CANCERS LINKED TO HPV CERVICAL VAGINAL VULVAR PENILE

CANCERS LINKED TO HPV CERVICAL, VAGINAL, VULVAR, PENILE, ANAL, OROPHARYNGEAL 1

THE LINK BETWEEN HPV AND CANCER • CANCER OFTEN TAKES YEARS TO DEVELOP AFTER A PERSON GETS HPV. THE TYPES OF HPV THAT CAN CAUSE GENITAL WARTS ARE NOT THE SAME AS THE TYPES THAT CAN CAUSE CANCER. • THERE IS NO WAY TO DETERMINE WHICH PEOPLE WHO HAVE HPV WILL DEVELOP CANCER OR HAVE OTHER HEALTH PROBLEMS. • HPV CANCERS INCLUDE CANCER OF THE CERVIX, VAGINA, VULVA, ANUS, PENIS AND OROPHARYNGEAL (IN THE BACK OF THE THROAT, INCLUDING THE BASE OF THE TONGUE AND TONSILS). • CANCER CAUSED BY HPV USUALLY DOES NOT HAVE SYMPTOMS UNTIL IT IS WELL ADVANCED. IT IS VERY SERIOUS AND HARD TO TREAT. • FEMALES CAN GET REGULAR SCREENING WITH A PAP TEST FOR CERVICAL CANCER. IF EARLY SIGNS OF THE DISEASE ARE FOUND THEY CAN BE TREATED BEFORE THEY TURN INTO CANCER. 2

NUMBER OF HPV-ASSOCIATED CANCERS BY YEAR AND SEX, UNITED STATES, 2003– 2013 3

CANCERS CAUSED BY SPECIFIC HPV TYPES 4 Based on Viens et al. MMWR 2016. https: //www. cdc. gov/cancer/hpv/statistics

RATES OF HPV-ASSOCIATED CANCERS AND AGE AT DIAGNOSIS AMONG WOMEN IN THE UNITED STATES, 2009– 2013 5

VAGINAL CANCER • VAGINAL CANCER STARTS IN THE VAGINA (ALSO CALLED THE BIRTH CANAL). • MOST VAGINAL CANCERS DO NOT CAUSE SIGNS AND SYMPTOMS EARLY. • WHEN VAGINAL CANCER DOES CAUSE SYMPTOMS THEY MAY INCLUDE: VAGINAL DISCHARGE, ABNORMAL BLEEDING, A CHANGE IN BATHROOM HABITS SUCH AS BLOOD IN THE URINE OR STOOL, HAVING MORE FREQUENT OR URGENT NEEDS TO URINATE; OR FEELING CONSTIPATED. • THE BEST WAY TO FIND VAGINAL CANCER IS TO GET REGULAR CHECKUPS AND TO SEE A DOCTOR IF YOU HAVE ANY SIGNS OR SYMPTOMS, SUCH AS LUMPS OR CHANGES IN THE VAGINA. 6

VULVAR CANCER • WHEN CANCER FORMS IN THE VULVA, IT IS VULVAR CANCER. • THE VULVA IS THE OUTER PART OF THE FEMALE GENITAL ORGANS. • VULVAR CANCER MOST OFTEN OCCURS ON THE INNER EDGES OF THE LABIA. • VULVAR CANCERS OFTEN CAUSE SIGNS AND SYMPTOMS SUCH AS: ITCHING , BURNING, PAIN, OR TENDERNESS ON THE VULVA THAT DOES NOT GO AWAY; CHANGES IN THE VULVA SKIN COLOR, WHERE IT WOULD BE REDDER OR WHITER THAN NORMAL FOR THE INDIVIDUAL; CHANGES IN THE VULVA SKIN, SUCH AS A RASH, WARTS, SORES, LUMPS, OR ULCERS. • PAY ATTENTION TO YOUR BODY AND KNOW WHAT IS NORMAL. IF YOU HAVE UNUSUAL PROBLEMS THAT ARE NOT NORMAL FOR YOU, SEE A DOCTOR. 7

