genital warts

Cancer-Preventing Vaccines Given To Less Than Half Of US Kids

Author: Carrie Feibel

U.S. regulators approved a vaccine to protect against the human papilloma virus (HPV) in 2006, but cancer experts say misconceptions and stigma continue to hamper acceptance by both doctors and parents.

Eighty percent of Americans are exposed to the human papilloma virus in their lifetimes. Some strains of HPV can cause genital warts, but most people experience no symptoms and clear the virus from their systems within a year or two. But for an unlucky minority, the virus causes damage that, years later, leads to cervical cancer, throat cancer, and other types.

Researchers at MD Anderson are frustrated that ten years after the first vaccine arrived on the market, only 42 percent of U.S. girls, and 28 percent of boys, are getting the three-shot series.

The series can be given to girls and boys between the ages of 9 and 26, but the immune response is strongest at younger ages, before sexual activity begins.

n 2007, then-Texas governor Rick Perry proposed making the HPV vaccine mandatory for all preteen girls.  At the time, the vaccine was only approved and marketed for girls.

Dr. Lois Ramondetta, a cervical cancer specialist at MD Anderson, remembers the outcry.

“A lot of people felt that was the right idea, but the wrong way to go about it. Nobody really likes being told what to do, especially in Texas,” Ramondetta said. “I think there was a lot of backlash.”

Eventually, the legislature rejected Perry’s plan, even though it included an opt-out provision. Ramondetta said too many politicians focused on the fact that HPV is sexually transmitted. That had the unfortunate effect of skewing the conversation away from health care and into debates about morality and sexuality. She said the best and most accurate way to discuss the vaccine is to describe it as something that can prevent illness and death.

“I try to remove the whole concept of sexuality,” Ramondetta said. “When you’re talking about an infection that infects 80 percent of people, you’re really talking about something that is part of the human condition. Kind of like, it’s important to wash your hands because staph and strep are on all of us.”

Today, only Virginia, Rhode Island and Washington, D.C. mandate HPV vaccines.

“Our vaccination rates are really terrible right now,” Ramondetta said.

In Texas, only 41 percent of girls get all three of the required shots, and only 24 percent of boys.


Kara Million of League City finds those numbers upsetting.  Million survived two rounds of treatment for cervical cancer.

“Even if you had a chance that your kid could have any kind of cancer, and you could have given them two shots or three shots for it? To me, it’s a no-brainer,” Million said.

Million always got regular Pap tests. But she missed one appointment during a busy time following the birth of her second child. When she went back, it had been only 15 months since her last Pap test. But the doctor found cervical cancer, and it had already progressed to stage 3.

“That was a huge surprise,” Million recalled.

Million had chemotherapy and radiation at MD Anderson. But a year later the cancer returned.

The next step was surgery, a radical procedure called a total pelvic exenteration.

Million and her husband looked it up online.

“When I was reading it, I was just, like, ‘this is so barbaric, there is no way they are still doing this in this day and age,’” Million said. “‘For certain, in 2010 we have better surgeries to do than this.’”

But there weren’t better surgeries. This was her only option.

“I had a total hysterectomy; they pulled all the reproductive system out,” she explained. “They take your bladder out, they take part of your rectum, they take part of your colon, they take your vagina, all of that in your pelvic area comes out.”

The surgery took 13 hours, and left her with a permanent colostomy bag and urostomy bag.

“At that point, with two kids at that age – I think they were one-and-a-half and three – there’s no option. I’m a mom, so I’m going to do whatever it takes so they can have their mom.”

Most women survive cervical cancer if it’s caught early enough. But Million’s cancer was diagnosed at a later stage, where only a third of women make it past five years. She has already made it past that five-year anniversary, and she’s not wasting any time.

She now volunteers as a peer counselor at MD Anderson to other cervical cancer patients, and she urges parents to vaccinate their kids.

