Monthly Archives: December 2011

Review Finds Evidence Lacking for Dry Mouth Remedies

Source: Medscape Today

December 28, 2011 — There is not enough evidence to recommend any topical therapies for dry mouth, but that does not mean that they do not work, according to investigators who published a review of research on the therapies online December 4 in the Cochrane Library.

“There was very little evidence,” said Helen Worthington, PhD, a professor of evidence-based care at the University of Manchester, United Kingdom.

Dr. Worthington and colleagues scoured the literature for randomized controlled trials of topical therapies for dry mouth, or xerostomia. They found 36 studies of treatments such as lozenges, sprays, mouth rinses, gels, oils, chewing gum, and toothpaste.

Xerostomia often results from treatments for head and neck cancer that damage the salivary glands, as well as from Sjögren’s syndrome, an autoimmune disorder that also damages these glands. It is also a common adverse effect of many medications.

The authors cite an estimated prevalence of dry mouth of about 20% in the general population. This percentage may be increasing because people are living longer and suffering from more chronic illnesses for which the treatments can have xerostomia as an adverse effect.

It is possible to feel the sensation of dry mouth without having a clinically reduced saliva flow, the researchers point out.

The treatments in the review broke down into 2 broad categories: saliva substitutes, in which some other substance is intended to perform the role of the patient’s own saliva, and saliva stimulants, which are intended to activate the patient’s own mechanism for producing saliva.

Two of the trials compared saliva stimulants with placebos, 9 compared saliva substitutes with placebos, 5 compared saliva stimulants with saliva substitutes, 18 compared 2 or more saliva substitutes with each other, and 2 compared 2 or more saliva stimulants with each other.

The researchers found convincing evidence that 1 saliva substitute, oxygenated glycerol triester saliva spray, was more effective than another, an electrolyte spray (standardized mean difference, 0.77; 95% confidence interval, 0.38 – 1.15). This corresponded to an approximate mean difference of 2 points on a 10-point visual analog scale in which patients rate their mouth dryness.

However, this evidence did not actually prove that either substitute was useful for treating dry mouth, Dr. Worthington said.

The researchers concluded that an integrated mouth care system (toothpaste, gel, and mouthwash) looked promising, as did oral reservoir devices. Here again, however, the evidence was not quite strong enough to recommend either one.

Asked to comment on the review, Joel Napeñas, DDS, a specialist in saliva disorders at Carolinas Medical Center in Charlotte, North Carolina, told Medscape Medical News that it is still possible to treat dry mouth despite the lack of evidence for a particular therapy.

“There are a lot of nonrandomized controlled trials that do show variable results,” said Dr. Napeñas, who was not involved in the Cochrane review. “Since there is no strong evidence for any individual agent, we are left with trial and error on an individualized basis.”

Dr. Napeñas begins by measuring saliva flow: He has the patient spit into a cup and then asks the patient to suck on something like a piece of wax and spit again to see whether the sucking action increases the patient’s saliva flow.

If the saliva flow increases, this suggests that saliva stimulants may work. Barring contraindications, therefore, Dr. Napeñas prescribes systemic saliva stimulants, usually pilocarpine or cevimeline, often in combination with topical stimulants.

If the experiment does not increase saliva flow, Dr. Napeñas instead recommends various saliva substitutes. He also typically recommends that patients try a variety of topical therapies to see what works best. “Biotene-type products are some of the first we would go to,” he said.

Frequently sipping water and sucking on ice can help many patients, he said. He advises patients to avoid caffeine and alcohol, which can worsen symptoms, and he pointed out that patients with xerostomia should avoid many commercial mouth rinses because they contain alcohol.

Dr. Napeñas also initiates preventive measures to prevent caries, including topical fluoride, prescription fluoride products, and frequent recalls, because patients with low saliva flow are at high risk for caries.

“It’s a very difficult condition to treat,” he said. “The way I approach it is to throw everything I can at it.”

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

December, 2011|Oral Cancer News|

U.S. Government rolls out new teen anti-smoking program

Source:EmaxHealth.com

As 2012 draws nigh, many smokers will make yet another resolution to quit smoking. However, in a matter of days or weeks, many of them will be puffing away. Many of these smokers have damaged their health from the habit with ailments including chronic obstructive pulmonary disease (COPD), lung cancer, and throat cancer. One group of smokers is not yet afflicted with those ailments and would benefit the most from quitting: teen smokers. Unfortunately, however, research suggests most of those teens will keep smoking and some light smokers will become heavy smokers.