STATISTICS FOR VAGINAL AND VULVAR CANCER • VAGINAL AND VULVAR CANCERS ARE VERY RARE. WHILE ALL WOMEN ARE AT RISK FOR THESE CANCERS, VERY FEW WILL GET THEM. TOGETHER, THEY ACCOUNT FOR 6% TO 7% OF ALL GYNECOLOGIC CANCERS DIAGNOSED IN THE UNITED STATES. † • IN 2014 (THE MOST RECENT YEAR NUMBERS ARE AVAILABLE)— • 1, 312 WOMEN IN THE UNITED STATES WERE DIAGNOSED WITH VAGINAL CANCER. † • 430 WOMEN IN THE UNITED STATES DIED FROM VAGINAL CANCER. † • 5, 133 WOMEN IN THE UNITED STATES WERE DIAGNOSED WITH VULVAR CANCER. † • 1, 085 WOMEN IN THE UNITED STATES DIED FROM VULVAR CANCER. † 8 †DATA SOURCE: U. S. CANCER STATISTICS WORKING GROUP. UNITED STATES CANCER STATISTICS: 1999– 2014 INCIDENCE AND MORTALITY WEB-BASED REPORT. ATLANTA (GA): DEPARTMENT OF HEALTH AND HUMAN SERVICES, CENTERS FOR DISEASE CONTROL AND PREVENTION, AND NATIONAL CANCER INSTITUTE; 2017. AVAILABLE

PENILE CANCER • CURRENTLY THERE IS NOT A HPV TEST RECOMMENDED FOR MEN. SCREENING TESTS ARE NOT AVAILABLE FOR PENILE CANCER. • THE FIRST SIGNS OF PENILE CANCER ARE CHANGES IN COLOR, SKIN THICKENING, OR A BUILD-UP OF TISSUE ON THE PENIS. • LATER SIGNS INCLUDE A GROWTH OR SORE ON THE PENIS THAT IS USUALLY PAINLESS, BUT IN SOME CASES, THE SORE MAY BE PAINFUL AND BLEED. • TREATMENT FOR PENILE CANCER CAN INCLUDE SURGERY, RADIATION THERAPY, AND CHEMOTHERAPY. OFTEN TWO OR MORE OF THESE TREATMENTS ARE USED TOGETHER. • IF ANY CHANGES ARE NOTICED, THAT PERSON SHOULD SEE THEIR DOCTOR. 9

ANAL CANCER • SOMETIMES THERE ARE NO SIGNS OR SYMPTOMS FOR ANAL CANCER. • IF SIGNS AND SYMPTOMS ARE PRESENT THEY CAN INCLUDE ANAL BLEEDING, PAIN, ITCHING, OR A DISCHARGE. • SWOLLEN LYMPH NODES IN THE ANAL OR GROIN AREA MAY ALSO BE A SIGN OR SYMPTOM AS WELL AS CHANGES IN BOWEL HABITS OR THE SHAPE OF THE STOOL. • TREATMENT FOR ANAL CANCER CAN BE SURGERY, RADIATION THERAPY, OR CHEMOTHERAPY. OFTEN, TWO OR MORE OF THESE TREATMENTS ARE USED TOGETHER. 10

ANAL CANCER RATES BY RACE, ETHNICITY, AND SEX UNITED STATES 2009 -2013 11 Based on Viens et al. MMWR 2016. https: //www. cdc. gov/cancer/hpv/statistics

CERVICAL CANCER • CANCER THAT STARTS IN THE CERVIX IS CALLED CERVICAL CANCER. • THE CERVIX IS THE LOWER, NARROW END OF THE UTERUS. • HPV IS THE MAIN CAUSE OF CERVICAL CANCER. • EARLY ON, CERVICAL CANCER MAY NOT CAUSE ANY SIGNS OR SYMPTOMS. ADVANCED CERVICAL CANCER MAY CAUSE BLEEDING OR DISCHARGE FROM THE VAGINA THAT IS NOT NORMAL FOR THE INDIVIDUAL. • IF ANY SIGNS OR SYMPTOMS ARE PRESENT, THE INDIVIDUAL SHOULD SEE THEIR DOCTOR. • THE PAP TEST LOOKS FOR PRECANCERS, CELL CHANGES ON THE CERVIX THAT MAY BECOME CERVICAL CANCER. 12