“If most of cervical cancer is caused by HPV, and now we have something that can help prevent what I went through, and what my friends went through, and the friends that I lost?” Million says, “I don’t understand why people don’t line up at the door to get their kids vaccinated for it.”

But Dr. Ramondetta said parents can’t consent to the vaccination if pediatricians or family doctors don’t offer it. And they’re not offering it nearly enough, she said.

Some doctors don’t know how to broach the topic, fearing it will lead to a difficult conversation about sexual behavior. Some mistakenly think boys don’t need it, although they do – not only to protect their partners from HPV, but to protect themselves against oropharyngeal and anal cancers, which are also caused by HPV.  Ramondetta added that some doctors incorrectly assume that giving the vaccine will promote promiscuity.

Ramondetta says extensive research actually shows it doesn’t.

“There should be this understanding of an ethical responsibility. That this is part of cancer screening and prevention, just like recommending mammograms and colonoscopies.”

In Texas, only 41 percent of girls get all three of the required shots, and only 24 percent of boys.

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

September, 2016|Oral Cancer News|

Why men need to start caring about HPV

Author: Sarah Jacoby

The human papillomavirus (HPV) is one of very few STIs that we have a vaccine for. And — bonus! — that vaccine prevents cancer. But a report from the U.S. Centers for Disease Control and Prevention (CDC) released last month indicated that although we’ve made some improvements in the vaccination rates, they still aren’t where we want them — especially for boys. This is despite the fact that pretty much everyone who’s sexually active will get the virus at some point and men are at risk for their own unique set of HPV-related health consequences.

Let’s start with the basics: “HPV is a virus that’s sexually transmitted, but it’s incredibly common,” explains Kathleen Schmeler, MD, of the University of Texas MD Anderson Cancer Center. Up to 80% of people get it at some point in their lives, she says, which is why some doctors refer to it as the “common cold” of STIs. For most people, the virus goes away on its own, without causing symptoms or needing treatment. Some people develop genital warts that can be treated with medication. But in some rare instances, the virus can go on to cause more serious health issues — including some types of cancer.

“The problem is we don’t know who’s going to clear it and who won’t,” Dr. Schmeler says. Most notably, HPV is known to cause cervical cancer. In fact, nearly all cases of cervical cancer are attributed to HPV. In 2013, the most recent year with available data, almost 12,000 women were diagnosed with cervical cancer in the U.S. and about 4,200 women died from the disease.

In addition to the risks of passing on the virus to their partners, men may face other consequences of HPV. Some types of HPV-related cancer, including throat cancer, are actually more common among men than women. “The rates for that are increasing significantly,” says Dr. Schmeler. “That’s been a huge deal recently.”

However, there is currently no accepted test for HPV-related cancers in men. Women are recommended to get a routine Pap screening, which can detect abnormal cervical cells that may be a result of an HPV infection. But similar screening for anal, penile, and throat cancers in men isn’t recommended.

“The common story that we hear is that [men are] shaving and they find a big lump in their neck,” says Dr. Schmeler. “But by then, it’s advanced disease because it’s spread to the lymph nodes.”

So although Dr. Schmeler’s team is working to find one, there’s no early or precancerous-stage test to detect HPV-related cancer in men.

Because they can’t be tested, it’s that much more important for boys to get the vaccine. Currently, the vaccine is recommended for boys and girls ages 11 to 12 to make sure they get it before they come in contact with the virus. But according to that August report, only about 50% of boys and 63% of girls actually got the vaccine in 2015. While the rates are improving quickly, they’re still nowhere near where they should be.

So why is it that the already-low vaccination rate is even lower for boys than girls? Part of that appears to be due to the way the vaccine was originally marketed: “When it first came out [in 2006], it was recommended only for girls because the primary focus was cervical cancer,” explains Dr. Schmeler. Since then, the CDC has expanded its recommendations to include boys, too. Parents may simply be unaware of the update.

