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Health

Clues to the cancer

David Hastings doesn't fit the throat cancer profile. So he looked for answers and was surprised by what he found.

By John Barry
Published April 17, 2007

ADVERTISEMENT [Times photo: Martha Rial] David Hastings nearly died last year from throat cancer. His wife Jo saved him by nagging him to see a doctor.

During the grisly battle for his life, David Hastings played medical detective. He read everything he could find on what was trying to kill him. Nothing made sense. Hastings had throat cancer, mostly known for killing old people. Imagine an elderly soul addicted to cigarettes and alcohol for 40 years. There's a likely victim.

Hastings didn't fit. He was 58. He looked 48. He hadn't smoked since college, and he doesn't drink. His chief addiction is cycling. He rides his bike about 100 miles per week.

He'd never have guessed where he finally did fit in.

He did not have an old smoker's disease, after all. His throat had been attacked by a cancer-causing virus infamous for killing women. It was HPV, the human papilloma virus, that causes most cervical cancers. HPV is the virus at the center of a national argument over preventive vaccinations of young girls.

To his great surprise, Hastings discovered that this controversial women's vaccination plan aimed at ridding the world of HPV cancers may have started with the wrong gender.

One day, the answer might be found here. A thousand Tampa men are currently participating in the world's largest study of male HPV infections. The National Institutes of Health has awarded the H. Lee Moffitt Cancer Center in Tampa $10-million for the work. It involves 3,000 men worldwide, including the Tampa thousand, and may soon include their female partners. One preliminary finding is a male infection rate double that of women.

Hastings found other studies as well that have long linked HPV to anal and penile cancers. Gay men and men in impoverished countries are most afflicted. They were horror stories - cancers that required the most ghastly of surgical remedies.

By the end of his searches, Hastings had become an official HPV cancer statistic - one of 10,000 American men afflicted by any one of five types of HPV cancers each year. The male number is close to the annual number of HPV cervical cancers detected in women.

Doctors are seeing more and more cases like Hastings': young, nonsmoking men and women who are turning up with oral cancers they aren't supposed to have. There has been an 11 percent increase - after 50 years of constancy - even as smoking has declined. A Chicago conference is planned for June. The maker of the current vaccine for girls is seeking FDA approval to give it to boys, too. Some Johns Hopkins University patients are receiving a new experimental vaccine.

Hastings even found himself briefly inserted into the debate in Tallahassee over requiring vaccinations of schoolgirls. His message to the lawmakers: HPV kills men, too.

It almost killed him.

- - -

Hastings had shaved over a swelling on the left side of his neck in March 2006. "It felt muscular," he says, "almost as if I'd been working out." He ignored it. That was typical of his personal approach to all things medical. "I didn't even know what a primary care physician was."

He's a CPA. His tax office is next door to the Habana Cafe in Gulfport, run by his Cuban wife, Josefa. They've been married for 17 years. They have one of those marriages where the fun and fur fly simultaneously. "She promised me I'd never have to work in the restaurant when we started it 10 years ago," he says. "I've been there every night since the first night."

A month went by before he showed his wife the swelling. It was a Friday morning.

"God, you've got golf balls in there," she said.

Jo wanted his neck checked that day. Over his protests, she started calling doctors. The only one she could find late on a Friday was their neighbor, a plastic surgeon. He felt two swollen lymph nodes and arranged a Monday appointment for Hastings with a primary care doctor. That doctor referred him to a general surgeon.

The general surgeon said it might be cancer or might not be, but, regardless, they should come out. He scheduled surgery for that Thursday.

Hastings was finally paying attention. He wanted a second opinion. Jo thought he was trying to get out of the surgery. She called another doctor neighbor, this one an oncologist.

That doctor told Hastings he didn't fit the profile of a "cancer candidate." He thought Hastings might have caught cat-scratch fever from one of Jo's eight cats. Surgery was scrubbed; Hastings went on an antibiotic. But the oncologist also ordered a CT scan.

Then Jo tricked her husband. She asked him to take her mother to an ear, nose and throat specialist. After examining the mother-in-law, the specialist turned to Hastings: "I understand I need to look at you, too."

The doctor felt the neck. "That's not good." He took a foot-long needle out of a drawer. With the needle, he extracted fluid for biopsy. Then he looked over a report on the CT scan. It contained the word "necrosis." That means dead cells and usually indicates cancer. "I didn't want to read that," he told Hastings.

