HPV and Anal Cancer

Featuring: Cari Sudmeier, Jon Colbert
Eisenhower Health provides High Resolution Anoscopies for patients with HPV that are high risk of developing anal cancer. Because of the stigma around this type of cancer, there is often little discussion about it - it's the type of cancer that took Farrah Fawcett's life. It's time to shed light on this topic.


Cari Sudmeier is a graduate of Loma Linda University, where she obtained her Master of Science degree, Bachelor of Science degree and completed the Family Nurse Practitioner program. Sudmeier has been a Nurse Practitioner for more than 20 years, starting as Registered Nurse nearly 30 years ago. Since joining Eisenhower Health several years ago, Ms. Sudmeier has been part of Women's Health/Gynecology. After completing an internationally recognized course on Anoscopy and additional training, Ms. Sudmeier now joins the High Resolution Anoscopy clinic as an Anoscopist at the Eisenhower Surgery Specialty Clinic on the main campus in Rancho Mirage.

Prior to joining Eisenhower, Sudmeier worked locally in a family practice and in a cardiology practice. Her background also includes eight years as a critical care nurse, working in intensive care units and as an international air ambulance nurse.

"As a Nurse Practitioner, I focus on treating the whole person, while integrating disease prevention and management by partnering with patients to help them achieve their optimal health and wellness. I am very passionate about empowering patients with knowledge and education, seeing each patient as an individual and tailoring their care to their specific needs and lifestyle". 

Jon Colbert received his Bachelor of Science degree at Texas A&M University in College Station, Texas. He later completed a Master's of Science in Nursing at San Francisco State University and then continued his education and training to become a Family Nurse Practitioner while attending Sonoma State University. He has been involved in the HIV/Sexual Health Field for more than 20 years. Mr. Colbert was certified for the Anchor Study for Anal Cancer Surveillance in 2020 and received his training in High Resolution Anoscopy through the European High Resolution Anoscopy course in Amsterdam in 2017.

As a young man in the early 1980s, Mr. Colbert was misdiagnosed with what is now known to be HIV. He was admitted into a local hospital and treated with a lack of compassion during this fearful time in our history of HIV care. "That experience is what compelled me to pursue becoming a health care provider," states Mr. Colbert. "I vowed to always remember how I and others were treated and am committed to treating patients with dignity, respect and compassion in a supportive environment. I lost more than half my friends to HIV/AIDS during that time." As a result, he interacts with patients in a non-judgmental manner and tries to establish a relationship where patients feel as though they can speak freely and honestly regarding their health care needs. "Establishing trust in my relationships with patients is a key component in my approach to patient care," he says.

A little known fact about Mr. Colbert: He was a professional tennis umpire at one point and yes, has had John McEnroe screaming in his face...and he stands by his call! He remains active in the tennis community here in the Coachella Valley. When not working, you might find him out camping near some water - streams, lakes or oceans, or just relaxing with friends at his home here in the Coachella Valley.


INTRO: You're listening to another episode of Living Well with Eisenhower Health, healthcare as it should be.

Caitlin Whyte: Eisenhower Health provides high resolution anoscopies for patients with HPV that are at high risk of developing anal cancer. Because of the stigma around this type of cancer, there is often little discussion about it, although it's the type of cancer that took Farrah Fawcett's life. It's time to shed light on this topic. So today, we are joined by our nurse practitioners, Cari Sudmeier and Jon Colbert. Now Cari, start us off here. How does an individual acquire HPV?

Cari Sudmeier, NP: HPV is the most prevalent sexually transmitted disease in the world. HPV is contracted from just skin to skin contact, close contact with another individual that may have HPV. You could have one individual that's never had any other partner and then have an interaction with their first partner that may have only had one other partner and they can have close contact, skin contact of their genital area and contract HPV that way. You actually don't have to have actual intercourse or even anal intercourse to contract HPV.

Caitlin Whyte: And John with that, is there a way to not get this high-risk HPV?

Jon Colbert, NP: There is. There's numerous forms of HPV, most of which are benign. And the type that are associated with cancers are considered to be the high risk types. And we do now have immunizations for those high risk types. And we begin that early, you know, before anyone's had sexual contact. So parents are getting their children immunized. And so a lot of times pediatricians will bring it up and, if not, then the parents can bring it up or even the child can bring it up.

But in fact, uptake on that is not as great in the US as it probably should or could be. And so we need to do a better job of immunizing because we could actually eliminate the high risk transmission if everyone were immunized.

Caitlin Whyte: And Cari, my question for you is how does HPV affect us females?

Cari Sudmeier, NP: It's a great question. Women can contract HPV in the vagina, the cervix and their vulvar tissue. And if they contract HPV in the female genital region, it can migrate to the rectal area all on its own without any activity. Young girls are often taught to wipe front to back when they urinate to reduce the risk of urinary tract infection. And in that process, if she happens to have HPV, she can just move the HPV back to that region. But also the virus on its own has an affinity for anorectal tissue and can migrate there on its own. So HPV affects women because it can affect their cervical tissues and their vaginal, vulvar leading to cervical cancer, vaginal cancer, vulvar cancer, as well as the anal tissue and can lead to anorectal cancers.

Caitlin Whyte: And Jon, what is the difference between low risk and high risk HPV?

Jon Colbert, NP: Well, low risk HPV is, again, human papilloma virus, as is high-risk, the categories being low to high. High risk are those that are associated with cancers. So an individual can get, you know, vaginal cancers, anal cancer. We're beginning to see that there are some just skin cancers on the outside of the body that are involved with HPV as well, that high-risk type, as well as pharyngeal, so throat cancers. Mouth, oral cancers are associated with high-risk HPV as well. Low-risk HPV are often benign or what's called condylomas or commonly known as warts. So, you know, an individual gets warts on their hands and that's typically low risk HPV, but you can get warts in any area, genital warts. So that's really a big difference

Caitlin Whyte: Now with all of this talk about how transmissible it is, Cari, how can I "get rid" of HPV?

