Human Papilloma Virus among African-American Population - Essay Example

Infection with human papillimoavirus poses a significant health problem not just in United s but all over the world. Various diseases caused by this virus have been known but recently it has been recognized as a cause of cervical cancer. HPV’s genetic structures are called oncogenes. HPV has two types of oncogenes – E7 and E6 that take over the normal cells and cause cancer. E7 interferes with the normal functioning of the cell growth while E6 interferes with the cell’s ability to repair cell damage (Hager et al., 2004). Thus the cell growth remains uncontrolled and the cell damage cannot be repaired. This leads to the precancerous stage called the dysplasia or may lead further to squamous cell cancer of the cervix. Research has established the role of human papillomavirus (HPV) in squamous cell carcinoma of the uterine cervix. HPV DNA is detected in more than 99% of the cervical cancers (Scheurer et al., 2005). HPV infects many vertebrate species and the virion is composed of a double-stranded, circular, 8000-base pair DNA which lies encased in a naked iscosahedral capsid about 55 nm in diameter. There are at least 100 different types of genotypes of HPV identified. The HPVs can either be cutaneous, which are typically found in the general people and cause common warts. They can also be mucusotropic types which are found in individuals who are immunosuppressed. The mucosotropic types can further be segregated into low-risk and high-risk types depending on their association with cervical infection. HPV infects the basal cells of the epithelium and becomes est5ablished in basal cells as an episome. This is then replicated in tandem with the cell’s chromosomes, which means there is a continuous supply of cells. These ultimately generate progeny virions. These cells then travel upwards and deposit in the outer layer of the epithelium. It is a well established fact that HPV is linked to precancerous and cancerous cervical disease. HPV 16, 18, 31, 33, and 45 are most strongly associated with invasive squamous cell cancer of the cervix, and HPV 16 is found to be the most common of these in most studies (Palefsky et al., 2001). Women who had localized precancerous cervical intraepithelial neoplasia (CIN), HPV was prevalent in 70 to 85% of the cases (Savard et al., 1999). On the other hand, only 15.4% women without cervical infection, carried the HPV virus. This demonstrates the strong association between HPV and cervical diseases but only 58% HPV infections result in clinically apparent lesions. At the same time it is believed that HPV by itself does not lead to clinical lesions but immunosuppression acts in conjunction with HPV and leads to clinical lesions. Cervical dysplasia is mediated through papilloma virus but immune alterations may act as a mediator between psychological factors and the promotion of cervical disease. Palefsky et al., also state that HIV positive women are at increased risk of cervical HVP infection compared with HIV negative women. Scheurer et al., state that infection with HPV is the early step in cervical carcinogenesis. This invariably leads to HPV-induced cervical lesion. An experimental vaccine called Cervarix is being developed by GlaxoSmithKline and Merck which can be 100% effective in protecting women against two strains of HPV that are linked to more than 70% of all cases of cervical cancer (Capell & Barett, 2004). Normally body’s defenses are strong enough to fight the virus but persistent infection from others can lead to cervical lesions which can become cancerous. The gap between infection and caner could be up to two decades. African Americans are more likely than whites to have poor health and die prematurely. African American women are more than twice likely to die or cervical cancer than the white women. Symptoms like depression, subjective sleep quality, and enumerative measures of immunity are found in women with mild cervical disease indicative of early HPV infection. HPV can be present for years without showing any symptoms. HPV is a viral infection and as yet no cure is available. Condoms too can reduce the risks associated with HPV but does not provide any protection from this disease. Condoms are ineffective because the virus is prevalent not just on the gentalia but also on the dry skin surrounding abdomen and groin and can migrate towards vagina and cervix. Abstinence from sex is the safest or at best monogamous relationship provides safety to a great extent. Reduction in smoking may also lead to reduction of cervical cancer incidence and mortality (NCI, 1997). Cervical cancer awareness programs and importance of Pap smear tests are being promulgated for early detection and cure of the virus. The body’s immune system can be boosted to fight the HPV virus. A prophylactic virus given before the infection can prevent mucosal entry of the virus; if given during viral replication, it can eliminate the cells from multiplying, and when given after viral integration, it can control or stop the growth of HPV-viral related tumors by attacking the E6 and E7 viral genes. (Scheurer). Social and cultural factors affect the health by influencing health behavior, exposure and vulnerability to the disease, and access and availability of quality health care facilities and opportunities. To improve the quality of life for the African Americans, various programs are being conducted. On collaboration with the Church, the National Cancer Institute has started the Body and Soul program where they African Americans are advised to eat 5 to 9 servings of vegetables and fruits everyday (ACS, 2006). Pastoral leadership, educational activities and peer counseling helps develop healthy eating habits. “Look Good…Feel Better” – a program helps these young people restore their appearance and self-image during chemotherapy and radiation treatment. Community based interventions have led to greater use of condoms amongst the African Americans. School-based education programs have also shows positive results is delay in sexual activities or reduction in sexual play. The American Cancer Society (ACS) has issued guidelines which should be followed to avoid complication in later life. It recommends that annual screening for cervical cancer or the Pap test should begin three years after the sexual activity starts, but no later than 21 years of age. After three consecutive negative Pap tests, the screening can be done less frequently at the discretion of the physician. There is no upper age limit for cervical cancer screening. Screening for cervical cancer should be done every year with regular Pap tests and every two years using liquid-based tests. Women over 70 may choose to drop screening for cervical cancer if they have had three consecutive negative tests in the last ten years but those above 40 and with a weak immune system should continue even after negative results (ACS, 2006). The African Americans make up 13% of the total US population but account for one-third of the nation’s poor. As of 2001, 24% of the African Americans had no health insurance coverage (ACS, 2006). Improvement in education, economic level and lifestyle changes could reduce the incidence of cervical cancer among the young African-Americans. The less educated are less likely to understand the symptoms of cancer which could aggravate the problem as age advances. Due to lack of education, the African American women have reservations against the Pap smear test which can lead to early detection and cure. Thus, not all infection leads to cervical cancer and in most cases the infection may eliminate on its own. If the African American young adults follow the guidelines for regular screening and healthy eating and lifestyle habits, it will not be difficult to control the infection from leading to mortality. References: ACS (2006), Cancer facts and Figures for African Americans 2005-06, American Cancer Society. Kerry, C & Barrett, A (2004), "A Vaccine Every Woman Should Take"; GlaxoSmithKline and Merck are closing in on shots against HPV, the leading cause of cervical cancer." Business Week Online (Nov 18, 2004): NA. British Council Journals Database. Thomson Gale. 26 Oct. 2006 NCI (1997), Womens Health Report FY 95-96, National cancer Institute, 26 Oct 2006 Palefsky, J M (2001), Prevalence and Risk Factors for Anal Human Papillomavirus Infection in Human Immunodeficiency Virus (HIV)–Positive and High-Risk HIV-Negative Women, The Journal of Infectious Diseases 2001;183:383–91 Savard, J et al., (1999), Association Between Subjective Sleep Quality and Depression on Immunocompetence in Low-Income Women at Risk for Cervical Cancer, Psychosomatic Medicine 61:496–507 (1999) Scheurer, M E Tortolero-Luna, G & Storthz, A (2005), Human papillomavirus infection: biology, epidemiology, and prevention, Gynecol Cancer, Vol. 15 pp. 727-746 Read More