A week later, the doctor saw him again. "Your wife saved your life," the doctor said.

He diagnosed a deadly squamous cell carcinoma. He said Hastings would need a radical remedy that involves the removal of lymph nodes, jugular veins, nerves and muscle between the tip of the ear and the collar bone. It would leave him with a drooped shoulder. And afterward, Hastings would still need chemo and radiation.

His chances of survival after all the cutting, chemo and radiation would be 60 percent.

Hastings fainted.

- - -

He again went looking for options. He ended up at Moffitt, which gave him the first good news since he'd felt the lumps. It concluded he didn't need the surgery. It preferred simultaneous radiation and chemotherapy as a first step, saving Hastings from a crippled upper torso.

During 35 treatments in seven weeks and nausea and dehydration that nearly killed him, Hastings read up on HPV.

It's sexually transmitted. About two-thirds of the population are infected with it in young adulthood. But about 3 percent of women get a strain called HPV-16 that causes cervical cancer and kills about 3,700 women a year.

Last July, the FDA approved a HPV-16 vaccine called Gardasil for young girls. Almost immediately, legislatures, including Florida's, drafted laws to require the vaccinations for girls in public schools.

Almost immediately, parents and religious groups protested, fearful that the vaccinations might encourage sexual promiscuity and take medical choices away from parents.

Overlooked in the furor was the fact that men can get HPV-16 from having sex, too. Sexual encounters in their teens can come back to haunt them in their 50s. The virus usually lies latent until middle age. Then it can show up in anal and penile cancers or in oral cancers like Hastings'.

HPV vaccinations of schoolgirls are a fine thing, contends Brian Hill, founder of the Oral Cancer Foundation in California and a survivor of HPV cancer in his tonsils.

"But if they don't do boys it's solving only half the problem."

- - -

Studies at Moffitt are tending to confirm that. Early findings in one study are showing a 60 percent overall HPV infection rate among men, compared with less than 30 percent among women.

Anna Giuliano, Moffitt's lead HPV researcher, is seeking an additional grant in order to add female partners to her study of the 3,000 men. Then she should know if men are more commonly infected than women.

The ultimate goal, she says, is "one simple vaccine" for all.

Merck, the maker of Gardasil, has already submitted to the FDA its tests of the vaccine on boys ages 9 to 15. They're in the process of testing boys and men ages 16 to 23. Moffitt is participating in those trials. Gardasil is already given to boys in European Union countries, as well as Australia and New Zealand.

Hopkins is testing an HPV vaccine specifically for men who already have oral cancers. "It's designed to enhance the immune response to the HPV-16," Maura Gillison, the lead HPV cancer researcher at Hopkins, said by e-mail.

Hastings has tried to get into the trial. He did so by pressing Moffitt to send his cancer tissues to Hopkins for HPV-16 testing.

Last month the tests for HPV-16 came back positive, vindicating his medical detective work.

Some good news from Hopkins came as well: People like Hastings with HPV cancers have a higher survival rate than those with oral cancers from smoking.

Now Moffitt, which has sent other samples besides Hastings' to Hopkins, is testing a screening procedure of its own.

- - -

Hastings took his message to the Legislature's House Education Committee in early April. He flew to Tallahassee with Ed Homan, a Tampa representative who was sponsoring the schoolgirl vaccination bill. He told Hastings, "Tell them you're a man with HPV."

He had three minutes. Hastings is a guy who has trouble telling his name in three minutes. He rattled off his message as fast as he could. "I was told my testimony was emotional."

Then, with little discussion, the committee rejected the vaccination plan.

Hastings left the hearing shocked by his three-minute civics lesson.

"Unbelievable!" he sputtered. "Kids will die in Florida."

John Barry can be reached at (727) 892-2258 or jbarry@sptimes.com

Fast Facts: HPV- The human papilloma virus is one of the most common sexually transmitted viruses. More than half of all people will be exposed to any one of 80 HPV viruses.- The HPV-16 strain causes most cervical cancers, nearly 10,000 a year in the United States. It kills about 3,700 U.S. women annually.- HPV-16 has been linked to oral, penile and anal cancers in men. About 9,800 U.S. men are afflicted each year.

[Last modified April 16, 2007, 17:00:42]