HPV vaccination programme - What about boys?

The Mouth Cancer Foundation, while welcoming the government’s introduction of a human papilloma virus (HPV) immunisation programme for girls aged 12 - 13 years of age against cervical cancer, is concerned that boys are not being vaccinated.

This decision follows the advice of the Joint Committee on Vaccination and Immunisation (JCVI) which, based on a detailed review of evidence surrounding HPV vaccination, did not consider it to be cost-effective in preventing cervical cancer.

But according to an article recently published in the British Journal of Cancer, researchers from Finland using mathematical models of human papillomavirus (HPV) type 16 virus infection to determine the optimal age to vaccinate individuals as well as different approaches to introducing the vaccine into the general population concluded that:

• Vaccination generates the greatest long-term benefit when administered prior to the first sexual contact.
• Vaccination of males as well as females has a greater impact when administered at an early age.

While males cannot get HPV-linked cervical cancer, they make up half of the equation when it comes to spreading the sexually transmitted virus. This is a viral infectious process, and the majority of the time it is passed through heterosexual contact. Men can pass on the virus to their sexual partners, so it makes sense to vaccinate boys against HPV, and it would also protect them from throat cancer as the virus is also a leading cause of throat cancer, which affects both sexes.

The MCF is concerned that the JCVI may not have given due consideration to the vaccine's cost-effectiveness in preventing anal and throat cancers, plus genital warts, among boys.

Recent mounting evidence is confirming that infection with HPV via oral sex is by far the leading cause of throat cancer. This threat of throat cancer is especially troubling because doctors traditionally only look for these malignancies in long-time smokers and drinkers. And while girls and women typically see a gynecologist for their Pap smear to look for cervical cancer, not many boys and men are going to go to a doctor and ask them to look at their throat.

Historically, at least 25% of those diagnosed with mouth cancers are non-smokers. The other 75% of those diagnosed have used tobacco in some form during their lifetimes. But today the research into the relationship of HPV and mouth cancers gives us clues as to the origin of cancer in those 25% of diagnosed individuals who did not smoke, and also into changing behaviors both in tobacco use and sexual practices. The age standardised incidence of oral cancer in British males stayed at around 7 per 100,000 males between 1975 and 1989, but since then, the rate has steadily increased to reach 9.8 per 100,000 in 2004, an increase of 40% since 1989. While female oral cancer rates have remained significantly lower than male rates, their incidence trends have been similar with an average increase of 2.5% each year since 1989.

Given the decline of tobacco use over the last ten years, (the historic primary cause of the disease) and the increasing rate of incidence of oral cancers, particularly those of the posterior mouth, it is likely that the ‘75% – 25%’ statement which has been made by everyone is no longer an accurate representation of the situation. There have been large increases in the incidence of oral cancer diagnosed in men in their 40s and 50s whose rates have doubled from 3.6 to 8.8 per 100,000 for men aged 40-49 and from 11.5 to 24.9 for men aged 50-59. These rising trends of oral cancer in young and middle-aged men, particularly of cancer of the tongue, have also been reported in other European countries and the USA. This increase in a cancer that is often difficult to treat and sometimes debilitating and disfiguring, is alarming.

In general it appears that HPV positive tumors occur most frequently in a younger group of individuals than tobacco related malignancies. They also occur more in white males, and in non smokers. The rising incidence and mortality rates in young and middle-aged adults is incontrovertible. There has been debate over the causes of this increase but in recent years, there has been mounting epidemiologic and experimental evidence of a role for human papillomavirus (HPV) as the etiologic agent of a subset of head and neck cancers. The association is strongest for oropharyngeal cancers, especially those of the tonsil. The HPV group is the fastest growing segment of the oral cancer population.

The Oral Cancer Foundation (our sister organisation in the U.S.) strongly believe that in a younger population of non smoking mouth cancer patients, that HPV will present itself as the dominant causative factor. We both believe that since the historic definition of those who need to be screened is now changed by this newly defined HPV etiology, and no longer valid, it is NOT POSSIBLE to definitively know who is at risk for the development of the disease, and who is not. Simply stated, today ANYONE OLD ENOUGH TO HAVE ENGAGED IN SEXUAL BEHAVIOURS WHICH ARE CAPABLE OF TRANSFERING THIS VERY UBIQUITOUS VIRUS ARE AT RISK. For this reason we are concerned that boys are not being vaccinated.

It is hoped that the new cervical cancer vaccines approved for use in pre sexual individuals for the prevention of cervical cancer being developed and marketed by Merck and GlaxoSmithKline, will have a positive collateral impact in the world of head and neck / mouth cancers in the next couple of decades, as these young, vaccinated individuals do not develop HPV related malignancies in sites far removed from the cervix.

