“If you are not recommending the vaccine, you are not doing your job. It’s the equivalent of having patients in their 50s and not recommending a colonoscopy — and then having them come back with cancer.”

— Dr. Lois Ramondetta, gynecologic oncologist, urging pediatricians to recommend and provide HPV vaccines for their young patients. (Washington Post6/19/16)

 

Human papillomavirus (HPV) is a highly-contagious, sexually-transmitted infection that causes cancer in some people. Any sexual activity, including simple touching in a sexual sense, can spread this virus. Infection with HPV can also cause genital warts in infected individuals, which are usually embarrassing and often difficult and painful to treat. Even though all infected people have the potential of developing an HPV-related cancer in the future, most infected people have no symptoms of infection and most will clear their infections spontaneously and not develop HPV-related cancers.

Infection with certain strains of HPV can cause tumors of the cervix, vagina, and vulva in women; penile cancer in men; and oral, anal, and rectal cancers in both men and women. Globally, cervical cancer remains one of the leading cancers in women. Routine pap smears can catch the disease in its early, precancerous state, and vaccines against most of the virus strains which cause this type of cancer can prevent infection from happening in the first place. As a result, the prevalence of cervical cancer and its accompanying morbidity and mortality have decreased in the United States over the past 2 decades. A recent study, published earlier this year in Pediatrics, found that vaccination deserves most of the credit for this decline:

Within 6 years of vaccine introduction, there was a 64% decrease in 4vHPV type prevalence among females aged 14 to 19 years and a 34% decrease among those aged 20 to 24 years.

 

But HPV is not just a women’s health issue. And while cervical cancer rates are slowly declining with better access to gynecologic care and the HPV vaccine, HPV-associated cancers as a whole are on the rise, especially in men. The vast majority of head and neck cancers (mostly involving the tongue and throat) are now caused by HPV infections, rather than the usual suspects of tobacco and alcohol. David Templeton writes in the Pittsburgh Post-Gazette that there are now  “more men getting HPV-associated head and neck cancers than women being diagnosed with HPV-associated cervical cancer”:

“This has been a major blockbuster in the field with the growing number of head and neck cancers caused by HPV, which also causes cervical cancer,” said Julie Bauman, co-director of the UPMC Cancer Institute’s Head & Neck Cancer Center of Excellence and Dr. Wilson’s oncologist. “For the first time, there are more men with HPV-related cancer [of the head and neck] than women [with cervical cancer].”

HPV-associated head and neck cancers now are epidemic, she said, and “changing the face” of her clinic. Twenty years ago 80 percent of such cancers were linked to tobacco or alcohol use with HPV now responsible for that percentage.

“HPV long has been viewed as a women’s health issue, but now it’s a bona fide men’s health issue because they are on the front line of an epidemic, and this epidemic won’t peak for another generation,” Dr. Bauman said, noting the typical age of diagnosis being 40 to 60 years old.

The U.S. Centers for Disease Control and Prevention confirmed in a report Friday that more men now are being diagnosed with HPV-associated head and neck cancers (15,000) than women with HPV-based cervical cancers (11,000).

 

The CDC tracks the prevalence of HPV infections and reported last month in its Morbidity and Mortality Weekly Report (MMWR):

During 2008–2012, an average of 38,793 HPV-associated cancers were diagnosed annually, including 23,000 (59%) among females and 15,793 (41%) among males. By multiplying these counts by the percentages attributable to HPV, CDC estimated that approximately 30,700 new cancers were attributable to HPV, including 19,200 among females and 11,600 among males.

 

Melissa Jenco says the CDC estimates that well-over-90% of HPV-associated cancers can be prevented with today’s HPV vaccine:

Of the 38,793 annual cancer cases associated with HPV based on their location and cell type, the CDC estimates 30,700 (79%) are attributable to HPV and 28,500 could be prevented with a 9-valent HPV vaccine.

 

Templeton believes these statistics may ultimately motivate parents to immunize their children against HPV infections and HPV-related cancers:

[T]he turnabout in gender results with head and neck vs. cervical cancers could convince parents to get their children immunized with the HPV vaccine, regardless of gender, with boys often overlooked because of the now-errant perception that the vaccine predominantly protects against cervical cancer.

A vast majority of people are infected with HPV in their teens or 20s as a result of the person’s first sexually intimate experience, given that the virus commonly is present in the area of the anus and genitals, Dr. Bauman said. For that reason, adolescents must receive the vaccine before their “sexual debut.”

Once a person is exposed to the virus or infected, it’s too late for the vaccine. While the virus is eliminated by the immune system in most people without ever causing a symptom, persistent infection does occur in a small percentage of people, raising their risk of HPV-based cancers later in life.

 

HPV vaccines are safe and effective tools for preventing a number of different types of cancer. The American Academy of Pediatrics (AAP), Centers for Disease Control and Prevention (CDC), and every other organization which represents and reflects evidence-based medical science (including Pediatric Alliance) recommends the 3-dose HPV vaccine as part of the routine pediatric immunization schedule, with the first dose given to boys and girls between 11-12 years of age. (The second dose comes 1-2 months later, and the third-and-final dose is 4 months after that.) Like all vaccines given to children, HPV vaccine is not complicated in how it is made and how it works. After tens of millions of doses already given, there is ample objective evidence that the vaccine is very safe (adverse reactions are extremely rare — the risk of getting HPV-related cancer (and dying from it) is much, much higher) and very effective.

You can bet we will be talking about preventing the growing “epidemic” of HPV-related cancers at your tween’s and teen’s next checkup. And, now, this message from the CDC:

 

More on HPV on The PediaBlog here. 

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