Selected Podcast
HPV Education
Dr. William Cieplinski discusses HPV. He shares how it is acquired, how it is linked to certain cancers and how the vaccine is changing the landscape of HPV infection.
Featuring:
William Cieplinski, MD, Ph.D.
Dr. William Cieplinski is an oncologist based in Newburgh, New York. He received his medical degree from Universidad Nacional Autonoma de Mexico and has been in practice from more than 20 years. Dr. Cieplinski is a valuable part of the Oncology team at Montefiore St. Luke’s Cornwall. Transcription:
Melanie Cole (Host): The HPV vaccine can offer protection against the types of HPV that are most likely to cause certain cancers and here today for a lesson in HPV education is Dr. William Cieplinski. He’s [a] board certified medical oncologist with Montefiore St. Luke’s Cornwall. Dr. Cieplinski, thank you so much for joining us today. Tell us a little bit about HPV. What is it, and how common are these infections?
William Cieplinski M.D., Ph.D. (Guest): HPV is actually the most frequent sexually transmitted infection. It is—HPV stands for human papilloma virus, and it actually is quite frequent, and it depends—the rates of infection are quite high, and it actually is related to the frequency of partners as well as the amount of sexual activity. That is people that have one single relationship have less of a risk of developing HPV, but multiple sexual partners have a higher risk. It’s been seen that actually among people that are sexually active, usually the infection appears within the first ten years. In women, it can be seen [in] almost 10% of the population. The thing to keep in mind is that HPV is not one single virus. There are [a] whole variety of viruses, and the ones that we’re mostly concerned [about] are those that are associated with the cause of a variety of cancers of which we’re going to be talking momentarily.
Host: So, let’s talk momentarily about those. What kinds of problems or cancer does the HPV infection cause? What has it been linked to because it’s not only cervical cancer, right? There’s other things now.
Dr. Cieplinski: No. Absolutely, but in this world, when all the time we hear that everything causes cancer, which is not true, when you have an actual cause that can be prevented, I think that’s majorly, majorly important. Cervical cancer in women actually accounts for the—it’s the fourth most frequent cancer in women and can be totally prevented with a vaccine, which is something extraordinary that I think it’s very, very important to know. Cervical cancer can be extremely, extremely aggressive and cause a large number of deaths in a year, and if it can be prevented, then obviously a woman would live a normal life without any problems. Now, cervical cancer is not associated with all types of HPV, but there’re at least four types of HPV that are known as the number 6, 11, 16, and 18, which are associated with cervical carcinoma. As a matter of fact, HPV 16 accounts for at least half of all the cervical cancers. The reason I’m mentioning those numbers is not so much for people to memorize, but that the vaccine specifically will prevent infection with these types and therefore will prevent cancer. However, this is not the only type of cancer associated with it.
The other thing—the other type of cancer that we see quite frequently that is HPV-associated is oropharyngeal cancer. That is cancers of the tongue, cancers of the tonsil and those are increasing in frequency. It used to be that HPV was not a frequent cause, but—and that smoking was a main element causing, but right now, most of the oropharyngeal cancers are actually being seen with associated HPV.
In men, cancers of the penis [are] also associated with HPV, and another type of cancer that [is] relatively infrequent, but that we can see that [is] HPV associated are cancers of the anal canal. Not of the colon, but around the anus, and those are usually HPV-related. So, we can see we have a variety of cancers that are absolutely preventable if the people are vaccinated ideally before they become sexually active. So, they should be something that pediatricians should bring up with patients and family somewhere before the age of 12.
Host: Wow. That was an excellent explanation, Dr. Cieplinski. So, if somebody does get HPV, sexually transmitted, are there treatment options? I want to talk a little bit more about the vaccine, and it is amazing that this is a prevention for certain types of cancers, which many people don’t realize, but if they do have HPV, is this a treatable condition?
Dr. Cieplinski: HPV can be treated, but the interesting thing is that just because somebody becomes infected with it doesn’t mean that they’re going to have it for life, and so these infections actually come and go in many people, and as a matter of fact, it’s very likely that people acquire HPV multiple times, and it is associated with the frequency of new sexual partners. Another thing that we have to keep in mind is that the fact is men and women carry it. So, if a woman has HPV infection, which actually disappears, she can be re-infected, and the same goes for the men.
The role of the vaccine is actually to prevent the infection with the types associated mostly with cancer. We’re not trying to prevent HPV in everybody because it’s close to impossible. Just like when we get flu vaccines in the winter, we don’t get a vaccine that covers all of the flu viruses because that would be impossible. We choose for those flu viruses that are most likely to be the ones that will attack in that winter. The same goes for HPV. The vaccine is to prevent infection, either acute or chronic, with the one that may stay there and eventually develop a cancer, but one of the things that is important to keep in mind is that these infections do go away. It’s not only that the moment you get infected with HPV, let’s say type 16 that affects—causes 50% of cervical cancer, that that woman is doomed to have cervical cancer—that’s not true. There [are] other reasons/tendency to develop cancer—family history—all of those are important elements, but the vaccine will prevent infections with the ones that are dangerous in the long term.
