Gardasil

Frontline Cancer: vaccines for HPV near guarantee

Source: www.lajollalight.com
Author: Dr. Scott Lippman

Dear Scott: “Our son, who is 25, went to the GP yesterday and his doc wasn’t sure about giving the Gardasil I had been bugging him to get. Didn’t you tell me about the benefits of the HPV vaccination?”

The note was from a friend. It was personal, but also a topic of wide public interest and one that remains much discussed among cancer researchers and physicians. That’s why I’m answering my friend here.

Roughly 12 percent of all human cancers worldwide — more than 1 million cases per year — are caused by viral infections (called oncoviruses) and attributed to a relatively small number of pathogens: human papilloma virus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Epstein-Barr virus (EBV). Given the emphasis upon other causal factors of cancer, such as genetic mutations or environmental sources, it’s a statistic that’s not well known nor, I would argue, fully appreciated.

Human viral oncogenesis is complex, and only a small percentage of the infected individuals develop cancer, but that 12 percent translates into more than 500,000 lives lost each year to virus-caused malignancies. Many of those deaths are preventable because effective vaccines already exist for HPV and HBV. Right now. No future discoveries required.

I want to specifically talk about the HPV vaccine. Controversy has constrained its proven effectiveness as a public health tool, but if used as prescribed, the HPV vaccine could essentially eliminate cervical and other HPV-caused cancers. Infection with HPV is very common. It’s estimated that at least 80 million Americans are affected. HPV is actually a group of more than 200 related viruses. There is no cure for HPV, but the infection typically clears on its own without lingering effect.

Forty types of HPV are easily spread through direct sexual contact. They fall into two categories: Low-risk HPVs that do not cause cancer, but can cause skin warts on or around the genitals, anus, mouth or throat. And high-risk HPVs (mostly two strains, type 16 and type 18) that cause approximately 5 percent of all human cancers worldwide. High-risk HPV strains drive the rates of cervical (the leading cause of cancer deaths in women in many developing countries), anal and a dramatically increasing subset of oropharyngeal (the tonsil and parts of the throat and tongue) cancers among men in the United States and other developed countries.

The Food and Drug Administration has approved three vaccines for preventing HPV infection: Gardasil, Garadsil-9 and Cervarix. They have strong safety records and a near-guarantee of dramatically reducing the risk of infection. But they are not widely used. The HPV vaccination rate in the U.S. is just 36 percent for girls and 14 percent for boys (and even lower for Hispanics, blacks and the poor).

The chief reason, it has been argued, relates to the recommended age of vaccination: 11-12 years. Because cancer-causing HPV viruses are transmitted through sexual contact, the idea of vaccinating a young girl or boy as a preventive measure strikes many people (i.e. parents) as premature, unsettling or enabling. My friend and colleague, Howard Bailey, M.D., director of the University of Wisconsin Carbone Cancer Center and a national leader on this topic, believes this attitude costs lives. “We need to shift focus from behavior associated with infection to preventing major cancers,” he says.

There are other factors as well. For example, full vaccination requires three doses, so persistence is required. Safety concerns continue about the vaccine (perhaps part of a larger misplaced mistrust of vaccines in general). And there remains limited public understanding of HPV or HPV-related diseases, especially in men.

The reality is that these vaccines work best if they are given at an early age before exposure to HPV. However, as Howard explained, if this window is missed, the FDA includes indications where the recommendation rises to age 26, to get vaccinated for at least some cancer-causing strains of HPV. Howard recommends every young, unvaccinated adult receive at least the 9-valent HPV vaccine, “which can provide protection against five additional HPV types that cause cancer and are less common than types 16 and 18.” There is the potential for protection against HPV types that a person hasn’t yet been exposed to and if a person hasn’t been exposed to the common HPV types (6, 11, 16 and 18), it can provide protection against them as well.

In a recently published statement paper, the American Society of Clinical Oncology called for a broad, concerted effort by health care professionals and policymakers to increase awareness of the evidence and effectiveness of HPV vaccination. It should be routine. The public health benefit is obvious and indisputable. I completely agree.

Here’s a corollary to consider: Vaccines for HBV have been available for many years and are a routine part of pediatric immunizations in the United States. In the past, countries like Taiwan and Korea suffered endemic HBV infections and high rates of hepatocellular carcinoma (HCC) or liver cancer. In the 1980s, these countries implemented universal infant HBV vaccination policies that have resulted in a dramatic 80 percent decline in HBV infections, cases of hepatitis and, more importantly, reductions in HCC incidence and mortality.

Every day, you can read headlines about research to find new treatments and cures for the many diseases called cancer. Progress is painfully slow and uneven. We’ve been fighting this war for decades. Preventing cancer altogether is a better approach and with cancers caused by HPV, we have the right weapon already at hand. We just need to use it.

ASCO Urges Aggressive Efforts to Increase HPV Vaccination

Source: www.medscape.com
Author: Zosia Chustecka
 

Human papillomavirus (HPV) vaccines have now been available for 10 years, but despite many medical professional bodies strongly recommending the vaccine, uptake in the United States remains low.

Data from a national survey show that about 36% of girls and 14% of boys have received the full schedule of HPV vaccines needed to provide protection (Vaccine. 2013;31:1673-1679).

Now the American Society of Clinical Oncology (ASCO) has become involved, and in a position statement issued today the organization calls for aggressive efforts to increase uptake of the HPV vaccines to “protect young people from life-threatening cancers.”

