CDC

High-Risk HPV Prevalent in Oropharyngeal Cancers

Author: Roxanne Nelson
Source: medscape.com
 

A larger percentage of oropharyngeal cancers might be related to human papillomavirus (HPV) than previously thought. The Centers for Disease Control and Prevention (CDC) reports that in a large sample of invasive oropharyngeal squamous cell carcinomas, 72% were positive for HPV and 62% were positive for high-risk HPV types 16 and 18, which are covered by the 2 commercially available vaccines (Gardasil, Merck & Co.;Cervarix, GlaxoSmithKline).

On the basis of these data, the CDC researchers suggest that vaccines could prevent most oropharyngeal cancers in the United States.

The vaccines are marketed mainly for the prevention of cervical cancer, but there is hope, and some evidence, that the vaccines might also protect against oropharyngeal cancer. For example, last year, the Costa Rica HPV Vaccine Trial found that the Cervarix vaccine reduced oral HPV infections in women by more than 90%.

However, the effect of the vaccines could vary by demographic factors; HPV prevalence differed by sex and race/ethnicity, the researchers note.

In their study, Martin Steinau, PhD, senior scientist at the CDC, and colleagues report that the current global incidence of oropharyngeal cancers is estimated to be 85,000 annually, although there is considerable geographic variation. In the United States, there are about 12,000 new cases diagnosed every year, and most are classified histologically as squamous cell carcinoma (OPSCC).

The retrospective analysis was published in the May issue of Emerging Infectious Diseases.

Study Details

Dr. Steinau and colleagues sought to determine prevalence of HPV types detected in oropharyngeal cancers in the American population, and to establish a prevaccine baseline for monitoring the impact of vaccination.

They examined oropharyngeal tumors from 588 patients.

HPV was detected in 403 of the 557 patients with OPSCC (72.4%), and 396 (71.1%) were positive for only 1 or no high-risk types. A single HPV type was detected in 68.4% of cases, and 3.9% of samples contained 2 types. In 7 cases, only low-risk HPV types were detected. High-risk HPV16 was present in 337 (60.5%) cases, HPV18 was present in 14 (2.5%) cases, and 331 (59.4%) cases were exclusively positive for these 2 types.

Other high-risk types, including HPV31, 33, 35, 39, 45, and 52, were found at low frequency, the researchers point out.

There were differences in prevalence based on sex and race/ethnicity. The prevalence of the high-risk HPV16 and HPV18 was lower in women than in men (53%vs 66%), and in non-Hispanic black than other racial/ethnic groups (31% vs 68% to 80%).

When the researchers conducted a multivariate analysis for high-risk HPV, only race/ethnicity emerged as a significant independent factor (P = .003). The odds for high-risk HPV infections were significantly higher for all other race groups than for non-Hispanic black patients (P < .001).

When only HPV16/18 detection was considered, there were significant differences between those infected and those not infected for sex (P = .009) and race/ethnicity (P < .001), but not for age (P = .063).

“Future assessments are needed to monitor general prevalence and possible type-specific shifts,” the researchers conclude. “Data from the present and future studies will provide a baseline for early assessment of vaccine effects.”

This project was supported in part by CDC grants and federal funds for Residual Tissue Repositories from the National Cancer Institute SEER Population-based Registry Program, National Institutes of Health, Department of Health and Human Services. Coauthor Brenda Y. Hernandez reports receiving consultation and speaker fees from Merck and Co.

 

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

May, 2014|Oral Cancer News|

Fewer teens having oral sex

Source: CNN.com

Fewer teens aged 15 to 17 are having oral sex now than in 2002, according to a new report from the U.S. Centers for Disease Control, but the number remains high.

The report, based on data from The National Survey of Family Growth, found that more than a third of teens had engaged in oral sex by the time they turned 17. That number climbed to almost 50% by age 19, and more than 80% for 24-year-olds.

The study – based on computer surveys given to over 6,000 teens – also looked at the timing of first oral sex in relation to the timing of first vaginal intercourse. It found that the prevalence of having oral sex before vaginal intercourse was about the same as those having vaginal intercourse before oral sex.

“This new CDC analysis debunks many myths about when young people are initiating oral sex,” wrote Leslie Kantor, vice president for education at Planned Parenthood, a family planning advocacy group. “Although there has never been data to support it, there has been the perception that many teens engage in oral sex as a ‘risk-free’ alternative to intercourse. But the CDC analysis shows that sexually active young people are likely to engage in both activities,” she wrote.