According to current estimates, 19% of U.S. teens are smokers by the 12th grade. To address this issue, the National Cancer Institute (NCI) is introducing a new smoking-cessation program focused on teens. At present, a Website has been developed (teen.smokefree.gov) and texting support is available. In January 2012, the NCI will add a smartphone application. The program joins others with the same aim: Helping teen smokers quit before they become chronic adult smokers. For example, on September 1, Secretary of Health and Human Services Kathleen Sebelius published an opinion in the Washington Post in which she pointed out the national problem of teen smoking.

A new study by the National Institutes of Health (NIH), released on December 14, reported that smoking had declined among U.S. teens. Countering that bit of good news was that one out of every 15 high school students smoked marijuana on a regular basis. Smoked marijuana and smoked tobacco are chemically very similar; thus, like cigarettes, the greatest health hazard of marijuana is due to smoking. The chief difference between the two plants is that marijuana contains THC and tobacco contains nicotine. Moreover, one of the most potent carcinogens in tobacco smoke, benzo(α)pyrene, is present in larger quantities in marijuana smoke.

The new federal teen smoking-cessation program focuses on:

  • Messages that emphasize teens are in charge. One slogan on the site about teens and their health decisions: “We’re NOT going to tell you what to do.”
  • Materials that focus on teen-specific triggers. Those include mood, social life, test anxiety and peer pressure.
  • Technologies teens use. Teens who want to quit can text QUIT to iQUIT (47848) to start getting helpful messages or go to the website to connect with counselors via instant messaging or phone. They also can join support networks on Facebook, Twitter and Tumblr.

Many teens are not receptive to messages describing future health problems because they have little interest in a disease that may not affect them for decades. However, teen smokers are receptive to messages about staining their teeth, smelling bad, wasting money, harming the environment, and even the fact that second-hand smoke can be harmful to their siblings and pets.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

December, 2011|Oral Cancer News|

Distant Metastases in Head-and-Neck Squamous Cell Carcinoma Treated with Intensity-modulated Radiotherapy

Source: International Journal of Radiation Oncology, Biology and Physics (IJROBP Online)

December 2011

PURPOSE: To determine the pattern and risk factors for distant metastases in head-and-neck squamous cell carcinoma (HNSCC) after curative treatment with intensity-modulated radiotherapy (IMRT).

METHODS AND MATERIALS: This was a retrospective study of 284 HNSCC patients treated in a single institution with IMRT. Sites included were oropharynx (125), oral cavity (70), larynx (55), hypopharynx (17), and unknown primary (17). American Joint Committee on Cancer stage distribution includes I (3), II (19), III (42), and IV (203).

There were 224 males and 60 females with a median age of 57. One hundred eighty-six patients were treated with definitive IMRT and 98 postoperative IMRT. One hundred forty-nine patients also received concurrent cisplatin-based chemotherapy.

RESULTS: The median follow-up for all patients was 22.8 months (range, 0.07-77.3 months) and 29.5 months (4.23-77.3 months) for living patients. The 3-year local recurrence-free survival, regional recurrence-free survival, locoregional recurrence-free survival, distant metastasis-free survival, and overall survival were 94.6%, 96.4%, 92.5%, 84.1%, and 68.95%, respectively. There were 45 patients with distant metastasis. In multivariate analysis, distant metastasis was strongly associated with N stage (p = 0.046), T stage (p<0.0001), and pretreatment maximum standardized uptake value of the lymph node (p = 0.006), but not associated with age, gender, disease sites, pretreatment standardized uptake value of the primary tumor, or locoregional control. The freedom from distant metastasis at 3 years was 98.1% for no factors, 88.6% for one factor, 68.3% for two factors, and 41.7% for three factors (p <0.0001 by log-rank test).

CONCLUSION: With advanced radiation techniques and concurrent chemotherapy, the failure pattern has changed with more patients failing distantly. The majority of patients with distant metastases had no local or regional failures, indicating that these patients might have microscopic distant disease before treatment. The clinical factors identified here should be incorporated in future clinical trials.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

December, 2011|Oral Cancer News|

Researchers ID virus that causes salivary gland cancer

Source: DrBicuspid.com

Cytomegalovirus (CMV) has been confirmed as a cause of the most common salivary gland cancers (Experimental and Molecular Pathology, November 10, 2011).

CMV joins a group of fewer than 10 identified oncoviruses — cancer-causing viruses — including HPV.