“With safe and effective vaccines readily available, no young person today should have to face the devastating diagnosis of a preventable cancer like cervical cancer. But unless we rapidly increase vaccination rates for boys and girls, many of them will,” ASCO President Julie M. Vose, MD, said in a statement.

“As oncologists, we see the terrible effects of these cancers first hand, and we have to contribute to improving today’s alarmingly low vaccination rates,” she added.

The new policy statement is published online April 11 in the Journal of Clinical Oncology.

The statement notes that HPV vaccination has been previously recommended by many US medical societies, including the American Cancer Society, the American College of Obstetrics and Gynecology Committee, the American Dental Association, the American Head and Neck Society, the American Nurses Association, the American Pharmacists Association, the Association of Immunization Managers, the Society for Adolescent Medicine, and the Society of Gynecologic Oncology.

In addition, a joint letter was sent out to all physicians urging them to give a strong recommendation from the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the Centers for Disease Control and Prevention, and the Immunization Action Coalition.

Now oncologists are specifically being asked by their professional body, ASCO, to join in with the push toward greater uptake of the HPV vaccines.

“ASCO believes oncologists can play a vital role in increasing the uptake of HPV vaccines,” the new policy statement says. “Although most oncologists will not be direct providers of these preventive measures, this does not abrogate us from contributing to this process. Our unassailable role in the mission to lessen the burden of cancer…places us in a position of influence. We should use interactions with our patients, primary care colleagues, and health care systems to raise awareness of HPV-related cancers and the role of vaccination in preventing them.”

Oncology providers have a responsibility to serve as community educators.

“Oncology providers have a responsibility to serve as community educators, disseminating evidence-based information to combat misconceptions concerning the safety and effectiveness of the HPV vaccine,” it continues.

“ASCO encourages oncologists to advocate for and actively promote policy change to increase vaccination uptake,” the statement concludes.

Issues With the Statement

However, there are a few issues with the statement, says a prominent researcher in the field of HPV and cervical cancer, Diane Harper MD, professor and chair of the department of Family and Geriatric Medicine, University of Louisville, Kentucky. Dr Harper, who was approached for comment, was involved in early clinical trials with both HPV vaccines (Gardasil, Merck & Co, and Cervarix, GlaxoSmithKline), and has emphasized the need for ongoing screening with Pap tests to prevent cervical cancer.

This is also one of the issues she raises about the ASCO statement, which does not mention screening. “All messages about HPV vaccination must be couched in terms of continued lifetime screening for cervical cancer,” Dr Harper told Medscape Medical News.

The ASCO statement highlights the potential that HPV vaccination has for preventing cancer. (Both vaccines protect against HPV types 16 and 18, and Gardasil offers additional protection against several other types). The statement notes that HPV is the cause of nearly all cervical cancer cases and that HPV genotypes 16 and 18 are responsible for 70% of cervical cancers. In the United States, HPV is responsible for 60% of oropharyngeal cancers, 90% of which are caused by HPV 16. HPV is also the cause of 91% of anal cancers, 75% of vaginal cancers, 69% of vulvar cancers, and 63% of penile cancers, again with HPV 16 as the predominant oncogenic genotype.

However, the statement also notes that “because of the long latency and the prolonged preinvasive phase after infection with HPV, many years of follow-up are needed for the ongoing trials to demonstrate a significant reduction in HPV-related cancers.”

Therefore, intermediate outcomes are being used as surrogate endpoints, it continues. HPV vaccines have been shown to prevent new cancer-causing HPV genotype-specific infections and resultant diseases, such as grades 2 and 3 cervical intraepithelial neoplasias (CIN), vaginal, vulvar, and anal intraepithelial neoplasias (as precursor lesions to cancer).

There is “almost certainty that cancers caused by oncogenic HPV genotypes will be dramatically reduced,” according to the statement.

Dr Harper told Medscape Medical News that the studies conducted to date have shown that “Cervarix has a 93% efficacy against CIN 3 regardless of HPV type; Gardasil has a 47% efficacy against CIN 3 regardless of HPV type, and Gardasil 9 is equivalent to Gardasil in the prevention of CIN 3 disease regardless of HPV type. None of these vaccines can prevent all CIN 3 or potentially all cancers.”

“Hence, the most important take home point is that screening is absolutely necessary as a prevention tool for preventing cancer by early detection of disease that when found, is curable,” Dr Harper emphasized.

Also, Dr Harper noted that the studies ended at prevention of CIN 2/3 disease as a clinical outcome. CIN 3 on average progresses to cancer in 20% of women within 5 years, and to 40% of women in 30 years. But, she points out, “there are no long-term follow-up studies that show that cancers will be averted.”

“The modeling exercises indicate that we have to wait at least 40 years before we will have a detectable decrease in cervical cancers from vaccination, assuming that at least 70% of the population being surveyed is vaccinated,” she added.

In its statement, ASCO cites the success of widespread vaccination against hepatitis B virus in reducing the incidence of liver cirrhosis and liver cancer as “an exemplary health model that supports more widespread HPV vaccination.”

But Dr Harper argues that “the prevention of liver cancer was an unexpected highlight of HBV vaccination. The primary purpose was to relieve the symptoms of chronic HBV sufferers. The continual re-infection with HBV seems to allow a natural infection to act as a booster in this population, which may not be the same for HPV.”

There also remains a question of how long the protection offered by HPV vaccination will last.

The ASCO statement says, “Both vaccines have a known duration of protection of at least 5 years, with ongoing study of the full duration of their effect,” and it notes that “additional research is needed to evaluate duration of protection to determine if booster doses are required.”

Dr Harper said, “Estimates of long-term effectiveness are based on antibody titers, yet there is no surrogate of protection defined by antibody titers.”

