Illustrations by
Adrià Fruitós
When Karl Munger was a postdoctoral researcher at the National Institutes of Health in the late 1980s, he landed in the lab of pioneering virologist Peter Howley and began studying human papillomavirus. Scientists had noticed that HPV was often present in cervical cancer. But was it merely present, or did it drive the growth of cancer?
Munger was able to show that two HPV proteins, known as E6 and E7, played an active role in transforming host cells and allowing cancer to grow. It was a thrilling discovery and a defining moment for a young scientist.
“I couldn’t let go,” he said. He’s been working on HPV ever since.
Today, Munger, the Dorothy Todd Bishop Research Professor and chair of the Department of Developmental, Molecular & Chemical Biology at the School of Medicine, is helping to lead an effort at Tufts University and Tufts Medicine that brings research scientists together with clinicians to save lives through improved HPV care and research.
The team includes people who have come to HPV from every direction, with expertise in clinical care, policy development, and communication, as well as laboratory research. Together, they are advancing our understanding of HPV, a virus that causes cancers that kill more than 420,000 people each year. Their work is shedding light not just on how the virus works—which could open the door to potential treatments—but also how we can boost vaccination rates, improve screenings, and even eliminate some cancers.
A Common Virus That Can Cause Cancer
HPV is a group of more than 400 viruses that spread via skin-to-skin contact and cause a common infection. According to the Centers for Disease Control and Prevention, more than 80% of adults will contract the virus.
HPV often goes away on its own, sometimes without symptoms. But at least a dozen types can lead to cancers of the mouth, throat, cervix, vulva, vagina, penis, and anus. According to the World Health Organization, HPV causes 5% of all cancers worldwide.
That’s the bad news.
The good news is that HPV research has already produced ways to keep people safe. A vaccine, approved by the U.S. Food and Drug Administration in 2006, can prevent 90% of HPV-caused cancers if administered during someone’s adolescent years. And some precancerous conditions caused by the virus—especially those related to the cervix—can be treated, preventing the development of cancer.
Scientific questions remain, and the benefits haven’t reached all communities equally. Screenings for cervical cancer are highly effective, but there isn’t an equivalent for most other forms of HPV-caused cancer.
These are the challenges and questions that Tufts researchers and clinicians are mobilizing to address, backed by the Tufts University–Tufts Medicine (TU–TM) Research Enterprise—an effort to leverage academic, research, and clinical expertise to accelerate innovation.
One of the enterprise’s first investments was a 2024 cluster hire of Elizabeth White, an associate professor of developmental, molecular, and chemical biology at the School of Medicine, and Rebecca Perkins, an attending gynecologist at Tufts Medical Center and professor of obstetrics and gynecology at the School of Medicine.
Munger hopes that’s just the start of Tufts’ push to understand and treat HPV.
“This is an area where we can be first and best,” he said. “Tufts can stand out as a leader in the field.”
“This is an area where we can be first and best. Tufts can stand out as a leader in the field.”
Promoting an Effective Vaccine
Michael Paasche-Orlow is a primary care physician at Tufts Medical Center. He long ago realized that many people he sees, especially those with limited education, need help understanding information related to their healthcare. That drew him to the field of health literacy research. In his clinic and research, he has seen many people avoid vaccines because of misconceptions and misinformation—including the HPV vaccine, which has proven to be safe and effective.
Paasche-Orlow, who is also a professor of medicine at the School of Medicine, pointed out that the HPV vaccine is a powerful tool. “You can get rid of more than 90% of all HPV-associated cancers,” he said. Yet nearly 40,000 people develop an HPV-caused cancer each year in the United States.
“It’s all avoidable,” he said. “It’s a health services disaster.”
Cervical cancer screenings are standard care, and an anal screening was approved for high-risk populations in 2024. But without screenings for other forms of HPV-caused cancers, the vaccine is critical.
When Paasche-Orlow began looking at HPV, he connected with Rebecca Perkins, who was then at Boston University and Boston Medical Center. They received NIH funding for a study of embodied conversational agents, which are animated chatbots that can answer medical questions.
The researchers wanted to build an app that could dispel misinformation and educate people hesitant to get a vaccine or to have their child vaccinated. The chatbots could be customized for adolescents and, separately, for their parents, allowing each to learn at their own pace.
“What works in terms of communication has been proven over and over: It’s about getting the message to everybody,” Perkins said.
This is evident in countries that conducted major public health education campaigns about the HPV vaccine. Scotland hasn’t had a new case of cervical cancer among women who were fully vaccinated as adolescents since launching a widespread vaccination campaign in 2008. Neither has England. Australia, which publicly funded HPV vaccinations in 2007, is on pace to eliminate cervical cancer by 2035.