According to research from the CDC, another big problem is that parents don’t believe their kids are (or are about to be) sexually active at that age. Doctors may be reluctant to push the issue or, in some cases, even bring it up.

“Everyone’s so obsessed with the fact that it’s a sexually transmitted disease,” says Dr. Schmeler. “[And in the process, we’re] forgetting that, with this vaccine, we can prevent cancer.”

It may be too late for adult men to get the most out of vaccination — it’s recommended that everyone get the vaccine by age 26. But for it to be it’s most effective, you should ideally get the vaccine before you’re exposed to the virus. And if you’ve already had multiple sexual partners, it’s likely that you’ve already been exposed.

But that doesn’t mean men don’t have to worry about this. In addition to the risk of spreading the virus to their partners, men are at risk for various cancers, as well. The bottom line is that HPV affects everyone, so we should all be equally sharing the burden of stopping the virus — and its associated cancers.

September, 2016|Oral Cancer News|

HPV vaccines: Research on safety, racial disparities in vaccination rates and male participation

Author: staff

Since it became available in the United States in 2006, the Human Papillomavirus (HPV) vaccine has been a source of debate, with proponents lauding it as a substantial gain in the fight against cancer, and opponents concerned with its implications for sexual activity among youth. With the U.S. Food and Drug Administration’s recent approval of Gardasil-9 — a vaccine that protects against nine of the most common strains of HPV that account for approximately 90 percent of cervical, vulvar, vaginal and anal cancers — there is both a renewed interest and concern that calls for a nuanced and comprehensive review of the science.

HPV is the most common sexually transmitted infection in the United States, with nearly all sexually active men and women believed to contract at least one form of it during their lifetime. According to the U.S. Centers for Disease Control and Prevention (CDC), an estimated 79 million Americans have HPV, and about 14 million become newly infected annually. While most infections clear the body within two years, some can persist and result in genital warts, cervical cancer or other types of cancers in men and women. Of the many HPV strains that exist, HPV types 16 and 18 have been identified as high risk, accounting for about 70 percent of all cervical cancer, as well as a large proportion of other HPV-related cancers.

While cervical cancer was previously a leading cause of death among women in the U.S., death rates declined substantially after the introduction of the Pap test in the 1950s. Nevertheless, according to the CDC, more than 12,000 women in the U.S. are diagnosed with cervical cancer each year, and more than 4,000 die from it. Public discourse around HPV tends to focus on the health of women because they disproportionately bear the burden of its health consequences. However, men also face substantial risk, particularly as it relates to oral and anal cancers.

Although screening procedures are in place for early detection of cervical cancer, there are no comparable strategies to identify HPV-related cancer in its early stages for men. Consequently, the administration of a vaccine to prevent infection and transmission presents an important line of protection. Currently, the HPV vaccine is administered over a course of three injections, which must be completed within six months to confer full protection. A 2012 review of clinical trials of HPV vaccines shows that vaccines designed to protect against two or four of the most common strains have very high efficacy rates, ranging between 90 percent and 100 percent. For that reason, large public health efforts have focused on improving vaccination rates before boys and girls become sexually active.

Today, both the CDC and American Academy of Pediatrics recommend routine vaccination against HPV for all 11-year-olds and 12-year-olds in the U.S. Although the early age of vaccination has been a source of public debate, medical recommendations are based partly on evidence that shows that antibody responses are highest during this age period. Also, it is a good idea to vaccinate adolescents before they come into contact with the virus as the vaccine is not effective against HPV types that already have been acquired. Despite such recommendations from medical professionals, vaccination completion rates remain low — 40 percent for girls and 20 percent for boys in 2014. That is substantially lower than the vaccination rate for tetanus, diphtheria, and pertussis and the vaccination rate for meningitis among members of the same age group.

Below are a series of studies that will help journalists understand and explain this important health topic from a variety of angles, including vaccine safety and racial and gender disparities in vaccination rates. Beat reporters can find related reports and statistics from organizations such as the CDC, National Cancer Institute and World Health Organization.


