1. Human Papillomavirus (HPV) and Cancer
Cancer Education Project
University of Rochester

2. Human Papillomavirus (HPV)

3. Overview of HPV Activities
Part
Title
Strategy 1
“One Less” and “Tell Someone”
Short PBL 2
HPV Vaccine & Immune System
Making Notes 3
HPV Vaccine & Cervical Cancer
Jigsaw 4
The Pap Test
Reading for Understanding 5
Cancer Detection: A Laboratory Simulation
Hands-on Lab 6
Why Not the Boys?
Decision-Making

4. “One Less” and “Tell Someone”
Part 1:
“One Less” and “Tell Someone”

5. Part 1: “One Less” and “Tell Someone”
A “hook” for HPV lesson series
TV commercials
PBL teams of 3-4 students
“Facts” and “Questions” charts

6. After watching the video, students write one question about:
Human Papillomavirus (HPV)?
The Gardasil vaccine?
An ELSI* implication?
(*ethical, legal, or social issue )

7. Part 2: HPV Vaccine and The Immune System

8. Part 2: HPV Vaccine & the Immune System
Students will:
View Gardasil TV commercial
See National Cancer Institute (NCI) PowerPoint:
“HPV Vaccine to Prevent Cervical Cancer”
Make Notes from the NCI PowerPoint
Complete a Refection Sheet

9. Part 2: HPV Vaccine and Immune System

10. HPV Vaccine To Prevent Cervical Cancer
Understanding Cancer and Related Topics
HPV Vaccine To Prevent Cervical Cancer
This PowerPoint presentation from the National Cancer Institute explains the science behind the development of a new vaccine against high-risk types of human papillomaviruses, which can lead to cervical cancer over time.
These PowerPoint slides are not locked files. You can mix and match slides. In the Notes section, you will find explanations of the graphics.

11. Infection Is Sexually Transmitted
Anyone who has ever had genital contact with another person infected with HPV can get the infection and can pass it to another person. Since the virus can be silent for many years, a person can have genital HPV even if years have passed since he or she had sex.

12. Common Infection Infected with HPV
Human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. At least 70 percent of sexually active persons will be infected with genital HPV at some time in their lives. HPV infects both men and women.

13. Many Types of HPVs Different HPVs–Different Infections Harmless
No warts or cancer
Warts-Linked
Genital warts
Cancer-Linked
Most clear up
Some persist, but no abnormalities in cervix
Some persist, some abnormalities in cervix
A few persist and progress to cervical cancer
There are three groups of genital HPV strains: many no-risk types cause neither warts nor cancer; a few types cause genital warts; and 15 or so high-risk types can increase one’s risk of cancer.
If left untreated, genital warts do not turn into cancer.
High-risk HPV, on the other hand, may trigger an infection that leads to cervical cancer. The majority of infections with high-risk HPVs clear up on their own. Some infections persist without causing any additional abnormal cell changes. However, a few infections caused by high-risk HPVs end up triggering cervical cancer over many years.

14. Virus Penetrates Cervix
Papillomavirus
Uterus
Layers of
epithelial cells
Cervix
HPV
infection
Both harmless and cancer-linked human papillomaviruses pass by skin-to-skin contact. The high-risk types of HPVs need to penetrate deeply into the lining of the cervix to establish a chronic infection. A vaginal sore or sex, which can abrade the lining, may provide a point of entry for the papillomavirus.
Once inside the cervical lining, the virus attaches to epithelial cells. As these cells take in nutrients and other molecules that are normally present in their environment, they also take in the virus. Over 99 percent of cervical cancer cases are linked to long-term infections with high-risk human papillomaviruses.
Vagina

15. Virus Uncoats Nucleus Viral DNA enters nucleus
mRNAs for viral proteins E6 and E7
Virus
“uncoats”
The HPV sits inside the epithelial cells housed in a protective shell made of a viral protein called L1. After the virus enters the cell, the viral coat is degraded, leading to the release of the virus’ genetic material into the cell and its nucleus. From the nucleus, the genes of the virus are expressed, including two genes called E6 and E7, which instruct the cell to build viral proteins called E6 and E7.
Epithelial cell interior

16. Virus Disables Suppressors
Mucus
Healthy cells
E6 viral protein
Cancerous epithelial cells
Suppressor protein 1
Degraded suppressors
E7 viral protein
Suppressor protein 2
Viral proteins E6 and E7 then disable the normal activities of the woman’s own suppressor genes, which make suppressor proteins that do “damage surveillance” in normal cells. These proteins usually stop cell growth when a serious level of unrepaired genetic damage exists. Even after suppressors are disabled in a woman’s cervical cells, it usually takes more than 10 years before the affected tissue becomes cancerous.

17. Virus-Like Particles
The virus-like particles in the HPV vaccine, like the real human papillomavirus, have the same outer L1 protein coat, but they have no genetic material inside. This structure enables the vaccine to induce a strong protective immune response.

18. The Vaccination
The vaccination protects a person from future infection by the HPV high-risk types that can lead to cancer. It is not a vaccine against cancer itself. A person receives a series of three shots over a 6-month period. Health professionals inject these virus-like particles into muscle tissue. Once inside, these particles trigger a strong immune response, so the vaccinated person’s body makes and stockpiles antibodies that can recognize and attack the L1 protein on the surface of HPV viruses.