How Americans view teen sex

But oral sex, like vaginal intercourse, is not risk-free. According to the CDC’s website, “numerous studies have demonstrated that oral sex can result in the transmission of HIV and other sexually transmitted disease,” not the least of which is Human Papillomavirus (HPV), the disease known to cause both cervical and some throat cancers.

“It’s widely accepted that there is an increased number of head and neck cancers today due to changes in sexual practices in the ’60s, ’70s and ’80s,” – specifically, an increase in oral sex, said Dr. Otis Brawley, the chief medical officer of the American Cancer Society.

Regardless of whether teens have oral or vaginal sex first, Kantor says, it’s imperative they have the knowledge to make an educated decision about their sexual health.

“We need to make sure that young people have the skills to negotiate what they do and don’t want to do in sexual relationships, as well as education about and access to condoms and birth control so that they can protect themselves from STDs and pregnancy and remain healthy,” she wrote.

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

August, 2012|Oral Cancer News|

Viral Marketing: What’s Stopping Men From Getting the HPV Vaccine

Source: GOOD Mobile

By: Jake Blumgart on July 6, 2012 at 3:00AM PDT

In early 2011, my doctor informed me that a vaccine to protect against the human papillomavirus—HPV—was now available for men. I was relieved, then frustrated—my doctor didn’t actually offer the principal vaccine, Gardasil, to her male patients. After a couple days of hunting around town, I finally found the vaccine at the Mazzoni Center, a LGBT health clinic in downtown Philly. I received all three shots, and joined the less than 1 percent of American men who are vaccinated against the most dangerous strains of the virus.

While I was exceedingly grateful to the Mazzoni Center inoculating me, I knew of only one other male friend who’d received his shots. So since I got my shots, I’ve made a point of discussing my experience with any friend, acquaintance, or bemused bystander who will listen. And I’ve learned two things about young, straight men and HPV: We all know it exists, and not much else.

When I posted about my vaccinations on Facebook and Twitter, the response was largely positive—but the dozen or so likes and comments mainly came from my female friends. When I brought up the issue with a few straight guys, they seemed confused about my decision to air the information in public. Embarrassed, I let the conversation drop. But a couple weeks later, I received a Facebook message from an acquaintance in another city, freaking out about his own HPV scare, and asking me whether he could be vaccinated, and where. My status update provided a rare safe zone around a toxic topic.

Like local zoning policy, a death in the family, or what actually lurks within Taco Bell tacos, few people feel comfortable talking publicly about STDs. There’s no better environment for breeding misinformation than the dense cocoon of embarrassment we’ve woven around sex. The result is that most men I’ve spoken with are familiar with just one statistic that pervades the conversation around HPV: An estimated 50 to 80 percent of American adults will contract it. The universality of the threat engenders a laissez-faire attitude: Fuck it. I probably already have HPV, as do all my peers. Why worry?

The stats above are as accurate as we have. But the real story of HPV is more complicated. There are more than 130 strains of HPV, and the vast majority of them do no harm: No cancer, no warts, nothing. Most immune systems take care of the few nastiest strains just as they would any other virus. Then again, some don’t.

“[Nearly] everyone is going to be HPV positive in their lifetime, but we are only worried about the people who have an immune system who cannot clear the infection,” says Brian Hill, president of the Oral Cancer Foundation and a survivor of HPV-related oral cancer, which was located at the base of his tongue in 1997, before the virus was recognized as a cause. “Of the 99 percent of people that engage in a sexual activity that transfers the virus, orally or genitally, only 1 percent will have it cascade into a cellular event. It’s the luck of the draw in having a gene pool that does not recognize HPV 16”—the dominant cancer-causing strain—“as a threat.”

There’s no way to tell if you, or your partner, lost the genetic lottery. HPV is transmittable through skin-to-skin contact, so condoms aren’t as effective as they are at, say, preventing HIV/AIDS. There aren’t even worthwhile tests to determine if you have a dangerous HPV infection or, unnervingly, a way to test for the penile cancer HPV can cause. Anal and oral cancer screenings exist, but dental insurance often does not cover the latter, as I found to my dismay when I booked one while researching this article. (I decided that the $65 out-of-pocket fee was worth protecting against tumors on my tonsils.)