Barriers to vaccination

“Reasons for Not Vaccinating Adolescents: National Immunization Survey of Teens, 2008-2010”
Darden, P.M.; et al. Pediatrics, April 2013, Vol. 131. doi: 10.1542/peds.2012-2384.

Summary: Using data from the National Immunization Survey of Teens, researchers found that parental intentions to not vaccinate for HPV increased from 39.8 percent in 2008 to 43.9 percent in 2010. The most commonly cited reasons for not vaccinating were “not recommended/needed,” “not sexually active,” and “safety concerns/side effects.” Vaccine safety concerns increased from 4.5 percent in 2008 to 16.4 percent in 2010.

“Barriers to Human Papillomavirus Vaccination Among US Adolescents: A Systematic Review of the Literature”
Holman, D.M.; et al. JAMA Pediatrics, January 2014, Vol. 168. doi: 10.1001/jamapediatrics.2013.2752.

Summary: “Health care professionals cited financial concerns and parental attitudes and concerns as barriers to providing the HPV vaccine to patients. Parents often reported needing more information before vaccinating their children. Concerns about the vaccine’s effect on sexual behavior, low perceived risk of HPV infection, social influences, irregular preventive care, and vaccine cost were also identified as potential barriers among parents.”

Vaccine safety

“Adverse Events Following Immunization in Ontario’s Female School-Based HPV Program”
Harris, T.; Williams, D.M.; Feiurek, J.; Scott, T.; Deeks, S.L. Vaccine, January 2014, Vol. 32. doi: 10.1016/j.vaccine.2014.01.004.

Summary: After a school-based HPV vaccination program was implemented among eighth grade girls in Ontario, Canada, researchers analyzed reports of adverse events following immunization over the following four years. From 2007 to 2011, nearly 700,000 HPV vaccine doses were administered and 133 confirmed cases of adverse events were reported. The most commonly reported side effects included allergic reactions (25 percent), rashes (22 percent), reactions at the injection site (20 percent), and non-specific “other events” (26 percent). Ten serious cases were identified, which included two cases of anaphylaxis, two seizures, one thrombocytopenia, and one death, which was concluded by the coroner to be due to a previously undiagnosed cardiac condition. Ultimately, the researchers conclude that the findings are in line with existing evidence on the safety profile of the HPV vaccine, and no new safety concerns were identified.

“Safety of Human Papillomavirus Vaccines: A Review”
Macartney, K.K.; Chiu, C.; Georgousakis, M.; Brotherton, J.M.L. Drug Safety, June 2013, Vol. 36. doi: 10.1007/s40264-013-0039-5.

Abstract: “Both vaccines are associated with relatively high rates of injection site reactions, particularly pain, but this is usually of short duration and resolves spontaneously. Systemic reactions have generally been mild and self-limited. Post vaccination syncope has occurred, but can be avoided with appropriate care. Serious vaccine-attributable adverse events, such as anaphylaxis, are rare, and although not recommended for use in pregnancy, abnormal pregnancy outcomes following inadvertent administration do not appear to be associated with vaccination. HPV vaccines are used in a three-dose schedule predominantly in adolescent females: as such, case reports linking vaccination with a range of new onset chronic conditions, including autoimmune diseases, have been made. However, well-conducted population-based studies show no association between HPV vaccine and a range of such conditions.”

Disparities in vaccination rates

“Racial/Ethnic and Poverty Disparities in Human Papillomavirus Vaccination Completion”
Niccolai, L.M.; Mehta, N.R.; Hadler, J.L. American Journal of Preventive Medicine, October 2011, Vol. 41. doi: 10.1016/j.amepre.2011.06.032.