The Mouth Cancer Foundation is a strong supporter of the use of the vaccines, and encourages their use in young males as well as females in the U.K.

References:

• French KM, Barnabas RV, Lehtinen M, et al. Strategies for the introduction of human papillomavirus vaccination: modeling the optimum age- and sex-specific pattern of vaccination in Finland. British Journal of Cancer. 2007;96:514-518.
• UK Oral Cancer incidence statistics:
  http://info.cancerresearchuk.org/cancerstats/types/oral/incidence/?a=5441
• Sturgis EM, Cinciripini PM. Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus-associated cancers? Cancer. 2007;110:1429-35.
• The HPV Connection
  http://www.oralcancerfoundation.org/hpv/index.htm

Question:
Should girls be vaccinated?

Choices:
Yes
No

Question:
Should boys be vaccinated?

Choices:
Yes
No

 

The Mouth Cancer Foundation and NALC have started a petition to the Prime Minister to widen the planned HPV vaccination programme to include both sexes.

Please support it by going the HPV petition site. To sign the petition, you will need to give your name, address and email on the form provided. Once you have signed the petition, you will receive an email asking you to confirm that you wish to add your name to the petition by clicking a link. Once you have done this, your name will be added to the petition.

Thank you for your support.

Best wishes

Vinod

--
Dr Vinod K Joshi
Founder & Chief Executive
Mouth Cancer Foundation

I thought that in one of the articles I had read the trials had only been carried out for girls. Does anybody know if the vaccine has had its safety testing completed for girls and boys?

Jenni

from
Drinking And Smoking Don't Boost HPV-related Cancer Risk

quote:

New Brown University research, however, shows that alcohol and tobacco use doesn’t further increase the risk of contracting head and neck cancers for people infected with HPV16. This finding, published in the Journal of the National Cancer Institute, is the strongest evidence to date that these major cancers have two distinct causes — and may represent two distinct classes of cancer — and would require different prevention and treatment strategies.

Karl Kelsey, M.D., a Brown professor of community health and pathology and laboratory medicine and the director of the Center for Environmental Health and Technology, said the research has public health policy implications.

While the Centers for Disease Control and Prevention recommends that girls and young women receive the HPV vaccine to prevent cervical cancer — HPV16 causes about half of all cervical cancer cases — boys and men cannot get the vaccine. An estimated 20 million Americans are currently infected with genital HPV and 50 to 75 percent of sexually active men and women are infected with HPV at some point in their lives, according to the National Institutes of Health.

“Our current HPV vaccine recommendations should change,” Kelsey said. “Head and neck cancers, regardless of their cause, are predominantly male diseases. If boys and men received the HPV vaccine, a lot of these cancers could be prevented.”

Ref: Brown University (2007, November 27). Drinking And Smoking Don't Boost HPV-related Cancer Risk. ScienceDaily. Retrieved November 28, 2007, from http://www.sciencedaily.com/releases/2007/11/071127164933.htm

The full text PDF is freely available from the link immediately below:

Lack of Association of Alcohol and Tobacco with HPV16-Associated Head and Neck Cancer

Journal of the National Cancer Institute
Advance Access published online on November 27, 2007

Katie M. Applebaum, C. Sloane Furniss, Ariana Zeka, Marshall R. Posner, Judith F. Smith, Janine Bryan, Ellen A. Eisen, Edward S. Peters, Michael D. McClean, Karl T. Kelsey

HPV also blamed for oral cancer in men


BEIJING, Feb. 2 (Xinhuanet)--

quote:

Human papillomavirus, or HPV, the leading cause of cervical cancer in women, is also a major cause of oral cancer in men, according to a new study in the United States reported by media Saturday.

The sexually transmitted virus causing cancers of the mouth and upper throat is probably the result of an increase in oral sex and the decline in smoking, the study said.

The new study looked at more than 30 years of National Cancer Institute data on oral cancers. Researchers categorized about 46,000 cases, using a formula to divide them into those caused by HPV and those not connected to the virus.

They concluded the incidence rates for HPV-related oral cancers rose steadily in men from 1973 to 2004, becoming about as common as those from tobacco and alcohol.

However, the only available vaccine against HPV, made by Merck & Co. Inc., is currently given only to girls and young women.

Now Merck plans this year to ask government permission to offer the shot to boys.

In related research, Penn State University scientists reported that cigarette smoke may aggravate HPV and raise the risk of cervical cancer.