The truth is that most young men don’t know about the risks of HPV—and their options for preventing it—because our culture’s sexual awkwardness distorts corporate, government, and even scientific decision-making. In the mid-2000s, before the vaccination was marketed to the public, the CDC conducted extensive focus group research to ascertain the American public knowledge of, and attitude toward, HPV. “Current focus-group findings revealed that STD-associated stigma served as a barrier to HPV-vaccine acceptability,” the researchers found. “[E]xperts…cautioned strongly against focusing primarily on the sexually transmitted nature of HPV…which can be stigmatizing and detract from the more important public health concern of cervical cancer.”

Merck took note. The results can be seen in the company’s initial “One Less” advertising campaign, which used images of jump-roping school girls to advocate the vaccination use for girls ages 9 to 26. Any mention of sexual transmission, genital warts, male victims, and non-cervical HPV-linked cancers are noticeably absent. I don’t remember seeing those ads, which were rolled out in late 2006, in the midst of my higher education. But my college girlfriend knew about HPV and Gardasil, and I’m sure her awareness was directly affected by Merck’s framing. I remember her frustration at learning of another negative consequence of sex—and that women, as usual, were expected to bear its financial and health costs. Neither of us knew that men could be anything more than passive carriers, or that the vaccine might eventually be available to both genders. “When we talk to guys, often young men especially will say, oh, but that’s the girl vaccine,” says Dr. Robert Winn, Medical Director of the Mazzoni Center. The culture of silence around men and HPV means that the burden is on women to protect themselves and their partners—and that the virus can be doubly dangerous for men. Of the HPV-associated cancers, cervical cancer (11,967 cases annually) is only slightly more prevalent than oral cancer (11,726). The death rates are three times higher for the latter, and men are far more likely to contract it. In a population of 100,00, 6.2 men and 1.4 women are diagnosed with HPV-related oral cancer. Of the 2,500 cases of HPV-related anal cancer reported annually, 900 are in men and 1,600 in women. According to the CDC, men who have sex with men are 17 times more likely to contract anal cancer. Prevalence rates are also higher among those with HIV/AIDS. Some of the statistics on male HPV rates are still emerging, but the idea that HPV affects men, too, has long been obvious. “When vaccines were being developed, HPV had the clearest causal link to cervical cancer,” says Adina Nack, Associate Professor of Sociology at California Lutheran University and author of Damaged Goods: Women Living With Incurable Sexually Transmitted Diseases. “[But] they knew boys contract it. Boys transmit it. There was already a growing body of clinical research that some cancers men suffer from are caused by the same strains of HPV.” Three years after the 2006 release for women, the vaccines were quietly approved for men. Neither Merck nor the U.S. government widely advertises its universal availability. I consider myself relatively plugged-in when it comes to sexual health, and I didn’t learn I could use the vaccine until 2011—two years of exposure while protection was there, unknown and unasked for. But in men, the HPV vaccine is still only approved as a defense against genital warts and anal cancer. Oral cancer is not officially one of the cancers Gardasil protects against, although the CDC notes that it’s “likely that this vaccine also protects men from other HPV-related cancers,” like cancers of the penis and the back of the throat. The Oral Cancer Foundation has been pushing for studies on the issue, but Merck announced in 2010 that it had no “plans to study the potential of Gardasil to prevent HPV-related [oral] cancers.” These false assumptions can be easily reversed. But men and women are still paying for Merck’s crappy reasoning. It would be great if the CDC conducted a sweeping public health campaign to alert Americans to the full facts about HPV and its vaccines. Merck should advertise its services to both men and women. But with the institutional players showing little inclination to try another big push for HPV vaccination, word of mouth  remains our principal sources of information about HPV protection. So start calling your local clinics—LGBT and otherwise—to see if they offer free shots. And when you get your vaccine, tell everyone who will listen.

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

HPV Cancer Hits 8,000 Men, 18,000 Women a Year

Source: WebMD.com

HPV cancer isn’t just a female problem, new CDC figures show.

Although HPV causes 18,000 cancers in women each year, it also causes 8,000 cancers in men, the CDC calculates. To get the figures, CDC researchers analyzed data collected from 2004 to 2008 in two large cancer registries.

HPV, human papillomavirus, is the cause of nearly all cervical cancers. But that’s obviously not the only cancer caused by this sexually transmitted virus.

HPV also causes about two-thirds of mouth/throat (oropharyngeal) cancers, 93% of anal cancers, and more than a third of penile cancers. Men are four times more likely than women to get HPV mouth/throat cancer, while women are more likely than men to get HPV anal cancer.