She added: “I agree that observational studies will inform the public health authorities about when a booster will be needed and whether it is needed sooner if only 2 doses are received vs later if 3 doses​ are received.”

Last, but not least, there is the issue of safety.

The ASCO statement notes that both Gardasil and Cervarix “reported excellent short- and long-term safety results in clinical trials. The most common adverse effects were mild and included injection site pain (approximately nine in 10 people) and swelling (approximately one in three), fever (approximately one in eight), headache, and fatigue (approximately one in two). These symptoms were transient and resolved spontaneously. The incidence of serious adverse effects was low and was similar to those who received placebo (aluminum-containing placebo or hepatitis A vaccine).”

However, worldwide there continue to be reports of adolescents who report chronic side effects and pain syndromes after being vaccinated against HPV. Some of these have been documented in the medical literature, with physicians reporting instances of previously healthy athletic girls becoming incapacitated with pain, fatigue, and autonomic dysfunction, and some remaining permanently disabled.

The US Food and Drug Administration and the Centers for Disease Control and Prevention have repeatedly said that HPV vaccines have an excellent safety record and that no causal associations have been found with atypical or unusual pain syndromes or autonomic dysfunction. The European authorities have investigated two chronic syndromes reported with HPV vaccination, and have said that there is no evidence to show causation.

However, Danish researchers who were among the first to report these syndromes criticized the investigation and are conducting their own study. There have also been lawsuits filed in several countries, and a class action lawsuit is now planned in Japan against the government and the vaccine manufacturers.

In an interview with Medscape Medical News, lead author on the ASCO statement, Howard H. Bailey, MD, from the University of Wisconsin Carbone Cancer Center, Madison, said that the concerns over safety should not be dismissed and should be studied further.

These issues need to be studied further, even if the authorities say that the vaccines are safe, he emphasized. These reports of girls becoming very ill, having pain syndrome and weakness, should not be diminished, he said, adding: “We can’t just ignore these reports…if there is risk involved, then that needs to be sorted out better.”

However, there is always a possibility that the syndromes and side effects that have been reported “have nothing to do with the vaccine,” Dr Bailey commented, citing the case of now-discredited theory linking autism to the pediatric vaccine for measles, mumps, and rubella.

There may be other explanations for the symptoms that are reported, or it could be that the symptoms/syndrome would have developed in the individual, anyway, but the vaccination precipitated it sooner, he suggested.

Dr Bailey noted that across the United States physicians are very sensitive to the fact that rates of pediatric vaccination have gone down because of the link that had been made to autism, subsequently shown to be false. Even though science eventually showed no link between the vaccine and autism, public confidence in the vaccine was damaged.

“When a person’s life has been devastated by an illness, that is very important, but if it turns out that the illness is not related to the vaccine, and in the meantime, the concerns over safety have stopped thousands of young people from being vaccinated….”well, eventually this will mean that there are more people who die from cancer, he said.

“I would be very reluctant right now to shut down the goals of vaccination over what has been reported, because the bottom line is that we have a tremendous problem with the rising incidence of HPV related cancers including in men as well as women when it comes to oropharyngeal cancers here in the States,” he added.

“The data, at least in my opinion, are so strong that HPV vaccination if it’s done in a [systematic] way will reduce the incidence of these cancers…I don’t want to stop whatever progress we are making when there is at best disagreement over whether these things are associated,” he said, although he also added that “maybe if it was my daughter, I would feel differently.”

Dr Bailey also addressed some of the other issues that had been raised about the ASCO statement, and said he agreed about the importance of screening.

“Even if vaccination does all the things we expect it to do, there is no doubt that cervical cancer screening needs to continue, and that’s a pretty standard recommendation across all of the groups,” he said. “We do not mean to diminish the importance of continued screening,” he said, but he added that screening lies in the domain of other physicians, such as primary care and gynecology, whereas this statement was targeted specifically at oncologists. “To take a step back, we are taking the view of cancer physicians, who take care of women, who are unfortunately too often dying of cervical cancer, and…we wanted to remind people that HPV vaccination can prevent this…as well as other associated cancers,” he said.

“The audience in North America has not been paying attention to this vaccination issue very much,” he continued, and “we wanted to remind oncologists and the public that at the heart of the issue is cancer prevention.

“We have this relatively easy way of preventing cancers over and above the ways that we already use,” he added.

“We wanted to remind people, especially in the oncology community, that there is this intervention out there that we think is highly, highly likely — if applied and used in a population format — will significantly reduce the number of women dying of cervical cancer, the number of men and women dying from oropharyngeal cancer, which is increasing in the US…and that was the main focus of the article,” Dr Bailey commented.

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

April, 2016|Oral Cancer News|

Call for NZ Government to fund HPV vaccine for boys

Source: www.nzherald.co.nz
Author: Martin Johnston

Throat-cancer patient Grant Munro paid for his son to be vaccinated against the sexually-transmitted HPV virus because the Government has refused.

A 58-year-old scientific expert on viruses, he is backing a campaign by doctors calling for the extension of state funding of the controversial HPV vaccine to boys. Dr Munro, whose cancer was linked to HPV infection, says it is a form of discrimination against males that the Government will only pay for girls to have the vaccine.

State medicines agency Pharmac said it had decided not to fund the Gardasil vaccine for boys at present, but it is an option for the future. Its advisory committee assigned a low priority to funding it for all males aged 11-19 and high priority for males 9-26 “who self-identify as having sex with other males”.