Abstract: “Data from the 2008-2009 National Immunization Survey-Teen for girls aged 13-17 years who received at least one dose of HPV vaccine (n=7606) were analyzed in 2010-2011. During this 2-year period, 55 percent of adolescent girls who initiated vaccination completed the three-dose series. Completion was significantly higher in 2009 (60 percent) compared to 2008 (48 percent; p<0.001). After controlling for covariates, adolescents who were black or Hispanic were significantly less likely to complete vaccination than whites. Adolescents living below the federal poverty level were significantly less likely to complete vaccination than adolescents with household incomes >$75,000.”

“Social Inequalities in Adolescent Human Papillomavirus (HPV) Vaccination: A Test of Fundamental Cause Theory”
Polonijo, A.N.; Carpiano, R.M. Social Science & Medicine, April 2013, Vol. 82. doi: 10.1016/j.socscimed.2012.12.020.

Abstract: “Analyses of 2008, 2009, and 2010 United States National Immunization Survey-Teen data (n = 41,358) reveal disparities particularly for vaccine knowledge and receipt of a health professional recommendation. While parental knowledge is a prerequisite to adolescent vaccine uptake, low socioeconomic status (SES) and racial/ethnic minority parents have significantly lower odds of knowing about the vaccine. Receipt of a health professional’s recommendation to vaccinate is strongly associated with vaccine uptake, however the odds of receiving a recommendation are negatively associated with low SES and black racial/ethnic status.”

“Sociodemographic Differences in Human Papillomavirus Vaccine Initiation by Adolescent Males”
Agawu, A.; et al. Journal of Adolescent Health, November 2015, Vol. 57. doi: 10.1016/j.jadohealth.2015.07.002.

Summary: Researchers studied patterns of HPV vaccination among a sample of 58,757 adolescent males between the ages of 11 and 18 in a large primary care network. Results showed that African American males with private health insurance were twice as likely to initiate vaccination than White males with private insurance, while African American males on Medicaid were nearly three times more likely. Similar trends were observed among Hispanic males. The authors conclude that, “although the true mechanism underlying these differences remains unknown, potential candidates include provider recommendation patterns and differential vaccine acceptance within these groups.”

HPV vaccine and young males

“HPV Vaccination Coverage of Male Adolescents in the United States”
Lu, P.J.; et al. Pediatrics, October 2015, Vol. 136. doi: 10.1542/peds.2015-1631.

Summary: Researchers used data from the 2013 National Immunization Survey-Teen to investigate trends in HPV vaccination of adolescent boys. Findings revealed low rates of both vaccine uptake (34.6 percent) and completion (13.9 percent), however African American and Hispanic males were more likely to receive the vaccine than their White peers. In order to improve vaccination coverage, the authors conclude that a comprehensive approach is needed which includes physicians regularly assessing their patient’s vaccination status, educating doctors about current HPV vaccine recommendations as well as information on vaccine efficacy and safety, reducing costs, and improving health communication strategies to dispel misinformation about the vaccine.

“Longitudinal Predictors of Human Papillomavirus Vaccination Among a National Sample of Adolescent Males”
Reiter, P.L.; et al. American Journal of Public Health, August 2013, Vol. 103. doi: 10.2105/AJPH.2012.301189.

Abstract: “In fall 2010 and 2011, a national sample of parents with sons aged 11 to 17 years (n = 327) and their sons (n = 228) completed online surveys to identify predictors of HPV vaccination. Only 2 percent of sons had received any doses of HPV vaccine at baseline, with an increase to 8 percent by follow-up. About 55 percent of parents who had ever received a doctor’s recommendation to get their sons HPV vaccine did vaccinate between baseline and follow-up, compared with only 1 percent of parents without a recommendation. Willingness to get sons the HPV vaccine decreased from baseline to follow-up among both parents and sons.”

“Acceptability of Human Papillomavirus Vaccine for Males: A Review of the Literature”
Liddon, N.; Hood, J.; Wynn, B.A.; Markowitz, L.E. Journal of Adolescent Health, February 2010, Vol. 46. doi:10.1016/j.jadohealth.2009.11.199.