HPV ASSOCIATED CERVICAL CANCERS BY RACE, ETHNICITY UNITED STATES 2009 -2013 13 Based on Viens et al. MMWR 2016. https: //www. cdc. gov/cancer/hpv/statistics

OROPHARYNGEAL CANCER • HPV CAN CAUSE CANCERS IN THE BACK OF THE THROAT, MOST COMMONLY IN THE BASE OF THE TONGUE AND TONSILS IN THE AREA OF THE OROPHARYNX, THEREFORE GIVING THE NAME OF THIS CANCER OROPHARYNGEAL CANCER. • SIGNS AND SYMPTOMS OF OROPHARYNGEAL CANCER MAY INCLUDE PERSISTENT SORE THROAT, EARACHES, HOARSENESS, ENLARGED LYMPH NODES, PAIN WHEN SWALLOWING AND UNEXPLAINED WEIGHT LOSS. SOME PEOPLE MAY HAVE NO SIGNS OR SYMPTOMS. • THERE IS NO APPROVED TEST TO DIAGNOSE HPV IN THE MOUTH OR THROAT. • DENTISTS DO LOOK FOR SIGNS OF ORAL CANCER DURING THEIR PATIENTS’ ROUTINE DENTAL EXAMINATIONS. 14 • IF A PERSON NOTICES ANY CHANGES IN THEIR BODY THE PERSON SHOULD SEE THEIR HEALTHCARE PROVIDER.

OROPHARYNGEAL CANCER STATISTICS 15

PREVENTION: CANCERS CAUSED BY HPV CAN BE PREVENTED BY: • ABSTINENCE, WHICH IS THE MOST RELIABLE STEP TO TAKE IN PREVENTING THE DISEASE. • USING CONDOMS, WHICH CAN LOWER THE RISK OF GETTING HPV IF USED PROPERLY AND ALL THE TIME. HOWEVER, THE VIRUS CAN AFFECT AREAS NOT COVERED BY THE CONDOM, SO IT MAY NOT FULLY PROTECT AGAINST HPV. • LIMITING SEXUAL PARTNERS MAY HELP LOWER THE CHANCES BUT THERE IS NO REAL WAY TO KNOW WHETHER OR NOT THE PARTNER COULD EXPOSE YOU TO HPV. IT ONLY TAKES ONE PERSON TO PASS HPV TO ANOTHER PERSON. 16 • HPV VACCINATION IS A ROUTINE VACCINATION THAT CAN BE GIVEN TO MALES AND FEMALES. THE HPV VACCINES PROVIDE CLOSE TO 100% PROTECTION

THE HPV VACCINATION: FACTS • HPV VACCINES ARE A SERIES OF SHOTS RECOMMENDED FOR BOYS AND GIRLS WHO ARE 11 OR 12 YEARS OF AGE, BUT CAN BE GIVEN UP TO 26 YEARS OF AGE, IF NOT RECEIVED WHEN YOUNGER. • SINCE 2016, HPV VACCINES HAVE BEEN RECOMMENDED IN A TWO DOSE SERIES WITH THE FIRST DOSE GIVEN BEFORE THE 15 TH BIRTHDAY AND THE SECOND DOSE GIVEN 6 TO 12 MONTHS AFTER THE FIRST. IF THE TWO DOSES ARE GIVEN LESS THAN FIVE MONTHS APART A THIRD DOSE IS NEEDED. • TEENS AND YOUNG ADULTS WHO START THE SERIES AT AGE 15 -26 WILL NEED THE THREE DOSE SERIES. • FOR THE MOST EFFECTIVE RESULTS THE SERIES OF HPV VACCINES SHOULD BE GIVEN PRIOR TO EXPOSURE TO HPV. 17 • THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) RECOMMENDS HPV VACCINE SERIES BE GIVEN LONG BEFORE THE TEEN BEGINS ANY TYPE OF SEXUAL ACTIVITY TO ENSURE THAT INDIVIDUAL IS IMMUNE TO HPV IF/WHEN THEY ARE EXPOSED TO IT.