In Australia, the vaccine is government-funded for boys and girls. Gardasil can protect against four strains of HPV – human papilloma virus – that can cause pre-cancerous lesions in the genital tract and mouth, and genital warts. It has been offered to New Zealand girls partly to help reduce cervical cancer.

Rates of throat-related cancers have risen sharply since the 1980s and HPV, from oral sex, is thought to be the cause. The actor Michael Douglas was treated for tongue cancer caused by HPV and has spoken of the link between HPV and performing oral sex.

After Dr Munro was treated for a tonsil tumour that contained evidence of HPV, he paid $450 for his 14-year-old son to receive the three injections of vaccine.

In 2013, Dr Munro had delayed seeking medical help for throat problems he put down to hayfever – “a sort of sore throat, sometimes a little difficulty swallowing, sometimes a little blood in the saliva, snoring. I now also remember having ferocious night sweats.”

His GP sent him to a throat surgeon who, within days, removed his left tonsil. Chemotherapy and radiotherapy followed. He thought he was in remission from cancer, until last week when a PET scan showed up a “highly suspicious” lymph node in his neck. Now he has been referred to a cancer specialist to discuss his options.

Dr Munro is a patient-representative of the HPV project, a group of specialists and patients, which promotes vaccination against the virus, and he will speak at its Auckland University event this week.

Surgeons report seeing many more cases of cancer of the tonsils, the base of the tongue, the back of the throat and the soft palate – together called oropharyngeal cancers.

From around 1990 to 2010, the per-capita rate of these cancers in New Zealand men more than doubled, to more than 4 per 100,000. The female rate rose significantly too, but is much lower than for men, at around 1 per 100,000 each year.

“Men are more exposed to the virus,” said Auckland ear, nose and throat surgeon Dr John Chaplin, “because the route of exposure is understood to be oral sex and that the concentration of virus in the female genital tract is much higher than in the male tract”.

“Previously all these tumours related to smoking and alcohol exposure and the rates of those are going down.”

Patients with HPV-linked throat tumours have better survival prospects, at around a 90 per cent chance of still being alive without any progression of the disease two years after diagnosis, but the side effects of treatment can be severe.

Waikato ENT doctors Theresa Muwanga-Magoye and Julian White have said that in the US, the male oropharyngeal cancer rate exceeds the cervical cancer rate, and that reasons for this may include HPV vaccination of girls, cervical screening of women, smoking, alcohol and other lifestyle factors.

Dr White said that because the rate of male oropharyngeal cancer in New Zealand had risen significantly closer to the cervical cancer rate, “it should be seen as just as important as cervical cancer when discussing HPV-related cancers and their prevention and treatment”.

Gayle Dickson, of the Gardasil Awareness NZ group, has started an online petition calling for the suspension of Gardasil vaccination until various overseas actions, including legal cases against the vaccine supplier, “have been completely carefully analysed”. The petition has more than 1500 supporters.

Internationally and in New Zealand, deaths and serious illnesses have been blamed on the vaccine.

However, the NZ Health Ministry says the vaccine has a “good safety profile”.

More than 200,000 New Zealand females have received the vaccine since 2008. By last June, 568 cases of adverse reactions had been reported following vaccination, including 41 considered serious.

The ministry, citing overseas authorities and New Zealand’s Medicines Adverse Reactions Committee, says they have found “no association between HPV immunisations and a range of health conditions including chronic fatigue syndrome, auto-immune conditions, multiple sclerosis, complex regional pain syndrome, postural orthostatic tachycardia syndrome and sudden death”.

March, 2016|Oral Cancer News|

HPV rates down, CDC credits vaccine

Source: www.thv11.com
Author: Winnie Wright

Researchers say the rates of a cancer causing virus are on the decline thanks to vaccinations. In recent years, vaccinations have become a hot-button issue for parents and the HPV vaccine was no exception.

When the CDC began recommending the Human papillomavirus vaccine in 2006, there was a lot of push back from parents. A new study from the CDC says the rates of HPV infection are down 63 percent among girls ages 14 to 19 in the last decade and it credits the HPV vaccination.

The vaccine was very controversial when it hit the main stream 10 years ago, and THV11 wanted to know, have those findings changed parents’ minds about the vaccination?

“I think there was a great fear that the HPV Vaccine was some sort of signal to adolescent girls that sex was safe. And that there would be an increase in sexual activity and promiscuity, and in fact, that’s not happened. We’ve seen sort of the opposite,” explained Dr. Gary Wheeler, CMO for the Arkansas Department of Health.

HPV is most commonly spread through sex. According to the CDC, an estimated 79 million females aged 14-59 are infected with HPV. 14 million new infections are reported in the U.S. each year.

When Gardasil, the HPV vaccine, was introduced in 2006, it was a hard pill for many parents to swallow. The vaccine is especially encouraged for children under the age of 12, because it’s most effective the younger you are. Parents didn’t want to think of their kids as being sexually active at that age.

“I mean, of course nobody likes to think ‘my child is going to be sexually active’, but life happens and just sticking your head in the sand and pretending like it’s never ever going to happen, to me is just somewhat foolish’,” said Kate Bueche, a pro-HPV Vaccine parent.

According to Cancer.gov, virtually all cases of cervical cancer are caused by HPV.

For Bueche, the subject hits close to home. She survived early stages of cervical cancer and had her daughter vaccinated for HPV, in hopes that she won’t have to go through that same ordeal.

“You get the flu vaccine and you may still get the flu, but why not go ahead and get the vaccine and cut your chances for it.”