Abstract: “Among mothers of sons, support of HPV vaccination varied widely from 12 percent to 100 percent, depending on the mother’s ethnicity and type of vaccine, but was generally high for a vaccine that would protect against both genital warts and cervical cancer. Health providers’ intention to recommend HPV vaccine to male patients varied by patient age but was high (82 percent-92 percent) for older adolescent patients. A preference to vaccinate females over males was reported in a majority of studies among parents and health care providers. Messages about cervical cancer prevention for female partners did not resonate among adult males or parents. Future acceptability studies might incorporate more recent data on HPV-related disease, HPV vaccines, and cost-effectiveness data to provide more current information on vaccine acceptability.”

“Parents’ Decisions About HPV Vaccine for Sons: The Importance of Protecting Sons’ Future Female Partners”
Schuler, C.L.; DeSousa, N.S.; Coyne-Beasley, T. Journal of Community Health, October 2014, Vol. 39. doi: 10.1007/s10900-014-9859-1.

Abstract: “76 percent of parents reported vaccine decisions for sons were likely to be influenced by preventing HPV transmission from sons to their female partners. Parents likely to be influenced by female partner protection in vaccine decisions had greater intention to vaccinate sons than their counterparts (adjusted odds ratio 2.54). Because parents likely to consider female partners had increased intention to vaccinate sons, future efforts to improve vaccine uptake in boys should explore the benefits of highlighting potential female partner protection, as this concept may resonate with many parents.”

January, 2016|Oral Cancer News|

The Man’s Guide to HPV

Source: Men’s Health
By: Melaina Juntti

What men can do about HPV


What men can do about HPV

Michael Douglas caught major flak for saying oral sex gave him throat cancer. But if you’re laughing, it’s time to grow up. Oral cancers caused by the sexually transmitted human papillomavirus (HPV) have skyrocketed 225 percent in the past 15 years, with men accounting for 75 percent of all cases. The number-one culprit: HPV passed via oral sex.

It used to be that cigarettes caused most of these cancers. But since smoking rates have plummeted over the past few decades, and we’re having way more oral sex today than even our fathers’ generation, HPV has become the most common STD in the U.S. – inevitably leading to more oral cancer cases. It only takes one time going down on someone to contract HPV, and experts estimate that 80 percent of us will be exposed to the virus at some point in our lives. This STD sometimes causes genital warts, but according to the Centers for Disease Control and Prevention, that’s not very common. In most cases, HPV has no symptoms. And since no test exists to detect HPV in guys, you won’t know you have the virus until years later – if it turns into cancer.

“It’s very hard to determine when you acquired HPV,” says Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University. “It doesn’t usually come from just one sexual episode. That said, every once in a while, cancer develops within two years of when you think you acquired HPV. But most often it comes 10, 12, even 20 years later.”

Still, not all HPV cases lead to oral cancer. Far from it. So even though the rapidly rising prevalence of these cancers is scary – and nothing we should take lightly – we need to keep the actual risk in perspective. “It’s true that within the world of oral cancer, HPV-caused cases have become an epidemic,” says Brian Hill, executive director of the Oral Cancer Foundation. “They are rapidly increasing at a rate never seen before, and it’s going to get much worse by 2020. However, in the grand scope of the U.S. population, the term ‘epidemic’ is overstating the reality. Only a small percentage of sexually active people wind up with an HPV-related oral cancer. For 99 percent of those who get HPV, their immune system clears it within 12 to 24 months, and that’s that. So we have to look at the relative risk. Don’t stop having sex. That’s not an appropriate response.”

So what is the right response? To protect yourself without killing your sex life, there are HPV vaccines like Gardisil. These are proven to protect against HPV-caused anal and cervical cancers, and doctors overwhelmingly believe they also prevent oral cancers. However, the CDC recommends vaccination only for men under age 26, and most insurance plans won’t cover it for older guys. Still, that doesn’t necessarily mean you should rule out the vaccine if you’re past 26.