Cari Sudmeier, NP: That's a great question. Unfortunately, the current scientific theory is that once an individual has HPV, their body can keep it in check IF they have a great immune system, but they never really get rid of it. Even if it shows they've had it on a certain tests like a cervical Pap smear or anal Pap smear and then it tends to not show up in the future, it just means your body's doing a really good job of keeping that HPV IN check, but it's probably just laying in wait or quiescent and not active, but still present.

Caitlin Whyte: Now it sounds like a lot of the strains are benign like you mentioned, Jon, but what can I do to make sure that I don't get HPV-related anal cancer then?

Jon Colbert, NP: Well, that's also a great question. And Cari pointed out earlier, you can get an anal cancer related to HPV without having anal sex. Some people think that, you know, you have to have involvement in that area, but it's just skin to skin. So, you know, if you have HPV on your hand, you know, and you're washing yourself, that sort of thing. So the only real way not to get it is for a high-risk HPV is to have these immunizations and they keep you from getting this transmission of this high risk type. You may still get low risk HPV, but you just wouldn't get the high risk HPV. And a lot of people think that they can get this now because they've extended from age 20, I think it's 25 to age 45, it used to be 25 for this vaccine where your insurance would recognize and pay for it. Now it's 45 because, you know, there are some people that aren't sexually active as early. But that's really the only way not to get it. Other than that would be to never have contact with a human being in your entire life.

Caitlin Whyte: Well, I'm glad there are immunizations then.

Jon Colbert, NP: Yeah.

Caitlin Whyte: And now, Cari, can you tell us what HRA is?

Cari Sudmeier, NP: Absolutely. HRA stands for high resolution anoscopy. It's a procedure to examine the perianus, so the area around the external anal tissue and rectal area and into the anal canal. We use an anoscope, which is a plastic scope that's inserted into the rectum. And then we look through that anoscope with a colposcope, which is a microscope. So we use the anoscope and the colposcope in tandem, and we use solutions such as medical-grade vinegar and iodine to kind of paint the tissues and helps brighten up any irregular area. And we identify any regular or pre-cancerous anorectal cancers. Certainly, we're always looking for cancer. We see that as well.

And through the high resolution anoscopy procedure, we see irregular tissue. We can take a biopsy about the size of a half a grain of rice and send that to the lab and get a report back from the pathologist on the cell makeup of that. And if it's below a cancer, such as a pre-cancer, we can have that patient come back and treat them by having another anoscopy. But this time, we go in with a device called a hyfrecation device or electrocautery, and we can take a device that's about the size of the end of the toothpick and use electric current to destroy that abnormal tissue and prevent that lesion from progressing to cancer.

Caitlin Whyte: And Jon, we mentioned insurance when it came to the immunizations, but will my insurance cover the procedures for HRA?

Jon Colbert, NP: Absolutely. We've not had much of an issue at all with insurances covering these. When we do have one, there's usually a correction behind the scenes where something has gone in wrong or, you know, but it's a very low rate of that sort of an issue. But absolutely, insurances are covering this. You know, it's so much less expensive to cover prevention than it is to cover actually cancer. So that's a terrific thing

Caitlin Whyte: And close it out for us, Cari, again just touching on how I can infect someone else.

Cari Sudmeier, NP: That's a great point. Anybody that has HPV can infect another individual that they have close skin to skin contact with. Unfortunately, HPV is quite sneaky and a lot of, if not most all individuals that have HPV don't have any symptoms unless they have the low-grade version of HPV, which are warts. So yes, we can infect someone else without knowing it, because the individual, they themselves may not have any symptoms and it's fairly easily contracted. So as Jon so eloquently pointed out, really vaccine and prevention is the key to reducing HPV and HPV-related cancers.

Caitlin Whyte: Great. Well, Cari, is there anything else you'd like listeners to know about HPV, related anal cancers, anything else we discussed today?

Cari Sudmeier, NP: Thank you so much. We really appreciate this opportunity to talk to you and to get the message out that there are early detection and treatment for pre-cancerous HPV lesions that Jon and I are providing through Eisenhower Health at our High Resolution Anoscopy. So thank you so much for this opportunity to speak with you.

Caitlin Whyte: Well, of course. And Jon, same question to you as we wrap up, anything else you'd like to add?

Jon Colbert, NP: I would add one thing to this, which is kind of near and dear to my heart and that is, we've spoken about this already, which is the prevention issue. And I think that, you know, I've done some work overseas. And here in the United States, we tend to be a little more shy around the discussion of sexual activity when parents think of, you know, Susie having sex, well, you know, the chances are pretty much everybody in the room has had some form of sexual relation at some point in their life. And, you know, to think that, you know, that these children are not going to follow up with that as they mature is really a misnomer. And I think that we have to start thinking about that younger ages because, you know, like I said, if an individual's already achieved that transmission, then this vaccine is not about eradicating it, it's about preventing it from happening. You know, you got to get immunized. I know we talk here a lot of that in the news, especially with COVID, but it's an important thing with this . Virus.

Caitlin Whyte: Well, thank you both for taking the time and being with us today and bringing awareness to this issue, to this cancer. To find more information, you can go to eisenhowerhealth.org. Thanks for listening to Living Well with Eisenhower Health, healthcare as it should be. I'm Caitlin Whyte. Stay well.