Clearly, HPV is not just a female problem. Yet it was only last year that one of the two FDA-approved HPV vaccines was recommended for teen boys. Gardasil was recommended for girls in 2006; Cervarix was recommended for girls in 2009.

“HPV vaccines are important prevention tools to reduce the incidence of non-cervical cancers,” the CDC notes in a report in the April 20 issue of Morbidity and Mortality Weekly Report. “Transmission of HPV also can be reduced through condom use and limiting the number of sexual partners.”

HPV vaccines are most effective when given before people become sexually active. Yet in 2010, less than a third of teen girls had received all three doses of HPV vaccines. Numbers aren’t yet available for boys.

The slow uptake of the vaccine by teen girls is in stark contrast to the contribution HPV makes to women’s cancer risk. Taken together, HPV cancers are more common than ovarian cancers, and nearly as common as melanoma skin cancers in women.

Among men, HPV cancers are about as common as invasive brain cancers.

HPV Prevention

HPV is an extremely common sexually transmitted infection. At least half of sexually active people get HPV at some time during their lives. At any given time, more than 20 million Americans carry the virus.

Each HPV infection usually clears after a year or two. But that doesn’t always happen. Those HPV infections that persist can lead to the development of cancers.

Although condom use and limiting the number of one’s sex partners reduce HPV spread, vaccination — before a person becomes sexually active — is the surest way to prevent infection.

The Cervarix HPV vaccine protects against the two HPV strains most likely to cause cervical cancer. The Gardasil HPV vaccine protects against these and two other HPV strains.

Routine vaccination with three doses of Cervarix or Gardasil is recommended for girls aged 11 or 12. Routine vaccination with three doses of Gardasil is recommended for boys aged 11 or 12. Catch-up vaccination is recommended for females through age 26 and for males through age 21.

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

April, 2012|Oral Cancer News|

CDC report releases updated information on HPV-associated cancers

Source: www.dentistryiq.com
Author: staff

The Centers for Disease Control and Prevention released on April 24, 2012, an updated statistical count on the prevalence of HPV-associated cancers in the United States. Oropharyngeal cancers, primarily the base of the tongue and tonsils, were the second most common after cervical cancer.

Published in the April 20 edition of CDC’s Morbidity and Mortality Weekly Report (MMWR), the report, titled, ”Human Papillomavirus-Associated Cancers — United States, 2004–2008,” provides updated information from an analysis of data for all 50 states and the District of Columbia from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology and End Results (SEER) program.

An average of 33,369 HPV-associated cancers were diagnosed annually (rate = 10.8 per 100,000 population), including 11,726 cases of oropharyngeal cancers. CDC estimates that about 7,400—63%—of the cases of oropharyngeal cancer each year were attributable to HPV infection. These cancers were found three times more frequently among men.

The Centers for Disease Control and Prevention released on April 24, 2012, an updated statistical count on the prevalence of HPV-associated cancers in the United States. Oropharyngeal cancers, primarily the base of the tongue and tonsils, were the second most common after cervical cancer.

Published in the April 20 edition of CDC’s Morbidity and Mortality Weekly Report (MMWR), the report, titled, ”Human Papillomavirus-Associated Cancers — United States, 2004–2008,” provides updated information from an analysis of data for all 50 states and the District of Columbia from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology and End Results (SEER) program.

An average of 33,369 HPV-associated cancers were diagnosed annually (rate = 10.8 per 100,000 population), including 11,726 cases of oropharyngeal cancers. CDC estimates that about 7,400—63%—of the cases of oropharyngeal cancer each year were attributable to HPV infection. These cancers were found three times more frequently among men.

View the CDC report here.

April, 2012|Oral Cancer News|

Young Girls More Likely to Report Side Effects after HPV Vaccine

Source: Therapeutics Daily

PORTLAND, Ore., April 3, 2012 /PRNewswire/ — Younger girls are more likely than adult women to report side effects after receiving Gardasil, the human papillomavirus vaccine. The side effects are non-serious and similar to those associated with other vaccines, according to a new study funded by the Centers for Disease Control and Prevention and published in the Journal of Women’s Health.

As part of an ongoing study and evaluation of this relatively new vaccine, researchers surveyed 899 girls and young women (ages 11-26) within two weeks after they received the Gardasil vaccine injection in the upper arm. The survey, which took place in 2008, also found that while most girls and young women did know that the vaccine can prevent cervical cancer, and that three doses are recommended, many didn’t know that the vaccine can also prevent genital warts and abnormal pap smears.