But not all parents agree. We asked our THV11 Facebook friends if the CDC’s recent findings changed their opinions of the HPV vaccine. One mother said: “Not anymore. My daughter had the shot and she had a seizure right after.” Another mother said: “Not after reviewing the newest reports of side effects. “One mother even got the shot for her son. She said: “My son took the shots without any adverse side effects. If I had to make the choice again, I would have him take it again.”

Dr. Wheeler says vaccinating men is the next step in lowering the number of HPV infections. Most men who get HPV never develop symptoms, but they can still spread the infection.

“Males are at risk for cancer. They can have HPV-associated genital cancer, and also oral cancers because of sexual practices that would lead to HPV infection.”

The CDC now recommends the HPV vaccine for boys beginning at 11-years-old. There are also talks about including the HPV vaccine in infant vaccines, or even making it mandatory.

March, 2016|Oral Cancer News|

Study: HPV vaccine reduces HPV incidence in teenage girls

Source: www.upi.com
Author: Stephen Feller
 
Study-HPV-vaccine-reduces-HPV-incidence-in-teenage-girlsJust over half of girls have received the HPV vaccination, but a new CDC study shows it has significantly reduced prevalence of the cancer-causing STI among females who have received the vaccine when compared with those who have not. Photo by Adam Gregor/Shutterstock

 

WASHINGTON, Feb. 22 (UPI) — The prevalence of human papillomavirus infection among teenage and young adult women is down nearly two-thirds since the U.S. Centers for Disease Control and Prevention started recommending vaccine in 2006, according to a new study.

The study is the first to show a drop in prevalence among women in their 20s, and continues to show decreases seen in smaller studies during the last few years, but researchers say the effect could be much stronger.

The vaccine is recommended by the CDC and other organizations for girls and boys starting at age 11, experts say, in order to protect children from HPV before they become sexually active and can become infected.

Concerns that the vaccine would influence teens’ sexual practices have also been unfounded, as research has shown the vaccine does not make children more likely to engage in risky sexual behavior, based on a the lack of an increase in other STI incidence among vaccinated girls.

“It’s just like putting on your seatbelt before turning on the car,” Dr. Alix Casler, medical director of pediatrics for Orlando Health, told UPI. She suggests separating the adolescents’ eventual discovery of sex from the effort to prevent life-threatening diseases.

Recommendations for the HPV vaccine — Cervarix, Gardasil and Gardasil 9 — have been expanded to boys, because of the wide range of cancers for which HPV increases risk, including cervical, anal, head and neck cancer, though a 2015 study showed vaccination rates remain relatively low, with just 57 percent of eligible girls and 35 percent of boys vaccinated.

“We are continuing to see decreases in the HPV types that are targeted by the vaccine,” Dr. Lauri Markowitz, a medical epidemiologist at the CDC, told CBS News. “We have seen declines in genital warts [caused by HPV] already. The next thing we expect to see is a decline in pre-cancers, then later on declines in cancer.”

For the study, published in the journal Pediatrics, used survey information collected as part of the National Health and Nutrition Examination Survey between 2003 and 2006 and between 2009 and 2012 on females between the ages of 14 and 34.

The researchers compared prevalence of HPV between the pre-vaccine group before 2006 and post-vaccine group after the vaccine was introduced, finding HPV prevalence declined by 64 percent, from 11.5 percent to 4.3 percent, in girls between age 14 and 19, and by 34 percent, from 18.5 percent to 12.1 percent, among women age 20 to 24.

Among women aged 14 to 24, the prevalence of HPV among vaccinated women, at 2.1 percent, was also significantly lower than the 16.9 percent of unvaccinated women with the STI.

The research is based on the 4vHPV vaccine, which protects against the four most common forms, though the 9vHPV vaccine was approved by the FDA for use to prevent more forms of HPV.

Casler said data in the next several years is likely to show continuing decreases in HPV prevalence as more adolescents receive the vaccine, however some pediatricians are hesitant because of personal bias. Many parents also are nervous the vaccine will act as a message to teens that sex is OK, making some parents want to delay vaccination until their adolescents are sexually active — by which time it may be too late.

“The infection is sexually transmitted, but that doesn’t need to be part of the conversation,” Dr. Joseph A. Bocchini, a pediatric infectious disease specialist at Louisiana State University, told the New York Times. “If a parent is concerned, physicians should be prepared to talk about it. But we don’t really discuss how people become infected with every vaccine-preventable disease.”

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

February, 2016|Oral Cancer News|

Cancer Centers urge increase in HPV vaccinations

Source: www.wsj.com
Author: Ron Winslow

The top cancer centers in the U.S. jointly called for an increase in vaccination against the human papilloma virus, or HPV, saying low uptake of the three-shot regimens amounts to a “public health threat” and a major missed opportunity to prevent a variety of potentially lethal malignancies.

In a statement issued Wednesday, all 69 of the nation’s National Cancer Institute-designated centers urged parents and health-care providers to “protect the health of our children” by taking steps to have all boys and girls complete the three-dose vaccination by their 13th birthdays, as recommended by federal guidelines, or as soon as possible in children between 13 and 17 years old.

Currently, just 40% of girls and 21% of boys in the U.S. have received the vaccine, according to a report last year by the U.S. Centers for Disease Control and Prevention. The U.S. Department of Health and Human Services Healthy People 2020 initiative has set the goal for HPV vaccination for both boys and girls at 80%.

The first HPV vaccine, Merck & Co.’s Gardasil, was approved by the U.S. Food and Drug Administration in 2006. A second version of Gardasil and GlaxoSmithKline PLC’s Cervarix are now on the market. Neither company was involved in development of the cancer centers’ statement, those involved in the effort said.

