A five-year dispute over Gardasil, a vaccine that protects against human papillomavirus (HPV), just got hotter.
Last month, a Centers for Disease Control and Prevention panel recommended that, like girls, all 11- and 12-year-old boys should get vaccinated against HPV. Head and neck cancer experts at the University of Colorado Cancer Center agree.
“In my opinion, it’s a no-brainer,” says Antonio Jimeno, MD, PhD, director of the Head and Neck Cancer Medical Oncology Program at the CU Cancer Center. “Vaccinating both sides of the population—male and female—is the best way to protect people from these three types of cancers—cervical, anal, and head and neck.”
HPV is widely known for causing cervical cancer, yet few people know it also causes cancers of the vagina, vulva, anus, penis, and head and neck. Currently, there are no screening methods, like the widely-used Pap smear for cervical cancer, to screen for other HPV-related cancers.
This is a problem the vaccine may help alleviate, Jimeno believes.
“Because we have a safe vaccine, we have a safe method of preventing cancers that aren’t preventable any other way,” says Jimeno, associate professor of medical oncology at the CU medical school. “Vaccinating girls, in addition to decreasing cervical cancer, has already reduced costs and anxiety surrounding screening for cervical cancer, and I believe vaccinating boys could produce similar results.”
It is estimated that 75 to 80 percent of sexually active people will be infected with HPV at some point in their lives. Of those infected, 7,400 are diagnosed with a HPV-related head and neck cancer every year, according to the CDC.
In the past, head and neck cancers, such as those of the throat, tonsils and tongue, were largely linked to tobacco and alcohol use rather than HPV; but doctors are now seeing a reverse trend.
“We’ve seen a shift in our clinic from older patients being diagnosed with tobacco-related head and neck cancers to young, healthy patients being diagnosed with head and neck cancers that are related to HPV infection,” says David Raben, MD, a CU Cancer Center investigator and radiation oncologist who specializes in head and neck cancer at the University of Colorado Hospital.
“The good news is the fact that outcomes for HPV-positive patients are clearly superior to HPV-negative patients,” he continues. “These cancers appear to be very sensitive to chemotherapy and radiation.”
Additionally, a recent article published in the Journal of Clinical Oncology predicts that head and neck cancers may become the most common HPV-related cancer by 2020.
“We have seen a four-fold increase in the incidence of head and neck cancers in both males and females in the last decade,” Jimeno says, “and these patients are younger by an average of 10 years, and sometimes even in their late 30s and early 40s. If we can immunize young men and women, we can decrease the incidence of head and neck cancers in the years to come.”
Though there are more than 100 different strains of HPV, strain 16 is linked to head and neck cancer. Both Gardasil, the vaccine now recommended for boys and girls, and Cervarix, a vaccine only for girls, protect against it.
Expense shouldn’t the reason parents don’t vaccinate, says Raben.
“It’s cost effective,” he says. “The cost of treating patients with head and neck and cervical cancer is tens of thousands of dollars more than this vaccine.”
Controversies aside in regards to mandating vaccinations, Raben supports vaccinations for both girls and boys and will be getting his own son vaccinated shortly. He also says that there is no data to suggest that teenagers receiving the vaccine are more likely to engage in sexual practices.
“I don’t buy into the argument that vaccinating our kids against HPV will encourage them to have sex,” Raben says, “but people need to understand that vaccinating against HPV isn’t going to prevent other sexual diseases.”
Jimeno agrees. “There’s no data that says getting the vaccine will change the sexual behavior of our children,” he says.
Australia, which introduced a nationwide HPV vaccination program for girls a few years ago, vaccinated more than 80 percent of eligible young women. As a result, doctors are seeing a decline in cervical abnormalities in girls 17 and younger.
Now, there is a need to provide the same benefits to young men before sexual initiation. The vaccine is only effective if given before people have sex, and it doesn’t prevent cancer once people have been exposed to HPV.
“While a cancer is a cancer no matter how old you are,” Jimeno says, “we need to prevent it in young, healthy people; and we have a vaccine for that.”
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