The findings are the latest in a series of studies by researchers from the Laboratory for Developmental Genetics at the University of Southern California (USC) that together demonstrate CMV’s role as an oncovirus, a virus that can either trigger cancer in healthy cells or exploit mutant cell weaknesses to enhance tumor formation.

The conclusion that CMV is an oncovirus came after rigorous study of both human salivary gland tumors and salivary glands of postnatal mice, according to lead author Michael Melnick, DDS, PhD, a professor of developmental genetics in the Ostrow School of Dentistry at USC and co-director of the developmental genetics lab.

This study illustrates that the CMV in the tumors is active and also that the amount of virus-created proteins found is positively correlated with the severity of the cancer, Melnick said. After salivary glands obtained from newborn mice were exposed to purified CMV, cancer developed. In addition, efforts to stop the cancer’s progression identified how the virus was acting upon the cells to spark the disease.

The researchers also identified a specific molecular signaling pathway exploited by the virus to create tumors.

With the new information about CMV’s connection to cancer comes hope for new prevention and treatment methods, Dr. Melnick noted.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

December, 2011|Oral Cancer News|

Global oral cancer rates to rise 63% by 2030

Source:DrBiscupid.com

The International Agency for Research on Cancer, part of the World Health Organization (WHO), predicts that more than 790,000 people worldwide will be diagnosed with oral cancer by 2030, an increase of more than 63% compared with 2008.

Mortality rates for mouth cancer are predicted to be even higher with more than 460,000 deaths forecast by 2030, more than 67% higher than 2008 rates, according to the International Dental Health Foundation (IDHF).

The WHO believes modifying and avoiding risk factors could result in up to 30% of cancers being avoided, noted Nigel Carter, BDS, chief executive of the IDHF.

“Although cancer is not wholly preventable, mouth cancer is very closely related to lifestyle choices. Making more people aware of the risks and symptoms for mouth cancer will undoubtedly save lives,” Dr. Carter stated in a press release. “Forecasts for the incidence and mortality of mouth cancer are very grim. We hope more countries will develop their own oral cancer action campaigns to raise awareness.”

November is Mouth Cancer Action Month, sponsored annually by the IDHF.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

December, 2011|Oral Cancer News|

Study Endorses HPV Testing for All Women Over 30

Source: Medscape.com

LONDON (Reuters) Dec 15 – New DNA tests looking for the virus responsible for most cases of cervical cancer make sense for all women aged 30 or over, since they can prevent more cases of cancer than Pap smears alone, Dutch researchers say.

Results of a five-year study involving 45,000 women provided the strongest evidence yet in favor of using human papillomavirus (HPV) testing, Dr. Chris Meijer and colleagues from the VU University Medical Centre in Amsterdam reported in The Lancet Oncology on December 15.

In recent years, tests for high-risk HPV strains have been developed by companies including Roche and Qiagen.

The new tests are known to work well in detecting HPV, but the Dutch study is the first to show they are better than Pap smears alone over two screening rounds set five years apart.

The researchers, who looked at women aged 29 to 56, said use of HPV tests led to earlier detection of pre-cancerous lesions, allowing for treatment that improved protection against cancer.

Dr. Hormuzd Katki and Dr. Nicolas Wentzensen from the U.S. National Cancer Institute said the results reinforced earlier findings, and provided “overwhelming evidence” of the benefits of including HPV testing in cervical screening programs.

The government-backed U.S. Preventive Services Task Force currently urges women who have been sexually active and have a cervix to get Pap smears at least every three years. However, the group recommends against routinely screening women over 65 if they had normal results on a recent Pap smear.

December, 2011|Oral Cancer News|

Quality-of-Life Outcomes in Transoral Robotic Surgery

Source: SAGE Journals Online

Abstract

Objective. To report long-term, health-related quality-of-life (HRQOL) outcomes in patients treated with transoral robotic surgery (TORS).

Study Design. Prospective, longitudinal, clinical study on functional and HRQOL outcomes in TORS.

Setting. University tertiary care facility.

Subjects and Methods. Patients who underwent TORS were asked to complete a Head and Neck Cancer Inventory before treatment and at 3 weeks and 3, 6, and 12 months postoperatively. Demographic, clinicopathological, and follow-up data were collected.