The CDC estimates that 79 million Americans are infected with HPV, a sexually transmitted virus that causes 14 million new infections each year. While the body’s immune system fights off the virus in most cases, certain high-risk strains are responsible for cancers of the cervix, anus, and various genital sites as well as a growing rate of oropharyngeal or throat cancers, all told affecting about 27,000 patients a year in the U.S.

“We have everything we need to eliminate at least cervix cancer and many other HPV-related cancers and we haven’t taken advantage in this country,” said Lois Ramondetta, professor of gynecologic oncology at University of Texas MD Anderson Cancer Center, Houston. She said she is already seeing patients in their 20s and 30s who have developed precursors to cancer that she says could have been prevented had they been vaccinated.

The U.S. rates stand in contrast to those in some other countries, including Australia, where 75% of boys and girls are fully vaccinated; the U.K., with a rate between 84% and 92%;, and Rwanda, where 93% of children are in compliance with World Health Organization recommendations for HPV shots.

When the first vaccine hit the market a decade ago, it was targeted at girls in hopes of preventing cervix cancer. But the rising incidence of HPV-related head and neck cancers, especially among men, in recent years, led to including boys in the prevention effort as well.

Factors responsible for the low U.S. rates include resistance among antivaccination groups, a “misunderstanding” that vaccination might promote sexual activity and a reluctance of pediatricians to discuss prevention of a sexually transmitted virus for children, said Sarah Krobin, acting chief of health systems and interventions research at the NCI. Research shows no link between the vaccine and sexual activity, she said. Early administration is required because “for the vaccine to work, the child shouldn’t have yet had sex,” she said.

The three-dose vaccine can cost around $500, including doctor fees, according to the American Cancer Society, though it is often covered by insurance. It is available free to beneficiaries of the Medicaid program, a key reason why children in low-income families are more likely to have been fully vaccinated than those from wealthier families, Dr. Krobin said.

The statement emerged from a meeting of HPV experts from many of the cancer centers at MD Anderson in November, which in turn resulted from a special NCI initiative among 18 designated centers to study factors affecting HPV vaccination rates in their local markets. NCI designation recognizes centers for excellence in cancer research and care. The NCI wasn’t involved in drafting the document.

The statement urges physicians and other providers “to be advocates for cancer prevention by strongly recommending the vaccine for children. It encourages men up to age 21 and women up to 26 to get vaccinated if they missed the younger age targets.

“This is really a sentinel event to have all the centers get together and say we’re really not doing the best for our kids,” said Dr. Ramondetta, who is also co-director of MD Anderson’s HPV-related Moon Shot initiative. “We feel this is an effective, safe and long-lasting vaccine that we’re not taking advantage of.”

January, 2016|Oral Cancer News|

Throat and tongue cancers linked to sexually transmitted virus on the rise

Source: www.theage.com.au
Author: Julia Medew

The sexual revolution is producing a new wave of throat and tongue cancers among middle-aged people, who are falling victim to a rare side effect of the “common cold of sexually transmitted infections”.

A growing number of Australians with oropharyngeal cancer are testing positive to the human papillomavirus (HPV), suggesting it has caused their disease rather than smoking or heavy drinking – factors responsible for many head and neck cancers in the past. Oropharyngeal cancer is usually found in the back third of the tongue or the tonsils. In 2014, about 125 Victorians were diagnosed with it. Most were men.

An Australian study of 515 patients diagnosed with the condition between 1987 and 2010 found that the proportion of people with an HPV-related diagnosis increased from 20 per cent between 1987 and 1995 to 64 per cent between 2006 and 2010. Over the same period, the proportion of people diagnosed with throat cancer who had never smoked increased from 19 per cent to 34 per cent, suggesting HPV may overtake smoking and drinking as a cause of the cancer in future.

American doctors say more oral sex following the sexual revolution of the 1960s probably spread HPV to more people’s mouths and throats. Actor Michael Douglas said he believed oral sex was to blame for his HPV-related throat cancer in 2013. But Dr Matthew Magarey​, an ear nose and throat surgeon at Epworth and Peter MacCallum hospitals in Melbourne, said while HPV-related throat cancers were occurring in more people aged 40 to 60, it should not necessarily be associated with oral sex because scientists believe HPV may be transmitted through kissing or simple hand to mouth contact as well.

Up to 80 per cent of the adult population is thought to have had some sort of HPV infection during their life (there are more than 100 strains) and most of them will not have experience any symptoms. Many people clear the virus within months of getting it.

Dr Magarey said a tiny proportion of people will get an HPV-related cancer, such as cervical, anal, or throat cancer. He said HPV in the throat probably took 30 to 40 years to turn into a cancer in the minority of people it affects in that way. He said treatments were getting better for the cancer, which has a high survival rate if found early. Depending on the circumstances of the cancer, radiation, chemotherapy and sometimes surgery are used to treat it. While the surgery has been long and complicated in the past, Dr Magarey said a new robotic procedure available at Peter Mac and Epworth was helping surgeons remove cancers more precisely and in less time. This was reducing long-term recovery problems such as difficulty eating and drinking and swallowing.

Dr Magarey said the most common first sign of throat cancer was a lump in the neck that persists for more than two or three weeks. Symptoms can also include a sore throat that persists for more than three weeks and difficulty swallowing.

“If you have these symptoms, see your GP and get a referral to a qualified ENT surgeon who can properly examine the throat. Just looking in the mouth is not enough,” he said.

