When Amanda Saxon discovered that his pap smear had yielded an abnormal result, his doctor told him not to worry. A woman of her age should have no problem eliminating the papillomavirus, the most likely culprit. Therefore, the 21-year-old student from Tampa, Florida, returned to her normal routine. The results of your Pap tests, no.
After some years of "sometimes normal, sometimes not" annual exams, your Pap tests showed that the situation was getting worse. The results revealed a high-grade dysplasia, meaning there were significant changes in the cells of his cervix and that he had a high risk of developing cervical cancer. Again, his doctor assured him that everything would be fine, but that he needed more in-depth tests.
During the following year he underwent a series of invasive tests and biopsies. All of them had disappointing results, not to say alarming. If the problem continued, Saxon would need a cold cone biopsy, which is a surgical procedure used to remove lesions from the cervix.
"My husband and I had plans to start a family," Saxon recalls. "As if the cancer threat was not alarming enough, what would happen to my fertility? I wanted to know as much as I could about why this was happening to me. happening and if there was anything I could do to stop it. "
That's why he started doing his own research. Could a change in diet help her? And the exercise? If the problem was that you were not fighting the virus, could you boost your immune system in any way? In the course of her investigation, she found an online forum that said she should stop taking hormonal contraceptive pills, which she took regularly since she was 17 years old. Then, he researched more deeply and found several references (in respectable sites, such as the National Cancer Institute and the Guttmacher Institute) about the relationship of the contraceptive pill with cervical cancer. She mentioned her findings during her next consultation with her doctor, but he could not tell her if that could be the reason why she could not eliminate the infection.
"He said there was no evidence that suspending the pill could help me," Saxon said. "He suggested that I stop researching at Google since this was scaring me."
So far, what we know for sure is that any complications associated with the pill; including any effect on the immune system; It is exacerbated during pregnancy. And we know that the vast majority of women infected with HPV heal spontaneously.
Dr. Kari Braaten, obstetrician and gynecologist at Brigham and Women's Hospital in Boston.
Can the pill suppress your immune system?
If you do a quick Google search on the question above, you'll get more than 400,000 results, many of which are product of massive collaboration or "from dubious sources" (ie, unreliable) in forums questions like ChaCha or Yahoo! Answers. Maybe worse; curiously; you can find vague but glaring information about the possible effects of the pill on the immune response and cervical cancer in reliable sites, as it happened to Saxon.
Women are asking themselves questions about this, although they do not seem to get clear advice on what to do, even when they consult their doctors. "And when this happens, it's often because the answer is still unclear," he says. Dr. Kari Braaten, an obstetrician and gynecologist at Brigham and Women's Hospital in Boston.
"No one would say that the pill itself increases the chances of getting HPV, or that it makes you more susceptible to other infections like the cold or the flu," says Dr. Jen Gunter, an obstetrician and gynecologist in the area. from San Francisco Bay. And although there is evidence of the relationship of oral contraceptives with a slightly increased risk of cervical cancer, experts disagree on what lies behind. "It is debatable," says Gunter. "People are very divided about what actually happens. " It could be a matter of riskier sexual behaviors: for example, a 2012 study found that women who were taking the pill were less likely to use condoms, which are known to decrease exposure to HPV.
Contrary to what the doctor told Saxon, however, there is at least some evidence that the long-term use of the pill has a role in the persistence of the virus or the repetitive reactivation of a latent virus, according to Dr. Xavier Castellsagué, director of the WHO / ICO (Catalan Institute of Oncology) Information Center on HPV and Cervical Cancer in Barcelona. In 2002, the International Agency for Research on Cancer published a review that found the presence of precancerous lesions or cancer among HPV positive women who took the pill systematically for five years or more, and subsequent research supported it. There was no increase in women who had taken the pill for four years or less.
"Obviously, it is a cofactor", says Castellsagué, "even if there is no certainty as to what the mechanism is".
It is important, however, to emphasize that the case of Saxon and similar ones are rare. Saxon's doctor was right in assuming that at some point Saxon would heal spontaneously.
"Even biopsies can stimulate a positive immune response in the cervix and can help cure it," says Gunter.
HPV is the most common sexually transmitted infection in the United States.More than half of the sexually active population will be infected with one or more strains of the virus and will be cured over the course of their lives, and at some point, approximately 43% of women will be infected with HPV, according to National Cancer Institute. "Most women have positive results by age 23," says Gunter.
Almost all cervical cancers start with HPV, but scientists are still studying why some infected women develop cancer while others do not have any effect. According to Castellsagué, 90% of those infected with the virus will be cured within two years.
It is impossible to say why Saxon ended up in 10% of women who develop persistent infections and cervical lesions that, if left untreated, can become cancerous. She was young and otherwise healthy. And this was the real problem: there is still no way of knowing, on an individual level, who will eliminate the virus and who will need more complex treatments.
The development of cervical cancer, like other forms of cancer, is a complicated dance of genetic, environmental and several other factors. The high-risk or "oncogenic" strains of the virus are the ones that are most likely to cause cancer. (Two of these, types 16 and 18 are responsible for almost all cancers related to HPV and are those that are present in the vaccine). But there are many other known factors, in addition to a possible relationship with the pill.
Although it is possible that your individual genetics influences the ability to eliminate the virus, "That is the key is the immune system," says Castellsagué. The idea is that a suppressed immune system is what allows the virus to remain and cause problems, which is the reason why people with HIV or taking immunosuppressive drugs for autoimmune diseases have a higher risk of suffering cervical abnormalities. Similarly, smokers are twice as likely to persist due to the effects of smoking on immunity.
The main point
Medical advice represents a weighing of the risks and benefits of certain tactics based on what is most common or what is most likely.
"I would never suggest to a patient that she stop her contraceptive simply because she can not eliminate her HPV infection," says Braaten. "So far, what we know for sure is that any complications associated with the pill (including any effect over the immune system) is exacerbated during pregnancy and we know that the vast majority of women infected with HPV will eliminate the infection themselves. " That is, in most cases pregnancy is both the biggest and most likely threat.
If you are currently taking the pill, do not panic. Oral contraceptives are still among the safest and most effective drugs on the market.While your annual health checkups and regular Pap tests are normal, there is no reason to worry. The best way to prevent the problem is to talk to your doctor about the HPV vaccine, not to stop the pill, regardless of how long you are taking it. And remember, the pill does not protect you from sexually transmitted diseases, so do not stop using condoms!.
For women who are struggling with a problematic and persistent virus, the official word is that there is not enough evidence to say that stopping the pill will undoubtedly help eliminate the infection. But this will not hurt either, as long as they use another reliable method of contraception.
Saxon finally decided to change his contraceptive method because of the use of condoms, after it became clear that he would need surgery. "It was so frustrating," he said. "All the time, [the doctor] told me the infection would go away but things only got worse, I felt that if there was even a slight possibility that suspending the pill could help my immune system fight the infection, it was worth trying. "
While there is no way to tell what difference this change made, Saxon has at least one expert on his side. "His situation is very rare, but it happens," said Castellsagué. Cervical abnormality for more than a year and it does not go away, it's a good idea to change to another contraceptive method. "
Saxon might be a rare case, but the fact is that he is one of the people who, for some reason, had difficulty keeping the virus under control. If there is a minimal chance that the pill could play a role in fighting what could become cancer, why should I take the risk?
Finally, in October 2012, after six years, a long string of invasive tests and surgery to remove a 1-inch piece from his cervix, Saxon achieved the peace of mind of having a normal Pap test result..
"And so far," she said, "I'm still healthy."