Results. Sixty-four patients who underwent TORS were enrolled. A total of 113 TORS procedures were performed. The mean follow-up time was 16.3 ± 7.49 months. The HRQOL was assessed at 3 weeks and at 3, 6, and 12 months, with a response rate of 78%, 44%, 41%, and 28%, respectively. TORS was performed most frequently for squamous cell carcinoma (88%). There was a decrease from baseline in the speech, eating, aesthetic, social, and overall QOL domains immediately after treatment. At the 1-year follow-up, the HRQOL scores in the aesthetic, social, and overall QOL domains were in the high domain. Patients with malignant lesions had significantly lower postoperative HRQOL scores in the speech, eating, social, and overall QOL domains (P < .05). Patients who underwent adjuvant radiation therapy or chemotherapy and radiation therapy had lower postoperative scores in the eating, social, and overall QOL domains (P < .05).

Conclusion. The preliminary data show that patients who undergo TORS for malignancies and receive adjuvant therapy tend to have lower HRQOL outcomes. TORS is a promising, minimally invasive, endoscopic alternative surgical treatment of laryngopharyngeal tumors.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

December, 2011|Oral Cancer News|

Biosciences aims to lower oral cancer mortality with simple screening test

Source: www.proactiveinvestors.com
Author: Amanda Brandon

Vigilant Biosciences is a privately held medical technology company based in Norcross, Georgia focused on improving healthcare products to improve patient care. Their most recent research efforts center on early oral cancer detection.

In the United States, approximately 37,000 people will be diagnosed with oral cancer this year and its most common risk factor is exposure to the human papillomavirus (HPV). Nearly 40 percent of oral cancer patients will die within five years of diagnosis.

The high mortality rate for oral cancer is due to late discovery of the malignancy. In its early stages, the disease can either present no symptoms or the symptoms are often mistaken for other conditions.

VigilantBIO is currently trialing an easy-to-use, low-cost and noninvasive oral cancer screening product which tests the saliva (a very desirable biofluid). The patient and practitioners (e.g. dentists, hygienists, periodontists) benefit from the simplicity of the test – no venipuncture means higher test participation and no specialized staff is required to perform the test. In the oral clinical setting, this is ideal because it does not interfere with chair turnover ratio. In addition, test results can be delivered at the point of care.

When oral cancer is detected early, patients experience an 80-90 percent survival rate. Combined with the lowered treatment cost (an estimated 36 percent) and easy-to-implement product for oral care practitioners, the early detection product appears to be a winner for all involved.

With two clinical trials in process at the University of Miami, the sensitivity and specificity of the VigilantBIO salivary oral cancer biomarkers in detection of pre-cancerous cells are comparative to that of the Pap smear, which is considered the “gold standard” in HPV detection. The sensitivity factor falls within the 62-79 percent range for the VigilantBIO biomarkers compared with the 61-72 percent range for the Pap smear. Specificity is in the 88-100 percent range for the VigilantBIO oral cancer test compared with 82-94 percent for the Pap smear.

VigilantBIO has an exclusive license on the intellectual property from the University of Miami and the U.S. Patent Office issued a Notice of Allowance in October 2011 for key claims related to the technology. Additional patent applications are pending.

Note:
1. VigilantBIO will be presenting its products and technologies at OneMedForum SF 2012, on January 9–12.

December, 2011|Oral Cancer News|

Consider dental issues before beginning cancer treatment

Soure: www.curetoday.com/
Author: Lacey Meyer

Dentists advise resolving tooth and gum issues before starting cancer treatment.

Bettye Davis admits she has never had very good teeth. But when she received a diagnosis of salivary gland cancer, she was surprised that her oncologist recommended she visit a dentist before beginning radiation treatments to her jaw.

“When we first saw her, she still had quite a few teeth, but she had severe periodontal disease and severe bone loss,” says Dennis Abbott, DDS, Davis’ dentist. Knowing radiation would do more damage, he recommended removing the remainder of her teeth and allowing time to heal before she began 33 radiation treatments.

“We knew that if we took the teeth out after radiation, we risked the bone not healing well, which would have meant osteonecrosis, dead bone in her mouth, and lots of systemic problems.”

According to the National Cancer Institute, eliminating pre-existing dental and mucosal infections and instituting a comprehensive oral hygiene protocol before and throughout therapy can reduce the severity and frequency of oral complications from cancer therapy. Abbott says the NCI recommendations, as well as an increasing number of studies, are bringing more recognition to the importance of dental issues before, during and after cancer treatment.