“Gardasil is an important cancer-prevention vaccine, but too few girls are getting it. Our study found that young girls do have some knowledge about the vaccine, but they need to know more. If these girls and their parents know what to expect, they will likely be less afraid of getting the vaccine,” said study lead author Allison Naleway, PhD, a senior investigator with the Kaiser Permanente Center for Health Research in Portland, Ore.

Since 2006, the CDC has recommended Gardasil for girls ages 11-12, and for older girls and women (ages 13-26) who did not receive the vaccine when they were younger. The CDC also recently recommended Gardasil for boys ages 11-12, and for older boys and men (ages 13-21) who did not receive the vaccine when they were younger.

Information about side effects has been reported by the manufacturer, the CDC, and by the federal government’s Vaccine Adverse Event Reporting System, but this study is one of the first to survey girls themselves shortly after they received the vaccine. Many other studies have relied on information reported by health care providers and parents.

For this study, researchers used electronic health records to identify 3,490 Oregon and Washington girls and young women (ages 11-26) who received their first dose of HPV vaccine between February and September of 2008.  Within a week of vaccination, researchers sent out surveys to young women ages 18-26. For girls under 18, researchers notified parents that their daughters would be receiving the surveys the following week, and gave the parents a choice to opt out. The survey included 50 questions about vaccine side effects, about girls’ knowledge of the vaccine and the HPV virus, and about what kind of information their doctors shared with them before vaccine administration.

Of the 899 girls and women who responded to the survey, 78 percent reported pain when receiving the vaccine. Seventeen percent reported bruising or discoloration, 14 percent said they had swelling at the injection site, 15 percent reported dizziness, and 1 percent of the girls reported fainting.

Younger girls were more likely to have received other vaccines such as tetanus, meningitis and hepatitis A at the same time they received the HPV vaccine, and they were also more likely to report side effects. For example, 84 percent of girls aged 11-12 reported pain with the injection vs. 74 percent of women aged 18-26. Nineteen percent of girls aged 11-12 reported feeling dizzy after receiving the vaccine, but fewer than half that many (8 percent) of women aged 18-26 reported dizziness.

“These side effects are non-serious and very manageable,” said Mike Wilmington, MD, a Kaiser Permanente pediatrician in Vancouver, Wash., who was not involved in the study. “The main complaint I hear about is pain with the injection, but there are ways to lessen the pain. Some girls will feel dizzy after this and other vaccines, so I follow CDC guidelines and have them sit or lie down for a few minutes after receiving the vaccine.”

Eighty-four percent of girls and young women said they knew that the HPV virus can cause cervical cancer, but only half reported knowing that it can also cause genital warts and abnormal pap smears. Most respondents said their providers told them they needed three doses of the vaccine, and most also said their providers talked with them about the vaccine’s benefits, possible side effects, and about HPV infection. Most girls, however, said their providers did not discuss genital warts or abnormal pap smears, and only one-fifth of girls said their provider asked them to sit and rest after receiving the vaccination.

Study authors include Allison Naleway, PhD, Rachel Gold, PhD, MPH, Lois Drew, Karen Riedlinger, MPH and Michelle Henninger, PhD — all from the Kaiser Permanente Center for Health Research in Portland, Ore., and Julianne Gee, MPH, from the Centers for Disease Control and Prevention in Atlanta.

This study is part of Kaiser Permanente’s ongoing research to understand the safety and efficacy of Gardasil. A study of 189,629 girls, teenage girls and young women, published earlier this year in the Journal of Internal Medicine, found that Gardasil does not trigger autoimmune conditions such as lupus, rheumatoid arthritis, type 1 diabetes or multiple sclerosis after vaccination in young women.

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

April, 2012|Oral Cancer News|

CDC to launch new, graphic anti-smoking campaign

One of the ads by the Centers for Disease Control shows Shawn Wright who had a tracheotomy after being diagnosed with head and neck cancer.

ATLANTA — Tobacco taxes and smoking bans haven’t budged the U.S. smoking rate in years. Now the government is trying to shock smokers into quitting with a graphic nationwide advertising campaign.

The billboards and print, radio and TV ads show people whose smoking resulted in heart surgery, a tracheotomy, lost limbs or paralysis. The $54 million campaign is the largest and starkest anti-smoking push by the Centers for Disease Control and Prevention and its first national advertising effort.

The agency is hoping the spots, which begin Monday, will persuade as many as 50,000 Americans to stop smoking.