The HPV is the fastest growing sexually transmitted disease in the nation. Cervical cancer is a leading cause of cancer-related death in women in developing countries.

According to the American Cancer Society, it was estimated that 11,150 new cases and 3,670 deaths would be reported in the U.S. from cervical cancer in 2007.

Hmmm, So that's what caused it.

Going Down

Is it advisable / possible for the partner and (adult, sexually active) children of a (non-smoking & hardly drinking)relatively young oral cancer sufferer to get themselves checked out / vaccinated against HPV?

Hello Joy

Yes it is possible to be tested for HPV. See:HPV Test.

The current vaccines,Gardasil and Cervarix, are preventative (rather than therapeutic) vaccines and so recommended for women who are 9 to 25 years old and have not contracted HPV. There is work being done on developing therapeutic vaccines but nothing to report yet.

Hope that helps.

Best wishes
Vinod

Oral sex a factor in oral cancer increase
3rd March 2008

quote:

The cases of oral cancer caused by a virus transmitted during oral sex appear to have increased drastically over the last 30 years, according to a study by US researchers.

The number of tongue, mouth and throat cancers due to the sexually transmitted human papilloma virus (HPV), which can also cause cervical cancer in women, rose by about a third from 1973 to 2004, say researchers.

The team – led by Maura Gillison at Johns Hopkins University in Baltimore, Maryland, US – studied trends in oral cancers recorded by US National Cancer Institute registries.

Earlier work had established a link between certain strains of the common sexually transmitted virus and oral cancer.

The latest study, which looked at nearly 46,000 cases, is the first to quantify an increase in mouth and throat cancers due to sexual activity.

‘What we do know is that the prevalence of HPV is high, particularly among young people and this shouldn't be a surprise given that, since the sexual revolution, people have been having more sexual partners,' a New Scientist article quoted Lesley Walker, director of cancer information at Cancer Research UK.

The rise was largest among young white males, suggesting this group is more likely to have oral sex at a younger age now than it was 20 years ago, says Gillison's team.

Although, oral cancers linked to HPV infection have risen, the study notes the incidence of oral cancers in parts of the mouth or throat not linked to HPV infection remained constant until 1982, and then started to decline.

Gillison called for a need to consider giving boys the HPV vaccine, to protect them from the disease.

A Merck vaccine is presently licensed for use in young women and girls to protect them against the most common cervical cancer-causing strains of HPV.

‘We need to start having a discussion about those cancers other than cervical cancer that may be affected in a positive way by the vaccine,' Gillison said.

The study is published in the journal of Clinical Oncology.

The Mouth Cancer Foundation and NALC have started a petition to the Prime Minister to widen the planned HPV vaccination programme to include both sexes.

Please support it by going the HPV petition site. To sign the petition, you will need to give your name, address and email on the form provided. Once you have signed the petition, you will receive an email asking you to confirm that you wish to add your name to the petition by clicking a link. Once you have done this, your name will be added to the petition.

Thank you for your support.

This message has been edited. Last edited by: Dr Vinod K Joshi,

Hi Dr Joshi
We have had the cervical cancer vaccinations for young girls free of charge to girls from about the age of 13 (I think ~ doesn't affect me so I don't know the age range for sure) for about 12 months (I think ~ again, it's been one hell of a year so not too sure).
Just this last week there has been television reports about adverse effects of Gardasil. I didn't pay too much attention to the programme other than to notice one woman in particular filmed having seizures which were attributed to the drug.
There are always those opposed to any vaccination, I know but hope those responsible are able to get the figures out into the public about the ratios of those who have had reactions and those who have not, weighing up the risks vs benefits etc. If males are going to benefit as well, I hope it is made available to them.
Mind you, I suspect there would not be the general support in the community if the vaccine is promoted as offering protection from a condition (as bad as it may be), associated with oral sex. That would cause a lot of heads to become firmly ensconsed in the sand I suspect.
Cheers
Deborah

Dr. Joshi,

I am very interested in this, as I have 3 boys and I have head and neck cancer. I have been preaching to everyone to have the HPV injection even if you are over 25. To not have it is just insane. Anything to protect yourself against this awful cancer. But my question is this, I am in the US and was wondering if you know where I can go to see about boys getting vaccinated here in the states.

Leann

Finally, there seems to be some coverage on this topic. It's a start. This is from today's New York Times (May 13, 2008).

"Oral Cancer in Men Associated With HPV"

Here's link, that I hope will work:
http://www.nytimes.com/2008/05/13/health/13canc.html?ex...ink&exprod=permalink

(If I should just embed the text, please let me know.)

Susan