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Sex, Viruses, and Cancer
28 Plays1 month ago
Today we talk about how Nixon accidentally made the US a virology superpower, the intricate ways that HPV may lead to cancer, the dangers of high-risk strains of HPV for BOTH men and women, and the necessity of just getting that damn vaccine. If not for you, for others.
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Transcript
Interconnection of Sex, Viruses, and Cancer
00:00:07
Speaker
So in this podcast, I'm going to talk about sex and viruses and cancer, which is a bit of a story with some twists and turns, interesting ones that are both really contemporary and also provide some important historical insight into American public policy about cancer for the last 50 or 60
Nixon's War on Cancer
00:00:27
Speaker
years. So back in 1971, President Richard Milhouse Nixon did a good thing, which is that he ah put forward legislation and signed it establishing the National Cancer Institute as an independent research entity.
00:00:44
Speaker
The reason why that was important, because there was an awareness of the importance of ah cancer and rising cancer rates and how we didn't understand a lot about cancer and there's still a lot of stigma about cancer. And it was felt that an independent agency ah that reported just to Congress ah for its appropriations every year would have the kind of independence and drive that characterized the Apollo program, which of course, just two years before, had safely brought men to the moon and brought them home again.
00:01:13
Speaker
A big American triumph of technology. And so kind of building on that momentum Nixon launched this first really serious war on cancer by establishing the National Cancer Institute, which was great.
Viruses and Cancer: Early Theories
00:01:25
Speaker
Now at the time, a lot of people thought, a lot of scientists felt that ah viruses were a major cause of cancer. They, especially the DNA viruses and RNA viruses, integrate their genetic material into human cells and then cause trouble.
00:01:42
Speaker
They change transcription of genes. they alter patterns of replication. They're kind of bad. Many viruses don't do that. Many viruses are kind of sort of ordinary and in in fact the human genome is littered with viruses that don't do anything. Or they're vestigial, they've been there for millennia, and we never even know about them.
00:02:00
Speaker
But there's tons of junk virus DNA in the human genome. But there are also these viruses that are kind of pathogenic and cause problems and can turn on genes that should not be turned on.
00:02:11
Speaker
So this was the belief at the time. It turns out that that resulted in a big investment in virus biology and understanding with new reagents and new technologies and new imaging techniques and ways of understanding virus infection and circulating viruses. How do these things work?
00:02:28
Speaker
that we learned a ton about viruses.
Shifting Focus: Environmental Causes of Cancer
00:02:31
Speaker
And that was important, but ultimately we realized that a lot of human cancers are not caused by viruses, but by environmental damage, by UV light, by smoking, by pollutants, by asbestos, by all kinds of groundwater contaminants. And so the idea that viruses were the central problem, the central worry,
00:02:52
Speaker
in oncology kind of faded a bit, but we had learned a ton about viruses.
AIDS and Antiviral Advances
00:02:56
Speaker
Now that was not misspent money because 10 years later, the Morbidity and Mortality Weekly Reports started noticing very strange immunodeficiencies and bizarre cancers like Kaposi's sarcoma, which typically occurs only in older men arising in young, healthy men in California and New York.
00:03:17
Speaker
People were scratching their heads going like, what is this? This is a new kind of acquired immune deficiency syndrome, which of course gave rise to our acronym AIDS. And we discovered that was of course virus driven and we were able to get ahead of it.
00:03:30
Speaker
rather quickly with a lot of biological understanding about how viruses work. And then new antiviral agents that made all the difference and turned what was essentially a death sentence into a chronic condition that's very manageable nowadays. So we have actually Richard Nixon to thank for that investment. But it was investment in basic science, you can never go wrong.
00:03:49
Speaker
with investing
HPV and Cervical Cancer Prevention
00:03:50
Speaker
in basic science. However, there is in fact one virus that is an important cause of cancers, and that's a human papillomavirus, or HPV, which is sexually transmitted and is primarily responsible for the cervical cancer cases that we see worldwide and also in the United States. This is still a major problem. It's the second most common cancer in women worldwide after breast cancer. so There are several types of HPV.
00:04:16
Speaker
Most of them are low risk. Most adults who are sexually active have it, but have no symptoms and never will. It's highly transmissible by sexual contact, um and it's generally not a problem.
00:04:29
Speaker
There are a few very high risk clades of HPV, which um in fact are associated with cancer. And within those virus genomes, we've learned there are two major genes, the E6 and E7 genes, which are the kind of the key troublemakers of this virus. The E6 protein inhibits the activity of an important human tumor suppressor called P53. That's the name of the gene on the human chromosome. And then the E7 gene inhibits the RB tumor suppressor.
00:05:00
Speaker
Now, these two proteins act as kind of breaks on the cell cycle or checkpoints for um cell cycle progression. And when they are damaged, ah cells don't know to stop growing and dividing, and then they get out of control. And so that's why these are really important genes. In fact, the genes that tend to go wrong in human cancers are not the stuck accelerator that makes your car dangerous. It's a failure of the brake. It's a failure of the the foot brake and then the emergency brake.