“This is incredibly important. It’s not every day we release something that will save thousands of lives,” CDC Director Dr. Thomas Frieden said in a telephone interview.

That bold prediction is based on earlier research that found aggressive anti-smoking campaigns using hard-hitting images sometimes led to decreases in smoking. After decades of decline, the U.S. smoking rate has stalled at about 20 percent in recent years.

Advocates say it’s important to jolt a weary public that has been listening to government warnings about the dangers of smoking for nearly 50 years.

“There is an urgent need for this media campaign,” Matthew Myers, president of the Campaign for Tobacco-Free Kids, said in a statement.

The CDC was set to announce the three-month campaign on Thursday.

One of the print ads features Shawn Wright from Washington state who had a tracheotomy after being diagnosed with head and neck cancer four years ago. The ad shows the 50-year-old shaving, his razor moving down toward a red gaping hole at the base of his neck that he uses to speak and breathe.

An advertising firm, Arnold Worldwide, found Wright and about a dozen others who developed cancer or other health problems after smoking for the ads.

Federal health agencies have gradually embraced graphic anti-smoking imagery. Last year, the Food and Drug Administration approved nine images to be displayed on cigarette packages. Among them were a man exhaling cigarette smoke through a tracheotomy hole in his throat, and a diseased mouth with what appear to be cancerous lesions.

Last month, a federal judge blocked the requirement that tobacco companies put the images on their packages, saying it was unconstitutional.

Graphic ads are meant to create an image so striking that smokers and would-be smokers will think of it whenever they have an urge to buy a pack of cigarettes, said Glenn Leshner, a University of Missouri researcher who has studied the effectiveness of anti-smoking ads.

Leshner and his colleagues found that some ads are so disturbing that people reacted by turning away from the message rather than listening. So while spots can shock viewers into paying attention, they also have to encourage people that quitting is possible, he said.

The CDC campaign includes information on a national quit line and offers advice on how to kick the habit, CDC officials said.

CDC unveils graphic anti-smoking ads. Click here to view the video: http://cnn.com/video/?/video/health/2012/03/15/early-cdc-anti-smoking-ads.cnn

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

March, 2012|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|

UI professors: HPV editorial misses the mark

Source: The Daily Iowan

The Nov. 29 editorial “Recommend Pap smears, not vaccines, to prevent cervical cancer” completely missed the mark with regard to HPV vaccines. We are researchers and clinicians at the University of Iowa who study and treat HPV and other infectious diseases. It is disturbing to think that the article might dissuade individuals from getting a safe and effective vaccine that can prevent cancer.

First of all, it has been conclusively demonstrated that the vaccines are effective at preventing HPV infection. Cervical cancer is caused by HPV. Additionally, cancers of the head and neck are linked to HPV, including cancers in males. It has been clearly shown that the vaccines prevent the development of precursors to cervical cancer. In the editorial, Dr. Diane Harper was quoted as saying, “If doctors tell patients that this vaccination will prevent cancer, they’re telling them a lie.” This statement from Dr. Harper is simply misleading.

In the vaccine studies, non-treatment of precursor lesions in the placebo group in the context of a clinical trial was considered unethical, and therefore, any precursor lesions were treated. Subsequent development of cancer in the placebo group was prevented by the required ethical treatment. Thus, the trials could not evaluate prevention of advanced cancer, per se. Because it takes cervical cancer a long time to develop, it will take about 15 more years to have data on incidence rates of cervical cancer from a large vaccinated general population. Because the vaccines prevent HPV infection and HPV-associated precursor lesions, they will prevent cancer.

The statement that the vaccines offer only five to seven years of protection is also misleading. The vaccine trials were initiated only five to seven years ago, and while we know that protection has been good for that period of time, there is no evidence that protection is waning. Only time will tell if protection is longer-term but this should in no way deter individuals from getting vaccinated. The earlier vaccinated populations are being carefully followed and, over time, it will be known if booster vaccinations are required. It is known with some other vaccines, such as the diphtheria vaccine, day-to-day potential encounter with the causative microbe stimulates additional protection in a significant part of the previously vaccinated population, reducing the need for re-vaccination.

Both vaccination and Pap smears are two important tools to prevent cervical cancer. It is not a question of “either/or.” The editorial failed to mention that Dr. Harper advocates vaccination for both sexes in several of her published articles. However, Pap smears are still critical. The HPV vaccines do not cure HPV infections once they have occurred, and most women do not know whether they have been infected or not. In addition, the current vaccines only protect against two cancer-causing HPV types which account for more than 70 percent of cervical cancers. Other cancer-causing types exist, so vaccinated individuals should not feel a false sense of security. In other words, women need to continue to get Pap smears even if they have been vaccinated.

