminated polio in the U.S. and most for the world. It is a sexually-transmitted virus that causes cancer and can be prevented and eliminated.
Alex (Chicago, IL) - 12:56 PM:
Can family history play a role in someone's chance of getting an HPV cancer? Is there a way to identify this?
Dr. Bruce Brockstein (NorthShore)
Possibly, but only indirectly. The HPV is still needed for the cancer; however, just like not all people who smoke cigarettes get cancer, not all who get HPV get cancer. It is possible that our built in genetics plays some role in our ability to fight the virus or not develop cancer. There is NO test though for this currently.
Jess (IL) - 12:58 PM:
Do contraceptives help protect against HPV-related infections?
Dr. Bruce Brockstein (NorthShore)
Condom/barrier may help somewhat. Oral contraceptives won't have much or any effects.
Kathryn (Moderator) - 1:00 PM:
This will be the end of our chat. Thank you for your questions. For more information on HPV and its related conditions, or to speak with a specialist like Dr. Brockstein, you can contact NorthShore's
Kellogg Cancer Center.