00:05:27
Speaker
and all the other negative regulatory systems of the car. That's what makes the vehicle dangerous, not the fact that the engine is revving out of control. In fact, most human cancers, I would say 50% or so of human cancers, have sun some kind of damage involving the P53 gene. So it's actually a very central player in human cancer. And so these two virus genes work to inactivate those ah human safety checks.
00:05:53
Speaker
And that's what gives rise to these epithelial cancers, most commonly um cervical cancer, but also any other cancers where the epithelium has been exposed ah in a sexual situation. So um oral cancer, anal cancer, cervical cancer, vaginal cancers, these things are sexually transmitted and pervasive in a problem.
Barriers to HPV Vaccination
00:06:13
Speaker
So there have been steps taken to um prevent this. So there are vaccines like Gardasil, which are very useful to prevent infections, but they don't work in a person who's already been infected with HPV. And so that's why pediatricians recommend vaccination of teens or preteens before they become sexually active to really provide that person with lifelong protection. But once you seroconvert, the Gardasil vaccine is not is not helpful. There's a strong gender bias with HPV vaccination. There's a belief that it's kind of a female problem, that because men don't get cervical cancer, it's not a male problem.
00:06:49
Speaker
But it really takes two to tango. And so there's every reason for male partners to be vaccinated as well, teen boys and adolescent boys, because they are part of the cycle of sexually transmitted viral infections.
00:07:04
Speaker
So um until we kind of address that, I don't think and we can relax. it's It's a problem that affects both sexes. It also affects ah men who have sex with men. So for example, 70% of head and neck cancers, it has oral and pharyngeal cancers, um and 91% of anal cancers and 63% of penile cancers involve um HPV. So vaccine hesitancy and misinformation, just like in measles, plays a role again in blocking public health improvements and ah ah better prevention for this cancer. Some parents have been quoted as objecting, saying, no no no, no, my little girl would never do that, or my little boy doesn't think those kind of thoughts.
00:07:47
Speaker
He's only 12 and 13. yeah So that's the problem. And religious belief and cultural practices have stood in the way of Gardasil and related products to vaccinate these
Impact of Misinformation on HPV Vaccination
00:07:59
Speaker
kids. And worse, today's mega villain, the destroying angel of public health, RFK Jr., currently the head of Health and Human Services, has attacked Gardasil with a pretty false and outrageous claim that it actually increases cervical cancer risk, not decreases it. This man is really dangerous and he's creating vaccine hesitancy, spreading lies and undoubtedly will cost lives ah in the future of people who would have been vaccinated and should have been vaccinated and could have been but didn't.
00:08:31
Speaker
and then developed cervical cancer of the high-risk HPV types, and then died of it. So thank you, RFK Jr., for your service. That man has even dismissed the CDC regulatory panel that makes recommendations for HPV vaccines. So, here's where
Cervical Cancer in the Global South
00:08:46
Speaker
we are.
00:08:46
Speaker
So HPV remains really a major problem, not only in America, in the global south, ah where cervical cancer death rates are still very high. For example, India reports every year about 80,000 women die of cervical cancer due to ah lack of screening and also a high transmissibility of the dangerous subtypes of HPV in the Global South. Despite advances in ah vaccination and screening and molecular diagnostics, the coverage in the Global South, especially in India, stays ah critically low. At the moment, only about 2% of Indian women undergo screening and only 1% have been vaccinated with Gardasil or related anti-HPV vaccine.
00:09:26
Speaker
So both a vaccination and screening for cervical cancer is going to remain important in the global south and also in the United States, and we need to keep our eye on it. And really, I think it's time to put stigma to rest, especially around sexually transmitted diseases and especially where sexuality involves children or young adolescents who are becoming sexually active.
Promoting HPV Vaccination and Overcoming Stigma
00:09:46
Speaker
It's time to just grow up and realize that this is helpful for everybody and it's lifelong protection and just like stop worrying about it and stop the pearl clutching because this is going to save lives in the long run. You don't want to mess with cervical cancer.
00:10:01
Speaker
It's difficult to treat. It's painful. It requires multiple visits and often radiation therapy as well as antiviral therapies. It's really a mess. It's difficult and it's stigmatizing. And I've known cases of men who blame their female partners for developing cervical cancer. It's difficult within relationships and it's a lonely experience for a woman.
00:10:23
Speaker
And we should not be in this position. We should just grow up and look the facts in the face and just do what's right for public health because it's about our health and our kids and our loved ones. And could we please just lower the temperature and look at the data and use that to guide our decisions, all right?
00:10:41
Speaker
It's not that complicated.
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00:10:47
Speaker
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00:11:00
Speaker
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00:11:11
Speaker
See you next time.