Explore This IssueOctober 2019
When two people are in a monogamous relationship for many years, it is impossible to know which person transmitted the original infection. —Lisa Shnayder, MD
Ask Family Members to Step Outside
Usually, when patients are diagnosed with these conditions, physicians bring up the subject of sexual transmission and how to prevent the spread of these contagious diseases. Dr. Shnayder said that, very often, her patients with cancer bring their families to their first consultation and may bring it up themselves when others are in the room. “When the conversation turns to the HPV-related infection and modes of transmission and what this means for the patient’s spouse, I usually politely ask the family members other than the patient’s spouse to step outside the room,” she said. Dr. Shnayder believes it’s important to have the patient’s partner present so they can discuss cervical cancer screenings, if the partner is a woman. She personally brings other family members back to the room when the conversation returns to discussing prognosis and treatment options.
Dr. Wang adds that a patient may be especially concerned about their partner’s reaction and potential risk, so it’s important for the physician to provide this information to both.
How to Break the News about HPV
When it comes to HPV-related oropharyngeal cancer, Dr. Shnayder tells patients that the virus is transmitted via sexual contact, but she doesn’t dwell too much on that part. “When two people are in a monogamous relationship for many years, it is impossible to know which person transmitted the original infection,” she said. “We need to focus on treating and recovering from this cancer, knowing that prognosis is better for HPV-caused tumors. We also need to focus on vaccinating family members within the age range of vaccination recommendation, to spare them from ever contracting this cancer.”
Dr. Wang tells patients that almost all sexually active adults will come in contact with this virus, and that when a patient is diagnosed with an HPV-positive cancer, it does not mean that they or their partner have been promiscuous, or that their partner is necessarily at risk of developing cancer. She recommends that the usual screening guidelines for oral and cervical cancer continue to be followed and that the patient see their physicians regularly.
And Dr. Amin explains to patients that approximately 95% of adults in the U.S. are circulating antibodies to HPV. “The immune system clears the virus, but in that cycle of exposure, clearance, and re-exposure, sometimes with the benign papillomas, patients develop an immune tolerance that allows the virus to propagate and create disease,” he said. “We don’t know if this happens in cancer, but it’s assumed it’s the same mechanism.”
As movie and television stars such as Michael Douglas and Marcia Cross have been forthright about their HPV-linked cancers, there is less of a stigma attached to talking about these conditions. “Patients are much more aware now because it’s being covered on the news,” Dr. Shnayder said. And because the incidence of HPV is on the rise, she added, it’s much more common now to have these discussions with patients than it was even five years ago. “I predict until we catch up with vaccinations we are going to see more patients over the next 10 years.”