The side effects and safety concerns of the vaccine are also greatly misrepresented in the editorial. The article fails to mention that the CDC and FDA have been closely monitoring the safety of HPV vaccines and have deemed them safe. The statement that 73 percent of those who received the vaccine reported new medical conditions gives a wrong impression regarding safety. The editorial fails to mention that almost all (more than 90 percent) of the reported “medical conditions” were considered minor (e.g. pain and swelling at the site of injection), common events in all vaccination protocols. While severe reactions to the vaccine have been encountered, these could not be directly tied to the vaccine, no specific patterns were observed in these events, and those that were reported were consistent with events that occur in healthy adolescent and adult populations of similar size. It should be mentioned that there were slightly elevated risks of fainting and anaphylaxis that occurred within 15 minutes of vaccination, which led to the recommendation that those who are vaccinated be monitored for 15 minutes after vaccination. This is true of all vaccinations. The CDC continues to closely monitor the safety of the vaccines and makes recommendations based on the data.

It is too easy to think of HPV cancers as preventable by Pap smears alone. Furthermore, it is too easy to understate the importance of both vaccination and Pap smears. It needs to be emphasized that not all HPV-associated cancers can be detected by Pap smears. Consider this: A male developed HPV-associated head and neck cancer six months ago. This was discovered in the male during shaving, simply as a swollen neck lymph node. The downstream consequence of this finding was the male received radiation and chemotherapy for months that had to be stopped prematurely since the patient was near death because of treatment. Three months later, the male is still being fed by tubes, does not have a sense of taste, cannot speak clearly, has radiation burns on his face, and has significant anxiety because he remains susceptible to recurrence of cancer. His cancer is linked to one of the HPVs that is in the vaccine, and to think, this could have been prevented with vaccination prior to his initial infection with HPV. It is too late now for him to have vaccine protection.

In the summary of the editorial it is stated “not enough is known about HPV vaccinations to be recommended to the general population by medical professionals.” This statement is false. The CDC, which does not take these things lightly, has recommended vaccination for prevention of cervical cancer and also more recently for anal cancer. The recommendation was based on sound medical and scientific findings. The editorial did not follow these same principles.

This opintion piece was signed by five University of Iowa professors: Al Klingelhutz, Ph.D., Pat Schlievert, Ph.D., Stanley Perlman, M.D., Marty Stoltzfus, Ph.D., and Colleen Kennedy Stockdale M.D., M.S.

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

December, 2011|Oral Cancer News|

New Report: States Slash Tobacco Prevention Funding by 36%, Spend Less than 2 Cents of Every Tobacco Dollar to Fight Tobacco Use

Source: TobaccoFreeKids.org

WASHINGTON, DC – States have slashed funding for programs to reduce tobacco use by 12 percent in the past year and by 36 percent over the past four years, threatening the nation’s progress against tobacco, according to a report released today by a coalition of public health organizations.

The states this year (Fiscal Year 2012) will collect a near-record $25.6 billion in revenue from the 1998 state tobacco settlement and tobacco taxes, but will spend only 1.8 percent of it – $456.7 million – on programs to prevent kids from smoking and help smokers quit. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use.

Both the total amounts states are spending on tobacco prevention programs and the percentage of tobacco revenue spent on these programs are the lowest since 1999, when the states first received significant tobacco settlement funds. With nearly 20 percent of Americans still smoking, the report warns that continued progress against tobacco use – the nation’s number one cause of preventable death – is at risk unless states increase funding for tobacco prevention and cessation programs. The report also calls on states to increase tobacco taxes and, for states that have yet to do so, to enact strong smoke-free laws that apply to all workplaces, restaurants and bars.

The report further calls on the federal government to launch a national tobacco prevention and cessation campaign, including a mass-media campaign and support for telephone quitlines, as the Obama Administration proposed in its Tobacco Control Strategic Action Plan. It also calls for preservation of the Prevention and Public Health Fund, created by the health care reform law to support such disease prevention initiatives.

The report, titled “A Broken Promise to Our Children: The 1998 State Tobacco Settlement 13 Years Later,” was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association, Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights. Issued annually, the report assesses whether states have kept their promise to use tobacco settlement funds – expected to total $246 billion over the first 25 years – to fight tobacco use.