“The CDC’s recommendations are based on a generality,” Schaffner says. “Statistics show that most guys, by age 26, have had multiple sexual partners and have probably been exposed to HPV. But every individual is different. A guy may have been in a long-term monogamous relationship that’s ended, and now he’s reentering the social scene and going to have sex. It won’t do him any harm to get immunized. Insurance probably won’t cover the vaccine, but he can certainly pay the $300 to $400 out of pocket.”

But if you’ve had a handful of partners – and, if the stats are correct, have probably already come in contact with HPV – the decision boils down to whether you want that extra piece of mind, says Schaffner. After all, you could be one of the lucky few who’s had lots of sex but never been exposed. “It’s kind of like wearing a belt and suspenders,” he explains. “Wearing both may be unnecessary, but at least can be sure your pants won’t fall down. By getting the vaccine, you know you’ve done everything you can to protect yourself from HPV.”

Besides being immunized, which only spares you from HPV if you haven’t been exposed, you should limit your sexual partners and always use protection. But even then, condoms and dental dams aren’t surefire HPV blockers, Schaffner says, because you can get the virus from skin-to-skin contact. “HPV can be present on the penis shaft and vaginal lips, not just on mucus membranes, semen, or vaginal fluid,” he says. “Therefore, condoms – both male and female types – are very helpful, but they don’t offer complete protection, even if they’re used as directed and don’t break.”

Schaffner says gay men aren’t necessarily at less risk of oral cancer just because they’re not performing oral sex on women. It has more to do with how often a guy has sex and how many different men he’s slept with. However, the CDC says gay and bisexual men are 17 times more likely to develop anal cancer – also caused by HPV – than men who only sleep with women.

Even if you already have HPV – and don’t know it – you can take steps to decrease your chances of oral cancer. Schaffner says to stop smoking immediately and cut back on booze. “We’re not sure why, but smoking and drinking too much both increase HPV’s likelihood of developing into cancer,” he explains.

To be safe, you should also be on the lookout for early signs of oral cancer, which tend to be subtle, so guys often ignore them, says Hill. Unlike tobacco-caused oral cancers, which present in visible symptoms like white lesions or red spots on the tongue, HPV-related cancer cells love lymph tissue and the way back of your tongue. “HPV-caused oral cancers have very stealthy signs, so you really have to pay attention if you feel changes,” he says.

Here’s what to look for: “If you notice it’s become more difficult to swallow, or you’re suddenly always hoarse or have a sore throat, those are definite cancer red flags, and you need to get examined,” Hill says. “Also, if a lymph node in your neck becomes enlarged – and it’s painless – that’s a warning sign of cancer starting inside the mouth and spreading to your neck. When lymph nodes swell up from ear infections or abscessed teeth, they hurt. But these ones don’t. And if you can’t push it around, that’s a definite sign.”

Thankfully, all you dads and future fathers can help spare your sons from these health issues. Get them vaccinated long before they wind up going down on a girl in the back seat of your car. “Don’t put it off until they’re 17,” Schaffner says. “Have them immunized when they’re 11.”


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

June, 2013|OCF In The News|

HPV vaccination—reaping the rewards of the appliance of science

Date: April 18, 2013
By: Simon Barton, clinical director

National programmes could virtually eliminate certain diseases and substantially reduce costs.

The optimism generated by scientific breakthroughs often turns to disappointment when applied to the real world of clinical care. It is therefore worth celebrating the extraordinary success of Australia’s national human papillomavirus (HPV) vaccination programme, which was implemented five years ago, as reported in the linked paper by Ali and colleagues (doi:10.1136/bmj.f2032).1 This analysis of data on 85 770 new patients from six Australian sexual health clinics shows a remarkable reduction in the proportion of women under 21 years of age presenting with genital warts—from 11.5% in 2007 to 0.85% in 2011 (P<0.001). Only 13 cases of genital warts were diagnosed in women under the age of 21 across all six health clinics in 2011. Such a reduction in this distressing disease caused by a sexually transmitted virus is a major public health achievement. Furthermore, the near eradication of genital warts in young Australian women will probably have a major impact on the costs of sexual healthcare.