Unfortunately, Perkins and Paasche-Orlow could not complete their research. Amid a wave of federal budget cuts in 2025, many targeting vaccine-related projects, NIH cancelled their funding.
Paasche-Orlow fears the cuts will have a chilling effect, discouraging researchers from exploring hard questions. “Science is a fragile ecosystem,” he said.
He’s optimistic that Tufts’ investment in HPV research and treatment can provide the stability needed to make a difference. “I’m hoping we can keep growing, can attract other people. We have a chance to eliminate cervical cancer and have a major decrease in other cancers, too.”
Closing the Education Gap
Jessica DiSilvestro runs the Tufts Medical Center Complex Dysplasia Clinic, where she sees many people with precancer and cancers caused by HPV. Even in Greater Boston, an area renowned for its hospitals and medical care, she notices disparities in health literacy. “A lot of our patient visits revolve around education,” she said. “A lot of patients don’t understand why they’re here.”
DiSilvestro, a gynecologic oncologist at Tufts Medical Center and assistant professor at the School of Medicine, is studying the healthcare barriers faced by Boston’s Native American residents. She plans to produce infographics and other visual materials to explain the importance of cervical screenings and what they involve.
Perkins and Paasche-Orlow are also working on education, refocusing their chatbot research from vaccines to screenings, in collaboration with Katina Robison, chief of gynecologic oncology at Tufts Medical Center. “The goal of this project is to help people understand their results, decrease fear, decrease stigma, and try to get them into their follow-up appointments,” Perkins said.
About a quarter of women with cervical cancer had an earlier abnormal screening result—which can indicate HPV or another infection—that wasn’t followed up on in time for treatment that could have prevented the cancer from developing. Improving screening and follow-up rates on abnormal results could reduce cervical cancer by 75%.
Screening Access for All
One way to improve screening rates—and boost access to all communities—is to make the process easier. Pap tests have been the standard cervical screening for abnormal cells for decades and require a pelvic exam with a healthcare provider. They’re effective but can be uncomfortable. In 2024 and 2025, the FDA approved the first self-collection devices to test for HPV.
In March, Perkins and DiSilvestro published an op-ed in the journal Obstetrics & Gynecology: “Expanding the availability of HPV self-collection to everyone who wants it is the next step in cancer prevention,” they wrote. It’s an especially important development for areas where access to healthcare is a barrier.
Testing is just the first step, however. Perkins wants to make follow-ups more accessible as well.
She is working with a multidisciplinary, multi-institutional team to develop a way to use artificial intelligence to assess photographs of the cervix taken with a portable colposcope, a magnifying tool used in gynecological exams. “We have a prototype of the AI algorithm that can run on the device and give you an answer in real time,” she said. If it detects precancerous cells, treatment could begin immediately.
This new system could narrow the testing-to-treatment time span from weeks to days, reducing the chances that people will miss follow-up care. And Perkins is hopeful that even simpler, less invasive treatments are on the horizon. She looks to the work of Munger and White: “They’re identifying the mechanisms that are necessary for the virus to cause cancer—and if you can identify them, maybe you can block them.”
Understanding HPV
Munger and White have focused much of their careers on studying E6 and E7, the cancer-driving proteins found in HPV. Their research has revealed that these two proteins contribute to the growth and spread of HPV-caused cancers—but how they do so remains a mystery.
The tissues where HPV thrives, like that on the inside of the mouth and on reproductive organs, is dynamic, meaning the outermost cells die off and regenerate often, White said. Yet HPV infections can persist for years. “The virus is changing the behavior of the cells,” she said.
White discovered that E7 helps HPV activate an oncogene—a cancer-causing gene when mutated—that allows tumors to grow unchecked. Finding a way to disrupt that process could unlock a treatment, such as an antiviral medication.
To advance their research, White and Munger are looking to their clinical colleagues to address a basic need: samples of HPV-infected tissue. Researchers often rely on cell lines that have been maintained in labs, sometimes for decades. “It’s not clear how similar these cells are to fresh cervical cell lines,” Munger said.
One goal is to identify a biomarker that predicts if an HPV infection could lead to cancer. “A gene that predicts whether or not a lesion will progress to cancer or not—that would be an absolute game changer,” Munger said. It would reduce uncertainty and anxiety for people and eliminate unnecessary procedures, since most HPV infections resolve on their own.
Establishing a supply of tissue samples is in the early stages as the researchers determine what permissions will be needed. But it’s a tangible example of how translational research will bridge the lab sciences with clinical care at Tufts.
“The sky is the limit as to what we can do,” Munger said of the Tufts team. “And we are uniquely situated to do it.”