Host: So, then, tell us a little bit more about the vaccine because as we hear more about this HPV vaccine, and kids are getting it—boys and girls in the 9-14-year-old age range. So, then, do those girls still need to have Pap smears because I know, doctor, that there’s a lot of controversy now about Pap smear, and how long, and if you’ve been tested and you don’t have HPV, you don’t get a Pap smear every single year or if you have gotten the vaccine—just clear a little bit of that up for us.
Dr. Cieplinski: Well, I’m not a gynecologist; I’m a medical oncologist, but there is no question that if the young woman or man get the vaccine at the right time that means that they will not get infected with the type of HPV that can cause cancer, but that does not necessarily rule out that there may be infections with HPV that may be symptomatic. As a matter of fact, the HPV not only affects the genital tract or the oropharyngeal tract, but all the types of HPV viruses can cause what are called common warts, and these can be present in the perianal area, and sometimes they’re plantar warts. There [are] other type of infections that can be seen with other HPV viruses.
However, for people that are vaccinated, I think that it really will depend mostly on number of sexual partners and sexual activity. When there’s a monogamous relationship and the young woman and man have received the vaccine in their youth, the likelihood of needing Pap smears every year is probably much lower, but not being a gynecologist, I cannot tell you the frequency, but we are preventing cancer. We’re not preventing other types of HPV infections.
Host: What a great segment, and it’s so important and interesting. So, doctor, as we wrap up, is there a way to prevent HPV if you are somebody who is past the age range—like you didn’t get the vaccine—and you know, is there a way for these people to prevent it, and what would you like us to know about the importance of asking our providers about the HPV vaccine—being educated?
Dr. Cieplinski: I think it’s important because it does not necessarily mean that if somebody has had multiple sexual partners, has had HPV in the past, that doesn’t mean that you cannot prevent and give a vaccine at an age initially just was ascribed to be given before age 26. Right now, it’s being given ideally between 10 and 14 which is the right age, but it certainly is a consideration as a vaccine to be given in somebody that’s going to be sexually active because they may not have received the—may not have been infected with the dangerous types of HPV. So, certainly prevention at any time is certainly more worthwhile than ignoring and taking a chance.
Host: Great information. Thank you so much, doctor, for joining us and sharing your incredible expertise. That wraps up this episode of Doc Talk, presented by Montefiore St. Luke’s Cornwall. You can head on over to our website at montefioreslc.org for more information and to get connected with one of our providers. If you’ve found this podcast as informative as I did, please share. Share with your friends and family. Share on social media because that way we all learn from the experts like Dr. Cieplinski at Montefiore St. Luke’s Cornwall together and be sure not to miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.
Melanie Cole (Host): The HPV vaccine can offer protection against the types of HPV that are most likely to cause certain cancers and here today for a lesson in HPV education is Dr. William Cieplinski. He’s [a] board certified medical oncologist with Montefiore St. Luke’s Cornwall. Dr. Cieplinski, thank you so much for joining us today. Tell us a little bit about HPV. What is it, and how common are these infections?
William Cieplinski M.D., Ph.D. (Guest): HPV is actually the most frequent sexually transmitted infection. It is—HPV stands for human papilloma virus, and it actually is quite frequent, and it depends—the rates of infection are quite high, and it actually is related to the frequency of partners as well as the amount of sexual activity. That is people that have one single relationship have less of a risk of developing HPV, but multiple sexual partners have a higher risk. It’s been seen that actually among people that are sexually active, usually the infection appears within the first ten years. In women, it can be seen [in] almost 10% of the population. The thing to keep in mind is that HPV is not one single virus. There are [a] whole variety of viruses, and the ones that we’re mostly concerned [about] are those that are associated with the cause of a variety of cancers of which we’re going to be talking momentarily.
Host: So, let’s talk momentarily about those. What kinds of problems or cancer does the HPV infection cause? What has it been linked to because it’s not only cervical cancer, right? There’s other things now.
Dr. Cieplinski: No. Absolutely, but in this world, when all the time we hear that everything causes cancer, which is not true, when you have an actual cause that can be prevented, I think that’s majorly, majorly important. Cervical cancer in women actually accounts for the—it’s the fourth most frequent cancer in women and can be totally prevented with a vaccine, which is something extraordinary that I think it’s very, very important to know. Cervical cancer can be extremely, extremely aggressive and cause a large number of deaths in a year, and if it can be prevented, then obviously a woman would live a normal life without any problems. Now, cervical cancer is not associated with all types of HPV, but there’re at least four types of HPV that are known as the number 6, 11, 16, and 18, which are associated with cervical carcinoma. As a matter of fact, HPV 16 accounts for at least half of all the cervical cancers. The reason I’m mentioning those numbers is not so much for people to memorize, but that the vaccine specifically will prevent infection with these types and therefore will prevent cancer. However, this is not the only type of cancer associated with it.