Dr Marcus Chen, a sexual health specialist with Alfred Health, said the Australian government’s HPV Gardasil vaccination program for young people will reduce such cancers in future. In the meantime, he said testing for HPV – the “common cold of sexually transmitted infections” – was not recommended because there is no way of treating the virus or preventing it from being passed on to others.

October, 2015|Oral Cancer News|

HPV vaccine now free for ‘at-risk’ boys and men under 26

Source: www.vancitybuzz.com
Author: Jill Slattery

vaccine

The government of B.C. announced this week the HPV vaccine for human papilloma virus will now be available free of charge to boys and men under age 26 who classify as ‘at-risk’.

Beginning in September, the free HPV vaccine program currently only available to young women will become available to men who have sex with males or who are “street-involved”.

“Providing the vaccine for all girls protects heterosexual boys as well, but leaves at-risk boys and young men unprotected. This change will address that gap,” said the province in a media release.

“The human papilloma virus is the most common sexually transmitted infection,” said Health Minister Terry Lake. “It can lead to serious health problems and could develop into an HPV-related cancer. Our vaccination program will help protect all young British Columbians from cancers and other diseases caused by HPV infection.”

HPV can be contracted by having sex with another person infected by the virus. According to the Centers for Disease Control and Prevention (CDC), HPV is “spread easily during anal or vaginal sex, and it can also be spread through oral sex or other close skin-to-skin touching during sex. HPV can be spread even when an infected person has no visible signs or symptoms.”

While HPV may cause little to no symptoms in some, it can lead to genital warts and certain kinds of cancer. In men, oropharyngeal cancers (cancers at the back of the throat) are the most common.

“In general, HPV is thought to be responsible for more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and more than 60% of penile cancers,” reports the CDC.

“It is clear that some men are more at risk for HPV related cancers than are others,” said Dr. Perry Kendall, B.C.’s provincial health officer. “As most of these infections are vaccine-preventable, extending B.C.’s HPV immunization program to this at-risk demographic is a cost-effective way to provide protection to the people who need it most.”

Men who have sex with other men carry a disproportionately high chance of contracting HPV.

The provincial HPV vaccine program uses the Gardasil vaccine, protecting from HPV types 16 and 18 that cause 70% of cervical cancers, 80% of anal cancers and other cancers of the mouth, throat, penis, vagina and vulva. It also protects against infection from HPV types 6 and 11 that cause about 90% of cases of genital warts.

Single Dose of HPV-16/18 Vaccine Looks to Be Sufficient

Source: www.medscape.com
Author: Jenni Laidman
 

A single dose of a vaccine against human papillomavirus (HPV) may prevent cervical cancer as effectively as the standard three-dose regimen, researchers concluded after analyzing the combined results of two large vaccine trials. The HPV vaccine in these studies was Cervarix (GlaxoSmithKline), which is effective against HPV strains 16/18.

If randomized controlled trials ultimately support the result of this post hoc analysis, it could broaden protection against cervical cancer in areas of the world where vaccination programs are hardest to administer and where cervical cancer is disproportionately burdensome, the study authors say.

“Even if you ignore the expense, the feasibility of implementing and getting back to individuals for a second and third dose is quite challenging, especially in places where there is no infrastructure,” coauthor Cosette Wheeler, PhD, Regents Professor, Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center in Albuquerque, told Medscape Medical News.

The studies are published online June 10 in the Lancet Oncology.

The possibility of a single-dose HPV vaccine is “a huge public health win,” coauthor Aimée R. Kreimer, PhD, Investigator, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, told Medscape Medical News. “Even if one dose protects only against HPV types included in the vaccine formulation, if we vaccinated most girls, we would have the chance to reduce cervical cancer by around 75%.”

That’s the exciting part, Dr Wheeler added. “If we’re able to achieve success with one dose, or frankly even with two doses, that makes the possibility for worldwide prevention much greater.”

HPV type 16 is the leading cause of cervical cancer, responsible for about 50% of all cases, and HPV 18 is the second-largest cause, at 20%.The authors note that this research was carried out with Cervarix, and it is unclear whether the results would also apply to the other HPV vaccine that is available, Gardasil (Merck & Co.), which is active against several more HPV strains and is the product that is commonly used in the United States. Whether results of this trial have any bearing on Gardasil will depend on what’s driving the strong immune response to Cervarix, the authors suggest. Cervarix carries a proprietary adjuvant, which may be responsible for the immune response.

Surprise Over Efficacy Findings

The idea of the current post hoc analysis arose from results in the large randomized controlled Costa Rica Vaccine Trial, in which about 20% of participants received fewer than three doses of HPV-16/18 vaccine. “We were surprised to observe that efficacy was the same regardless of the number of doses received,” Dr Kreimer told Medscape Medical News.

That led to the post hoc analysis of the immunization results from the Costa Rica Vaccine Trial combined with results from the only other large phase 3, double-blind, randomized trial of HPV-16/18, for a total of more than 14,000 participants, ages 15 to 25 years, including about 7000 control subjects. The second trial, called PATRICIA (Papilloma Trial Against Cancer in Young Adults), took place in 14 countries. The analysis found that 4 years after vaccination, women who received the required three vaccine doses and women who received fewer than three doses — usually due to pregnancy or a colposcopy referral — were equally protected against HPV-16/18. Further, the analysis showed a potential benefit of cross-protection against closely related HPV strains 31/35/45 among women whose two doses were 6 months apart — a benefit previously seen only with three doses.

