Increased understanding of the human papillomavirus can lead to better health outcomes and medical advancement
By Andrea S. Lukes, MD, MHSc, FACOG, Chief Medical Officer, Health Decisions and Elizabeth Messersmith, PhD, Chief Development Officer, Novan
March 4, 2019 is the second annual International HPV Awareness Day. This event, initiated by the International Papilloma Society to improve worldwide understanding of the human papillomavirus (HPV), is part of a growing movement to increase awareness about and research in HPV. HPV is a virus that is so common that nearly all sexually active men and women get it at some point in their lives. While progress has been made in recent years, gaps in patient care and understanding still present challenges and limit innovation.
The HPV Stigma
CDC data shows that roughly 42,700 people are diagnosed with an HPV-associated cancer in the United States every year, 57 percent of which are women. Yet this potential risk is often under-discussed, in part because women are uncomfortable with the topic. A recent survey conducted by Jo’s Cervical Cancer Trust found many women are still uncertain about what an HPV diagnosis means, and they associate the virus with fear and shame. Even though four in five sexually active adults will contract the virus in their lifetime, almost 40 percent of the 2000 women surveyed say they would be afraid to admit they had the virus for fear of judgment.
The survey also shows an alarming lack of understanding about the virus. Two thirds of the respondents believe that having HPV means that they have cancer, even though the infection is often harmless. Regular screenings can identify potentially cancerous cell changes well before cancer occurs.
The misinformation and fear attached to HPV has created a barrier to progress. The stigma related to a sexually transmitted virus can make it difficult for women to talk openly with their healthcare providers about the risks and how to protect themselves. These fears can prevent them from being honest about their potential exposure, scheduling the necessary screenings that would allow for earlier diagnosis and can complicate recruitment for clinical studies, which may delay the entry of new treatments to market.
Recommendations versus reality
That’s not to say there hasn’t been progress. Awareness and investment in HPV research have been steadily increasing over the past decade, which is bringing needed attention and resources to this issue. From 2010-2019 there were nearly two-and-a-half times the number of HPV study starts registered on ClinicalTrials.gov compared to the previous nine years, offering hope for new treatments, screening and preventive measures.
As of 2012, new recommendations from the United States Preventive Services Task Force suggested that all women aged 30 to 65 receive a combination of Pap and HPV screening every five years. As a result, Pap-HPV co-testing among women age 30–65 years rose from 10 percent in 2007 to 60.8 percent in 2016.
Similarly, the Department of Health and Human Services set a Healthy People 2020 goal to increase the rate of full HPV vaccination (three doses) to 80 percent among women aged 13–15 years. While this effort has made a difference, as of 2017 the rate of full vaccination in U.S. states ranged from less than 20 percent in Florida to 63 percent in Washington D.C., suggesting we still have a long way to go.
Communication and research are key
While there may be many reasons for the lag in HPV vaccinations and screening, the culture of secrecy and misinformation is a problem that can be addressed by more open dialogs between healthcare professionals and their patients. Expanding patient knowledge of HPV will help empower individuals to protect themselves and may open the door for increased participation in the clinical research that is critical for the improvement of health outcomes related to HPV and HPV-associated diseases worldwide.
As part of our ongoing efforts to improve women’s health globally, Health Decisions and Novan have committed to working together to drive research in HPV and associated cancers. Through this partnership, it is our hope to deliver new therapeutic approaches that eliminate HPV infection, thus inhibiting disease progression and offering significant benefit to patients.