The other thing—the other type of cancer that we see quite frequently that is HPV-associated is oropharyngeal cancer. That is cancers of the tongue, cancers of the tonsil and those are increasing in frequency. It used to be that HPV was not a frequent cause, but—and that smoking was a main element causing, but right now, most of the oropharyngeal cancers are actually being seen with associated HPV.
In men, cancers of the penis [are] also associated with HPV, and another type of cancer that [is] relatively infrequent, but that we can see that [is] HPV associated are cancers of the anal canal. Not of the colon, but around the anus, and those are usually HPV-related. So, we can see we have a variety of cancers that are absolutely preventable if the people are vaccinated ideally before they become sexually active. So, they should be something that pediatricians should bring up with patients and family somewhere before the age of 12.
Host: Wow. That was an excellent explanation, Dr. Cieplinski. So, if somebody does get HPV, sexually transmitted, are there treatment options? I want to talk a little bit more about the vaccine, and it is amazing that this is a prevention for certain types of cancers, which many people don’t realize, but if they do have HPV, is this a treatable condition?
Dr. Cieplinski: HPV can be treated, but the interesting thing is that just because somebody becomes infected with it doesn’t mean that they’re going to have it for life, and so these infections actually come and go in many people, and as a matter of fact, it’s very likely that people acquire HPV multiple times, and it is associated with the frequency of new sexual partners. Another thing that we have to keep in mind is that the fact is men and women carry it. So, if a woman has HPV infection, which actually disappears, she can be re-infected, and the same goes for the men.
The role of the vaccine is actually to prevent the infection with the types associated mostly with cancer. We’re not trying to prevent HPV in everybody because it’s close to impossible. Just like when we get flu vaccines in the winter, we don’t get a vaccine that covers all of the flu viruses because that would be impossible. We choose for those flu viruses that are most likely to be the ones that will attack in that winter. The same goes for HPV. The vaccine is to prevent infection, either acute or chronic, with the one that may stay there and eventually develop a cancer, but one of the things that is important to keep in mind is that these infections do go away. It’s not only that the moment you get infected with HPV, let’s say type 16 that affects—causes 50% of cervical cancer, that that woman is doomed to have cervical cancer—that’s not true. There [are] other reasons/tendency to develop cancer—family history—all of those are important elements, but the vaccine will prevent infections with the ones that are dangerous in the long term.
Host: So, then, tell us a little bit more about the vaccine because as we hear more about this HPV vaccine, and kids are getting it—boys and girls in the 9-14-year-old age range. So, then, do those girls still need to have Pap smears because I know, doctor, that there’s a lot of controversy now about Pap smear, and how long, and if you’ve been tested and you don’t have HPV, you don’t get a Pap smear every single year or if you have gotten the vaccine—just clear a little bit of that up for us.
Dr. Cieplinski: Well, I’m not a gynecologist; I’m a medical oncologist, but there is no question that if the young woman or man get the vaccine at the right time that means that they will not get infected with the type of HPV that can cause cancer, but that does not necessarily rule out that there may be infections with HPV that may be symptomatic. As a matter of fact, the HPV not only affects the genital tract or the oropharyngeal tract, but all the types of HPV viruses can cause what are called common warts, and these can be present in the perianal area, and sometimes they’re plantar warts. There [are] other type of infections that can be seen with other HPV viruses.
However, for people that are vaccinated, I think that it really will depend mostly on number of sexual partners and sexual activity. When there’s a monogamous relationship and the young woman and man have received the vaccine in their youth, the likelihood of needing Pap smears every year is probably much lower, but not being a gynecologist, I cannot tell you the frequency, but we are preventing cancer. We’re not preventing other types of HPV infections.
Host: What a great segment, and it’s so important and interesting. So, doctor, as we wrap up, is there a way to prevent HPV if you are somebody who is past the age range—like you didn’t get the vaccine—and you know, is there a way for these people to prevent it, and what would you like us to know about the importance of asking our providers about the HPV vaccine—being educated?
Dr. Cieplinski: I think it’s important because it does not necessarily mean that if somebody has had multiple sexual partners, has had HPV in the past, that doesn’t mean that you cannot prevent and give a vaccine at an age initially just was ascribed to be given before age 26. Right now, it’s being given ideally between 10 and 14 which is the right age, but it certainly is a consideration as a vaccine to be given in somebody that’s going to be sexually active because they may not have received the—may not have been infected with the dangerous types of HPV. So, certainly prevention at any time is certainly more worthwhile than ignoring and taking a chance.
Host: Great information. Thank you so much, doctor, for joining us and sharing your incredible expertise. That wraps up this episode of Doc Talk, presented by Montefiore St. Luke’s Cornwall. You can head on over to our website at montefioreslc.org for more information and to get connected with one of our providers. If you’ve found this podcast as informative as I did, please share. Share with your friends and family. Share on social media because that way we all learn from the experts like Dr. Cieplinski at Montefiore St. Luke’s Cornwall together and be sure not to miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.