HPV and Cancer. Probability and consequence.
So, we all have cancer.
I mean that in a really benign way. You have cancer, I have cancer. We have cancer. It is totally normal. It isn’t big, or scary, but it is normal. Which is a good thing, because it means that the body is generally really good at managing it. There are a ton of processes that lead to cancer, but broadly speaking it is a result of “uncontrolled cell growth”. Cells that get away from their normal job hanging out as skin, or as brain-parts, or as a big toe.
Most of the cells in your body are just doing their thing. Copy DNA. Make a twin. Split. Grow. Repeat. This is called “controlled cell growth.” Sometimes during the process of cells duplicating themselves, they make spelling mistakes. Who dosn’t? While we have genomic proofreaders working hard to catch those mistakes (mutations), even they aren’t perfect. And, on occasion, those mistakes change a big old “STOP” sign to a “WHY NOT KEEP GOING, FOREVER?” And that is the start of the whole thing. Small mistakes that lead to bigger ones. Always watch your grammar.
When I say we all have cancer, I really mean it. It often takes more than one mutation (mistake) to lead to a cancer that can do harm. We all have these tiny little cancers made up of 100–1000 cells that are just sort of — self limiting. These tiny balloons of cells grow and grow, but as soon as they get to a certain size? Plop. Those balloons collapse on themselves because they don’t have access to our circulatory system (capillaries, arteries, veins, and all that blood stuff).
There are a lot of different things that need to happen in sequence for a cancer to actually cause harm. In the grand scheme of things, it is super improbable. The vast majority of people live long, healthy lives; however, one of the tricky things about probability, is that given enough time (like 70–90 years or so in North America) those improbable events happen. Mistakes happen, mistakes add up, and people will get sick. For a long time we just called that dying of old age. Now, we understand the context a bit better, and a lot of deaths among older populations are a result of cancers. Plural.
One of the really difficult things to communicate about cancer, is that there are 1000s of different kinds of them. There is no capital C — Cancer that we can point to and target. Each of the different types of cells that exist in your body can potentially have lots and lots of different forms of cancer. All of the miracle cures that we hear about every few weeks (cardamom oil, stardust, moon starch, science sweat, etc.) target specific cancers. While hugely important to the populations those cures ultimately serve, individual cures are only a series of very small steps towards combatting the broader scourge we call cancer. And this is why prevention and screening is so important.
Cancers can form in three different ways: i) from random mistakes; ii) from natural and man-made substances that irritate cells to the point of causing mutations; and iii) agents found naturally out in the world that “seek to cause cancer”. Human Papilloma Virus (HPV), and a whole bunch of other viruses fit into number iii. More specifically, cancer (uncontrolled cell growth) is expressly one of the “goals” of the HPV itself, because when cells infected with HPV duplicate and duplicate and duplicate — the virus duplicates with them. So, in the end, even more cells end up carrying HPV. And, as a direct result, the more HPV there is out in the world to potentially infect new people.
Generally speaking, after infection, your body is usually able to clear the virus within about two years. While our immune system is incredible, it is also imperfect. If our immune system misses the virus and it is able to replicate, infected cells can slowly change as those mutations add up over the years. That slow and steady “goal” of HPV — that promotion of uncontrolled cell growth — is the cause of cervical cancers associated with HPV.
The transition from regular cells into cervical cancer takes a long time (10–15 years), which is exactly why screening is so important. Because it happens slowly. So slowly that without periodically checking for it (or the causative agent), people with pre-cancer don’t actively know it until it is already out of control. By screening regularly, you can a) know if you have HPV at all, and b) track if it goes away on its own. If the infection doesn’t go away, it enables you to make informed decisions. Decisions in partnership with your doc about further screening, monitoring, and treatment of the pre-cancer or cancer caused by HPV. Those who identify the infection early, often beat it early too. You don’t know what you don’t know.
Again, in the grand scheme of things. Across the entire population of earth, even across all of geological time. Cancer is improbable. It just doesn’t happen that often when you consider the trillions of cells that make up our bodies. We are amazing. You are amazing. There are, however, things that can actively cause cancers that can kill you, HPV included. You don’t have to take the risk. You have options. Either through prevention of infection, or by staying informed about your own body. The more we collectively care for ourselves, the more our entire community, and world benefit.
A little self care goes a long way.
Matthew German. MSc, Molecular Virology.
Matthew is currently at BlueDot, a B-Corporation that develops public health and consumer technologies to prevent the spread of infectious disease through global epidemic prediction, preparedness and response. On the side, Matthew is also exploring how we can change the way we interact with technology to align with our biology and psychology, through his project Veni.
Izabella Kaczmarek. MPH candidate.
Izabella is responsible for education and community coordination at Eve Medical, a social venture that is extending women’s health screening beyond the clinic into the privacy and comfort of women’s homes. Motivated by the 500,000 cases of cervical cancer that occur worldwide each year, Eve Medical developed and launched Canada’s first Eve Kit, the do-it-yourself at-home HPV screening service. On the side, Izabella is completing her Master of Public Health at the University of Waterloo with particular interests in addressing inequalities within the Canadian health system.