A Proactive Approach
Abbott’s goal is to help patients maintain healthy teeth and reduce the risk of future infection with an oral care plan that eliminates or stabilizes disease that could produce complications during or following therapy. These complications can range from irradiated bone and gums not healing properly to an oral bacterial infection spreading throughout the body due to chemotherapy-induced immunosuppression.

Radiation to the head and neck area can also cause severe dry mouth (xerostomia) and loss of the protective effects of saliva, which accelerates existing tooth decay and can damage tiny blood vessels in the bone that deliver nutrients and oxygen that allow the bone to grow. So any tooth extractions or invasive dental procedures in irradiated bone are likely to result in slow healing, leading to pain and infection.

Oral complications may be acute (developing during therapy) or chronic (developing or continuing long after therapy), with the most common and significant being oral mucositis (inflammation and ulcers in the lining of the mouth), salivary gland dysfunction, taste dysfunction, pain and dry mouth. Limited or no saliva can lead to increased risk of infections in the mouth, gum disease and dental disease, which can progress rapidly and be difficult to control.

Available medications to stimulate saliva production rely on residual salivary gland function, if enough function remains. Mouth gels, rinses and sprays can moisturize the mouth, but unlike natural saliva, they don’t contain antibodies; growth and repair factors; fluoride; and calcium phosphates that help keep teeth healthy and strong.

Abbott says this means patients must be proactive in caring for their teeth to prevent cavities. Topical antimicrobials or antiseptics can also help control infections, including dental decay related to acid-producing bacteria.

Oral Health and Overall Health
With radiation therapy directed at her salivary glands, Davis, 73, experienced extreme dry mouth, especially at night. But, she says, a mint-flavored antioxidant topical gel Abbott prescribed, AO ProVantage, effectively relieved this symptom. “It has really helped because it keeps your mouth refreshed, plus it helps you have more moisture in your mouth,” Davis says.

The decision to extract teeth prior to radiation, Abbott says, is based on the health of the tooth, the condition of the gums and bone around the tooth, the amount of radiation the bone around the tooth is scheduled to receive and the area that will be radiated. Gum disease is a cause for tooth extraction prior to therapy. Other causes include problems with previous root canals, tooth fractures and broken fillings that can’t be adequately restored.

“You can’t dismiss oral health because it affects systemic health,” Abbott says. “The mouth has a huge amount of bacteria, and if it’s not taken care of, there is the risk of that bacteria getting into the bloodstream.”

Catching Up to Get Ahead
The American Dental Association recommends all cancer patients schedule a dental exam at least two weeks before beginning treatment. This should involve a full comprehensive exam, gum probing around every tooth and X-rays. It may also include removal of local sites of irritation, such as broken teeth, or identifying chronic infections, such as gum disease.

“Those conditions need to be managed up front because we are very limited after treatment and the complication risk is so significant that not doing it before can lead to significant difficulties after,” says Joel Epstein, DMD, MSD, director of oral medicine services at City of Hope Cancer Center in Duarte, Calif.

Appropriate healing time for dental care prior to treatment is imperative, Epstein adds, because a surgically treated area in the mouth becomes vulnerable to bacteria. Patients with suppressed immune systems can develop infection, which could result in a treatment delay or dose reduction, ultimately affecting the treatment outcome and survival.

Epstein says two weeks of healing time is ideal, but the overall goal is to have the right dental treatment coordinated with medical therapy to avoid those types of risks. Therefore communication between the dentist and oncology team is key.

Dental Care During Treatment
Treating dental issues during cancer therapy is possible but can be difficult and can also lead to complications, such as infection in patients on immunosuppressing chemotherapy and delayed healing of affected oral tissue in patients receiving high-dose radiation.

If dental treatment is needed during a cycled chemotherapy, it must be coordinated between cycles and at a time when white cell counts are high, Epstein says.

For patients receiving radiation for head and neck cancers, the dentist needs to understand the risks for healing and communicate with the oncologist to understand which regions are involved in the radiation fields, Epstein says. The dentist should also be aware of any previous or ongoing bisphosphonate use and understand the associated risks.

“We function as a part of the oncology team for all of our patients,” Abbott says. “I understand the blood work that I get back, and I understand what it is that I need to look for in order to keep the patient safe and then develop my treatment plan around that.”

Preparation and Coordination
A less common but significant oral complication involves bone healing, or lack thereof. Because radiation can damage bone cells, limiting their ability to heal, any future trauma or surgery to irradiated bone can cause osteonecrosis, or bone death.

