Sexually transmitted infections and screening for chlamydia in England: 2022 report

Women With HPV, Metabolic Syndrome May Be At Nearly Triple The Risk Of Death

Women infected with high-risk strains of human papillomavirus (HPV) who also have metabolic syndrome (MetS) are at nearly triple the risk for all-cause death compared with women with neither condition, a decade's worth of US data suggest.

The findings, from researchers at York University in Toronto, were published last week in PLOS One. Data on 5,101 respondents (3,274 women) aged 18 to 65 years with data on HPV and MetS were taken from seven consecutive cycles of the US National Health and Nutrition Examination Survey (NHANES) from 2003 to 2016, with follow-up to 2019. Average follow-up was 9.4 years.

Links between MetS, HPV, and cancer

HPV is a vaccine-preventable sexually transmitted infection that can cause cancers of the cervix, vulva, vagina, penis, anus, and throat. MetS is a combination of conditions (ie, high blood pressure, high blood glucose, excess fat around the waist, and abnormal cholesterol levels) that increases the risk of heart disease, stroke, type 2 diabetes, and death from any cause.

MetS has been demonstrated to increase HPV persistence, which can in turn raise the risk of cervical and other cancers. Of the more than 200 HPV strains, only a few are considered high-risk, causing 4.5% of all cancers around the world. The high-risk strains—HPV 16 and 18—cause roughly 70% of all cervical cancers.

"HPV is the most prevalent sextually transmitted infection [STI] and has been referred to as the common flu of STIs," senior author Catriona Buick, PhD, said in a York University news release. "In most cases, the body will clear HPV fairly quickly, but lingering cases of high-risk HPV can develop into precancerous changes in the cervix and in some cases over many years cervical cancer."

Higher risk not seen in men

Using International Agency for Research on Cancer data, the 5,101 participants were classified as having no HPV (1,619), low-risk HPV (1,138), probable HPV (672), or high-risk HPV (1,672; 22% with type 16 and 10% with type 18). Women aged 18 to 24 years made up half of the high-risk HPV group, and a quarter of the women who had MetS also had high-risk HPV.

Current screening tailors to the clinical utility of knowing high risk HPV status as it has an impact on the treatment of precancerous lesions and the prevention of cancer.

During follow-up, 240 respondents died of any cause (no HPV, 46 deaths; low-risk, 60; probable, 37; and high-risk, 97). While HPV status alone wasn't tied to death in fully adjusted models, cross-classification into MetS/HPV strata revealed that women with high-risk HPV and MetS were at 2.6 times the risk for all-cause death compared with the no-MetS/no-HPV group. There was no significant association between HPV, MetS, and death in men.

"In this study, low, probable, and high-risk HPV and MetS were differentially related to mortality risk in men and women," the study authors wrote. "Further work is necessary to separate the temporal, age, vaccination, and sex effects of HPV diagnosis in these relationships using prospective studies with detailed histories of HPV infection and persistence."

The different findings in women and men may be partially due to differences in HPV vaccination and screening, with more women than men receiving both, the researchers noted.

It's not known how MetS influences HPV, lead author Parmis Mirzadeh, a PhD candidate, said in the release, but "it likely has something to do with a weakened immune response and chronic inflammation, but the research looking at a direct physiological pathway still needs to be done."

The authors advocated for following a healthy lifestyle, undergoing routine cancer screening, and receiving the HPV vaccine.

"Screening for low-risk HPV status lacks clinical utility; as such, knowing low-risk HPV status, or knowing that a low-risk HPV strain is present may not necessarily have an impact on the clinical management of patient with non-malignant conditions such as mucosal warts," they wrote. "In contrast, current screening tailors to the clinical utility of knowing high risk HPV status as it has an impact on the treatment of precancerous lesions and the prevention of cancer."

What A Pediatrician Wants You To Know About Certain HPV-Related Cancers

Created by Women's Health and Sponsored by Merck

Chicago-based pediatrician Anita Chandra-Puri, MD, enjoys her specialty for a variety of reasons. But when asked about why she loves pediatrics, she responds that she "cherishes the opportunity to watch a child grow."

To that end, she speaks to her patients of all ages about adopting practices that she would like them to take into their adult years, including nutrition, exercise, and other preventive measures. Dr. Chandra-Puri is also mindful of the various challenges that children may face during their transition into adulthood and focuses on providing parents of preteens and adolescents with the necessary information and support to navigate these different circumstances. One topic Dr. Chandra-Puri discusses with the parents of her patients is the human papillomavirus (HPV), a common infection that many people are likely to have at some point in their lives once they become sexually active.

Why it's important to speak to a pediatrician about HPV.

HPV may not seem like a pressing health concern to parents of adolescents now, but because the virus could potentially lead to certain cancers later in life, it's important to consider speaking to your child's pediatrician to learn more. For most people, HPV clears on its own. But for those who don't clear the virus, it can lead to certain cancers and diseases. "We encourage parents to discuss certain HPV-related cancers and diseases with their pediatrician because we want to help protect them later in life," says Dr. Chandra-Puri.

Unfortunately, there's no way to know who will or will not clear the virus. HPV typically has no signs or symptoms, and we don't know why some people develop certain HPV-related cancers and others don't. According to data from the Centers for Disease Control and Prevention (CDC), tens of thousands of people in the United States were diagnosed with certain HPV-related cancers each year from 2015 to 2019.

Dr. Chandra-Puri recommends parents consider proactive measures that can help protect their child's health, like keeping up with their annual check-ups to continue discussions about healthy habits, such as routine preventive care like exercise, screenings, and vaccination. She also suggests parents consider the CDC guidance around HPV vaccination, a type of prevention against certain HPV-related cancers. The CDC recommends HPV vaccination be given at ages 11 and 12 for both boys and girls; however, it can be given as early as 9.

Teaching your child about the importance of preventive care.

It is important to help children develop healthy habits they can continue once they are out of your care. "We know young adults go in to see their physician less frequently," says Dr. Chandra-Puri. "So now may be the time to speak to your adolescent's pediatrician about the certain HPV-related cancers that can happen later in life."

Plus, bringing your tween in to see their pediatrician helps provide them with an example of self-care they can apply to the rest of their lives. A doctor's appointment "is such a wonderful opportunity to talk about things that are affecting them, whether it's taking charge of their nutrition and exercise habits, considering preventive measures such as screenings or vaccination, or discussing mental-health pressures such as anxiety and depression," says Dr. Chandra-Puri.

By making sure that your child has regular medical checkups and a healthy dialogue with their healthcare practitioner, you're helping them understand the importance of prioritizing healthy behaviors like routine preventive care. "I think it's really important, to have those conversations in their adolescent years," says Dr. Chandra-Puri. Aside from setting up healthy habits, it helps show your child "that you trust your healthcare provider to give good guidance when it comes to so many things," she says.

As your child's role model, you can help them develop healthy habits in the future by emphasizing the importance of annual check-ups at an early age. These habits, including good nutrition, exercise, and regular check-ups and screenings, begin at your pediatrician's office and promote a mindset to benefit your child's health and wellbeing.

To learn more, speak with your healthcare provider and visit hpv.Com.

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