19. Antibodies Prevent Infection
Papillomavirus
No DNA strands can escape the capsid
After the vaccination, the person’s immune cells are prepared to fight off future infection by high-risk HPV viruses. If an exposure occurs, the vaccinated person’s antibodies against the L1 protein coat the virus and prevent it from releasing its genetic material.
= Antibodies

20. Pap Test Still Necessary
Normal Pap test
Abnormal Pap test
After the vaccination, a woman must still get routine Pap tests or another approved cervical cancer screening test. Although the anti-HPV vaccine prevents infection by the dominant HPV types, which are responsible for 70 percent of the cervical cancer cases, it does not prevent infection by most of the other types that can also cause cervical cancer. A Pap test can detect abnormal cervical growth regardless of what HPV type caused it to develop.

21. More Work Ahead 4 years later
Studies are under way to determine if a booster, in addition to the three initial intramuscular injections, will be necessary for long-term protection. Clinicians know that the new cancer vaccine remains effective for up to at least 4 years, but more research is needed to find out what happens after that time. An NCI study in progress will follow vaccinated women for several more years to obtain information on the vaccine’s long-term safety and the extent and duration of its protection.

22. HPV Vaccine and Cervical Cancer
Part 3:
HPV Vaccine and Cervical Cancer

23. Part 3: HPV Vaccine and Cervical Cancer
Students will:
In Jigsaw “home groups,” get one of four readings and decide on Top 5 facts.
In reading “specialty groups,” brainstorm top facts and decide on Top 3.
Discuss Top 3 with “home group” members.
Complete Personal Reflection sheet as Ticket-to-Leave.

24. Part 4:
The Pap Test

25. Part 4: The Pap Test Students will:
Receive directions about “Save the Last Word for Me” reading strategy.
Read Mayo Clinic handout and complete “significant passage” task.
Meet in groups of 3 to complete the “listening & reacting” protocol.
Complete The Pap Test review sheet

26. Part 5: Cancer Detection: A Laboratory Simulation
Students will:
Perform visual, radiation, and chemical testing on images of simulated biopsy samples to test for the presence of “abnormal” cells
Estimate the chances of a biopsy sample being cancerous
Write a lab report

27. Question?
What are two science laboratory skills that are critical to the work of a crime scene investigator (CSI)?

28. Observation (accurate and detailed)
Answer!
Observation (accurate and detailed)
Analysis of Data

29. Goal of The Pap Test Lab:
…. to understand medical professionals use three different kinds of observation and data analysis techniques to detect cancer cells when given a biopsy (tissue sample) from a person suspected of having cancer.

30. Introduction to the Lab: Student Version
Form into teams of 2-3 students.
Obtain 1 copy of the lab per team.
Read the first 4 paragraphs.
Be able to name the 3 procedures.
Be able to identify 3 medical careers involved in cancer detection.

31. Pre-lab For each student, obtain: 1 Cancer Detection Lab Report Form
2 biopsy images
1 cotton swab
For each lab group, obtain:
1 UV light source
1 bottle of “antibody”

32. Visual Detection
Study the two images carefully to identify what you believe are differences between “normal” and “abnormal cells.
Use a pencil to mark suspected abnormal cells with an “Ab.”
Be ready to state your hypothesis (Q-1).

33. Visual Detection
Brainstorm a list of different hypotheses that might be used to visually detect differences between “normal” and “abnormal” epithelial cells.
(Q-2)

34. Radiation Detection (Safety Warning: UV light)
Shine a UV light on your biopsy samples.
Use a pencil to mark suspected abnormal cells with “UV.”
Discuss differences between normal & abnormal cells (Q-3).
Accept or reject hypotheses (Q-4).

35. Chemical Detection
Use the swab to add a very light coating of “antibody” to cell membranes of “UV” cells, and describe observations (Q-5).
Coat all the cell membranes in both images.
Count your team’s biopsies (not cells) that show abnormal cells (Q-6).

36. Estimating Odds
What is the class’s “operation definition” of an “abnormal” biopsy sample (Q-7)?
What data have to be collected to estimate the odds that a biopsy sample will be cancerous? (Q-8)?
Calculate the odds and show your work
(Q-9).

37. Summary (“a” or “b”)
“a”: Write one sentence (or group of sentences) that summarize the main idea(s) behind this simulated cancer detection lab.
“b”: Choose one vocabulary word (or main idea) from this lab and write a Cinquain (a 5-line poem) to summarize this lab.

38. Rules of Writing a Cinquain
Line 1
1 word
Title
Line 2
2 words
Nouns or adjectives that describe Line 1
Line 3
3 words
“-ing” words that tell what Line 1 does
Line 4
4 words
Your personal, emotional reaction to Line 1
Line 5
Synonym for Line 1 (foreign words are OK)
A word and it’s root or derivatives can be used only once!
(e.g., life, living, alive)

39. Hiding, Dividing, Metastasizing Should’ve Worn Enough Sunblock!
Cinquain Example
Cancer
Abnormal Growth
Hiding, Dividing, Metastasizing
Should’ve Worn Enough Sunblock!
Tumor

40. Part 6:
Why Not the Boys?

41. Part 6: Why Not the Boys? Students will:
Read a Board of Education press release about mandating Gardasil vaccine for all middle school students
Complete 8-step decision-making model to formulate position statements for BOE
Steps 1-3 as whole class
Steps 4-6 in teams
Steps 7-8 individually