HPV VACCINATION FACTS (CONTINUED) • ACCORDING TO THE CDC, CLINICAL TRIALS SHOWED THAT HPV VACCINES PROVIDE CLOSE TO 100% PROTECTION AGAINST CERVICAL PRE-CANCERS AND GENITAL WARTS. • SINCE THE HPV VACCINE WAS RECOMMENDED IN 2006 THERE HAS BEEN A 64% REDUCTION IN VACCINE TYPE HPV INFECTIONS AMONG TEEN GIRLS IN THE UNITED STATES. • ACCORDING TO THE CDC, THE UNITED STATES CURRENTLY HAS THE SAFEST MOST EFFECTIVE VACCINE SUPPLY IN HISTORY. • THE NAMES OF THE HPV VACCINES ARE CERVARIX, GARDASIL, AND GARDASIL 18 9.

SIDE EFFECTS OF THE HPV VACCINE • LIKE ALL MEDICINES, VACCINES CAN HAVE SIDE EFFECTS. MANY PEOPLE WHO GET THE HPV VACCINE DO NOT HAVE ANY SIDE EFFECTS. • SOME MINOR SIDE EFFECTS HAVE SHOWN IN SOME PEOPLE AND INCLUDE • A SORE ARM OR PAIN AND/OR REDNESS WHERE THE SHOT WAS GIVEN • FEVER • HEADACHE • FEELING TIRED • NAUSEA • MUSCLE OR JOINT PAIN 19

HPV VACCINE SIDE EFFECTS • AS WITH ANY MEDICAL PROCEDURE, INCLUDING VACCINATIONS, BRIEF FAINTING SPELLS AND RELATED SYMPTOMS CAN OCCUR, WHICH IS WHY IT IS RECOMMENDED THAT THE PERSON SIT OR LAY DOWN WHILE GETTING A SHOT AND REMAIN SEATED OR LAYING DOWN FOR APPROXIMATELY 15 MINUTES AFTER THE SHOT. • VERY RARE OCCASIONS ALLERGIC REACTIONS MAY OCCUR. PEOPLE WITH SEVERE ALLERGIES TO ANY COMPONENT OF A VACCINE SHOULD NOT RECEIVE THAT VACCINE. 20

WEBSITES FOR MORE INFORMATION ABOUT HPV • HTTP: //WVRURALHEALTH. ORG/WIN/PP/FACESVPD_PP/ • HTTPS: //WWW. CDC. GOV/STD/HPV/DEFAULT. HTM • HTTPS: //WWW. CDC. GOV/VACCINES/VPD-VAC/HPV/VAC-FAQS. HTM • HTTPS: //WWW. CDC. GOV/STD/HPV/STDFACT-HPV-AND-MEN. HTM • WWW. CDC. GOV/HPV/INDEX. HTML • WWW. CDC. GOV/VACCINES/VPD/HPV/INDEX. HTML • WWW. CDC. GOV/STD/HPV/TREATMENT. HTM • WWW. CDC. GOV/CANCER/HPV/BASIC_INFO/HPV_OROPHARYNGEAL. HTM 21

REFERENCES: • HTTP: //WWW. CDC. GOV/CANCER/HPV/STATISTICS/CASES. HTM • HTTP: //WWW. CDC. GOV/CANCER/HPV/BASIC_INFO/PREVENTION. HTM • HTTP: //WWW. CDC. GOV/CANCER/HPV/STATISTICS/AGE. HTM • HTTP: //WWW. CDC. GOV/CANCER/HPV/STATISTICS/ANAL. HTM • HTTP: //WWW. CDC/GOV/CANCER/HPV/STATISTICS/CERVICAL. HTM 22