Four-year vaccine efficacy against HPV-16/18 in the combined analysis was 77% for the 13,296 (6634 case, 6662 control) women in the three-dose group, 76% for the 549 (273 case, 276 control) women in the two-dose group, and 85.7% for the 238 (138 case, 100 control) women in the single-dose group. Efficacy against the closely related HPV-31/33/35 was 59.7% for three doses, 37.7% for two doses, and 36.6% for one dose. When data for the two doses were analyzed according to dosing regimen, the cross-protective efficacy was 10.1% for those who received their second dose 1 month after the first and 68.1% for those who received the second dose at 6 months.

Antibody concentrations for two doses given 6 months apart were very close to concentrations for three doses, the research showed. One-dose vaccination titers at 6 to 48 months were lower than those for two or three doses, “but the titers were stable and several times higher than those identified for natural immunity,” the researchers write. “We can now infer that these lower, vaccine-induced antibody titers provide as strong HPV prevention as the titers from two or three doses, at least in the short term.”

Just how long these vaccines will provide protection still needs to be determined. “We know with three doses we can see the protection going out toward 10 years, and we hope that maybe the protection is lifelong,” commented Dr Wheeler. “That does not mean that we know we will never need a booster. And that doesn’t mean if we give less than three doses that we know about the longevity or durability of that protection. So that’s another piece of the puzzle.”

Although these results cannot be applied to Gardasil, Dr Wheeler notes that studies looking at Gardisil antibody titers after two doses look promising.

In an accompanying comment, Julia M.L. Brotherton, Medical Director, National HPV Vaccination Program Register, VCS Registries, East Melbourne, Victoria, Australia, commented: “These data suggest that one dose of bivalent HPV vaccine might be adequate to protect against HPV-16 and HPV-18 persistent infections and, therefore, probably disease. HPV-16 and HPV-18 cause more than 70% of cervical cancers and the vast majority of HPV-related cancers at other anatomic sites. If this finding is confirmed, it opens up a great opportunity to extend the reach of protection using HPV vaccines to more people than we would have previously thought possible.”

Four authors of the study are GSK employees and own shares and stock options in the company. Other researchers had financial or advisory relationships GSK, Roche Molecular Systems, Merck, and Sanofi Pasteur MSD. Dr Brotherton notes that she has been an investigator for investigator-initiated HPV epidemiology research grants partially funded by bioCSL/Merck, but this did not involve financial compensation.

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

HPV Vaccine Linked to Less-Risky Behavior

Source: torontosun.com
Author: Roxanne Nelson, Reuters
 

Contrary to concerns that getting vaccinated against human papilloma virus (HPV) will lead young people to have more or riskier sex, a new study in England finds less risky behaviour among young women who got the HPV vaccine.

“To my knowledge no studies have shown that HPV vaccination increases risky sexual behavior among young women and some of these studies have shown this (less risky behaviour) is also the case outside of the UK,” said Dr. Laura Sadler of the University of Manchester, who led the study.

It’s possible that getting vaccinated led to better education about sexual health, Sadler and her colleagues write in the Journal of Family Planning and Reproductive Health Care.

Sadler and other experts say it’s also possible that young women who are already less likely to take risks are the ones who are more likely to get vaccinated.

HPV is one of the most common sexually transmitted infections and causes the majority of cervical cancers. The virus has also been linked to anal and throat cancers. Two vaccines, Cervarix and Gardasil, are now available that protect against strains of HPV that cause most cervical cancers.

Even though public health officials recommend that girls and young women be vaccinated against HPV, some parents have hesitated, fearing that it could encourage sexual activity or unsafe sex.

For their study, Sadler’s team reviewed the medical records of 363 women born in 1990 or later who attended an English clinic. Almost two-thirds of the young women in the group had received at least one dose of the vaccine. Full vaccination requires three vaccine shots.

The researchers compared the womens’ histories of behaviours that are risky in themselves or tend to be linked to risky sexual behaviour, such as not using condoms, having sex for the first time when they were 15 or younger, having six or more sexual partners and drinking alcohol two or more times a week.

They found five variables related to sexual behaviour that were significantly different between women who had been vaccinated and those who hadn’t.

Women who were not vaccinated were more likely to have had three sex partners in the last six months, to have attended the clinic with symptoms of a sexually transmitted disease, to have had anal intercourse with their last sexual contact and to have tested positive for Chlamydia (a common sexually transmitted infection) at their clinic visit.

Being vaccinated, in contrast, was associated with less-risky behaviours, such as using condoms.

“In this study, the lower prevalence of some risk outcomes among vaccinated women relative to unvaccinated women may be related to underlying differences in preventive care seeking and preventive health behaviors,” said Robert A. Bednarczyk, an assistant professor at the Rollins School of Public Health at Emory University, and who was not involved in the study.

“The women in our study were mainly from the catch-up vaccine program – older teens – and as in the other studies, it shows that among this group, vaccination was taken up by those demonstrating other types of preventive or less risky behaviors,” Sadler told Reuters Health by email.

While the findings are encouraging, and consistent with other research demonstrating that HPV vaccination does not lead to riskier behaviors, the study does not demonstrate that vaccination causes less risky behaviors, said Dr. Jessica Kahn, a professor of pediatrics at Cincinnati Children’s Hospital Medical Center.

“One explanation for the findings is that girls who are vaccinated receive education about sexual health and prevention which decreases riskier behaviors,” Kahn said in an email.

Another explanation is that girls who practice healthier and less risky behaviors are more likely to receive the vaccine, she noted. “Preventive health behaviors tend to cluster, so it makes sense that girls who practice safer behaviors are more likely to be vaccinated.”

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
February, 2015|Oral Cancer News|