Bisphosphonates and the RANK ligand inhibitor Xgeva (denosumab)—used to maintain bone density and prevent fractures in people with bone metastases—have also been associated with increased risk for osteonecrosis of the jaw (ONJ), which can occur in 1 to 2 percent of patients on these therapies, according to a 2010 study published in the Journal of Clinical Oncology.

A study published in 2009 in Annals of Oncology showed that preventive dental measures can significantly decrease the risk of developing ONJ. In 2003 and 2004, the FDA updated inserts for the intravenous bisphosphonates Aredia (pamidronate) and Zometa (zoledronic acid) recommending a dental exam with preventive dentistry prior to cancer treatment.

“The main prevention is treatment of the at-risk dental conditions before you’ve had a long-term effect on the bone,” Epstein says. The FDA also warns against invasive dental procedures if possible during or following bisphosphonate use, noting that the majority of reported cases of ONJ have been associated with dental procedures, such as tooth extraction, and many had signs of local infection.

Whether a tooth is extracted from an irradiated area or following bisphosphonate use, Epstein says it must be done carefully. “You want a specialist surgeon to do that with coordination with the cancer center and with people who have supported this need before.”

Therapies Making “A Huge Difference”
After her diagnosis of metastatic renal cell carcinoma in 2009, Linda Morris had two extractions before starting Zometa. When an exposed jaw area wouldn’t heal, she developed osteonecrosis. After visiting six dentists over two years, the 67-year-old saw Abbott.

To prevent infection, Abbott had her apply AO ProVantage twice daily and rinse her mouth with non-alcoholic antibacterial chlorhexidine, as well as clean her teeth with a water flosser. To promote healing, Abbott removed necrotic tissue and performed a comprehensive cleaning every two weeks. For the first time, Morris began to see progress.

“The biggest problem I had was not being able to find the dental care I needed,” Morris says.

“The topically applied gel has made a huge difference in how we can treat this problem,” Abbott says. “We’ve had two cases where the necrotic bone has been totally resolved.”

December, 2011|Oral Cancer News|

Girls-Only Vaccine Could Be Best Weapon Against HPV

Source: Jezebel.com

A new study argues that vaccinating boys against HPV isn’t the best use of resources, since vaccinating more girls will actually lead to a greater reduction in overall infections. However, there are also political implications to consider.

Back in October, I wrote that the rise of HPV-related throat cancer in men was an excellent argument for vaccinating boys against the virus. And later that month, the CDC extended its vaccine recommendation to include boys as well as girls. But now, researchers say that focusing on vaccinating more members of one sex may be more effective than trying to vaccinate both. In a study published in PLoS Medicine, Johannes A. Bogaards used mathematical modeling to determine which vaccination strategy would lead to the greatest reduction in HPV prevalence. They found that increasing the percentage of girls vaccinated would actually have the biggest effect. Bogaards et al write,

“We show that, once routine vaccination of one sex is in place, increasing the coverage in that sex is much more effective in bolstering herd immunity than switching to a policy that includes both sexes. Universal vaccination against HPV should therefore only become an option when vaccine uptake among girls cannot be further increased. Adding boys to current vaccination programs seems premature, because female coverage rates still leave ample room for improvement in most countries that have introduced HPV vaccination. So far, only three countries have achieved a three-dose coverage of 70% or more in females.”

The authors do note that while vaccinating girls and women does offer some protection to men who have sex with men (because some of these men also have sex with women), a supplementary program to vaccinate these men could be a good idea. This might be less than effective in practice — since the vaccine is most effective when given before any HPV exposure, many vaccination programs have targeted children, who may not yet identify with a particular sexual orientation or practice. However, the study authors write that “vaccination of [men who have sex with men] remains cost-effective up to 26 y of age, an age range that might render targeted HPV vaccination acceptable.”

Bogaards et al make a persuasive case that, at least if their models are correct, vaccinating all girls would lead to a greater reduction in HPV than vaccinating some girls and some boys. However, they don’t address the political obstacles to this plan. As long as HPV is perceived as a women’s problem and HPV vaccination as a girls’ issue, it will be subject to the hysteria and moralizing that surrounds women’s and girls sexuality in the United States. This may prevent the US from ever reaching the level of girls’ vaccination that would confer herd immunity. A move to vaccinate boys, however, could increase public support for the project of vaccination in general. Further research needs to look not just at what would reduce HPV prevalence in an ideal world, but at what will work in the sometimes shitty world we actually live in.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

December, 2011|Oral Cancer News|