“More than ever, this report shows that the states have squandered the opportunity presented by the tobacco settlement to significantly reduce tobacco use and its devastating toll on our nation,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “It’s no coincidence that progress against tobacco has slowed at the same time that states have slashed tobacco prevention funds. We cannot win the fight against tobacco unless elected officials at all levels step up efforts to implement proven solutions.”

Key Findings

Other findings of this year’s report include:

  • Most states are falling far short of recommended funding levels for tobacco prevention programs set by the U.S. Centers for Disease Control and Prevention (CDC). The $456.7 million the states have budgeted is just 12 percent of the $3.7 billion the CDC recommends for all the states combined. It would take less than 15 percent of total state tobacco revenues to fully fund tobacco prevention programs in every state.
  • States have cut funding for tobacco prevention and cessation programs by $61.2 million (12 percent) in the past year and by $260.5 million (36 percent) in the past four years.
  • Counting both state funds and federal grants, only Alaska and North Dakota currently fund tobacco prevention programs at CDC-recommended levels. Only four other states provide even half the recommended funding, while 33 states and Washington, DC, provide less than a quarter. Four states – Connecticut, Nevada, New Hampshire and Ohio – and DC have budgeted zero state funds for tobacco prevention this year.
  • Tobacco companies spend $23 to market tobacco products for every $1 the states spend to fight tobacco use. According to the latest data from the Federal Trade Commission, tobacco companies spend $10.5 billion a year on marketing.
  • Federal grants have helped to cushion the impact of state funding cuts, but some of that funding is temporary and will run out this year. In fiscal year 2012, the federal government is providing $91.2 million in state and community grants to reduce tobacco use. States have also received $196.4 million in stimulus funds for tobacco prevention, some of which will be spent this year.

The report comes as recent surveys have found that smoking declines in the United States have slowed. The CDC recently reported that the adult smoking rate in 2010 was 19.3 percent — only a small decline since 2004 when 20.9 percent smoked. While smoking among high school students has declined by 46 percent from a high of 36.4 percent in 1997, 19.5 percent still smoke.

“It is truly penny-wise and pound-foolish for the states to cut funding for tobacco prevention and cessation programs,” said Nancy Brown, CEO of the American Heart Association. “These programs not only reduce smoking, but also lower tobacco-related health care costs that total nearly $100 billion annually. Tobacco prevention programs are smart investments that save lives and money.”

“Tobacco prevention and cessation programs are a great example that when we invest in prevention and public health, we save lives, improve health and reduce health care costs. For example, we know that smoke-free workplaces and funding programs to help smokers quit are a win for business, worker productivity and a healthier community,” said Risa Lavizzo-Mourey, M.D., M.B.A., President and CEO of the Robert Wood Johnson Foundation.

“We know that the most effective way to curb the tobacco epidemic in this country is through regularly and significantly increasing tobacco taxes, enacting comprehensive smoke-free laws and fully funding tobacco prevention and cessation programs,” said John R. Seffrin, PhD, chief executive officer, American Cancer Society Cancer Action Network, the advocacy affiliate of the American Cancer Society. “States are putting lives at risk and leaving potential state revenue on the table when they fall short of implementing strong tobacco control policies.”

“The continued devastating cuts in tobacco prevention spending in 2011 are unfortunately part of a broader pattern of states backsliding on putting in place policies and making investments to fight tobacco use,” said American Lung Association President and CEO Charles D. Connor. “States are missing a key opportunity to save lives and money.”

“Comprehensive tobacco control programs not only reduce smoking, but they also prevent a new generation of young smokers and lead to policies that protect workers from exposure to secondhand smoke in public places and workplaces,” said Cynthia Hallett, MPH, Executive Director of Americans for Nonsmokers’ Rights. “It is a tragedy that less that 2 percent of tobacco revenue goes to evidence-based tobacco prevention programs. States should be advocating for public health and not toeing the line for the tobacco industry.”

Tobacco use kills more than 400,000 people in the United States each year and costs the nation $96 billion in health care bills. Every day, another 1,000 kids become regular smokers — one-third of them will die prematurely as a result.

(NOTE: Alabama’s tobacco prevention program budget for FY2012 was not available when this report went to press. Alabama historically has provided minimal funding for tobacco prevention. In FY 2011, Alabama budgeted $860,000, which is just 1.5 percent of the CDC’s recommendation.)

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

December, 2011|Oral Cancer News|