In 2007, Australia became one of the first countries to implement a nationally funded HPV vaccination programme for girls and young women with the quadrivalent vaccine. It started with the vaccination of girls aged 12 years in schools and a catch-up programme for girls and women aged 13-26 years. Quadrivalent vaccine protects against HPV types 6 and 11, which cause more than 90% of genital warts, in addition to HPV types 16 and 18, which cause cervical cancer. Vaccination coverage rates were exemplary, averaging almost 80% for all three doses.

Ali and colleagues also found a significant decline in the proportion of women aged 21-30 years presenting with genital warts—from 11.3% in 2007 to 3.1% in 2011 (P<0.001). As might be expected, the rate of diagnoses of genital warts in women over 30 did not drop. The proportion of men under 21 years presenting with genital warts also decreased sharply, from 12.1% in 2007 to 2.2% in 2011 (P<0.001). From 2007 to 2011, there was no significant decrease in the prevalence of genital warts in heterosexual men over 21 years or in men who have sex with men.

In the United Kingdom, policy makers chose a bivalent HPV vaccine (effective against HPV types 16 and 18) for the national vaccination programme. This was judged the best option on economic grounds—economic analyses during the tendering process found that the bivalent vaccine was substantially cheaper than the quadrivalent one. At the time, there was much debate about whether the benefits of preventing genital warts had been properly assessed, given the current high rate of new and recurrent genital warts—more than 150 000 cases a yearin the UK, which cost more than £50m (€59m; $76m) to manage. This seemingly short sighted policy decision caused consternation among experts in sexual health services. However, in September 2012, the UK national programme began to use the quadrivalent vaccine. Given Ali and colleagues’ findings, the number of young women presenting with genital warts to sexual health services should drop substantially in five to nine years’ time, reducing the workload in sexual health clinics.

What about including boys in the national vaccination programme in the UK? In 2013 the Australian government began a publicly funded HPV vaccination programme for 12-13 year old boys, with a catch-up for 14-15 year old boys. This decision was prompted by two important considerations. The first was the increasing incidence of HPV related oropharyngeal cancers in men.5 The second was the realisation that young men who have sex with men, who would not benefit from heterosexual herd immunity, would be unfairly discriminated against under a vaccination programme targeted only at girls. Ali and colleagues state that, in addition to helping prevent genital warts and anal, penile, and oropharyngeal cancers in men, “the vaccination programme is expected to increase herd immunity and provide further indirect protection to unvaccinated women.” They comment that this may lead to control, if not elimination, of the target HPV types in Australia.1

Throughout Europe, there has been regional tendering to use quadrivalent or bivalent vaccines in young women only. Doctors in sexual health would obviously favour the quadrivalent vaccine because new and recurrent genital warts are the most common sexually transmitted diseases managed in clinics.

It remains to be seen whether we will see similar dramatic reductions in HPV-16 and HPV-18 associated diseases, such as cervical cancer, vulval cancer, other anogenital cancers, and head and neck tumours as a result of national vaccination programmes. This is likely given the reported evidence for the efficacy of the vaccines. It is hoped that future vaccines will protect against other HPV types, such as types 31 and 45, which are also involved in the genesis of genital cancer. Countries should carefully explore whether it is economically feasible to vaccinate young men.

Do HPV vaccines have a role to play in treatment? It is scientifically plausible that they do, because wart virus infection and recurrence are caused by failure of immune recognition. The immunity induced by vaccination is four or five times greater than that induced by natural infection. Recent treatment studies indicate benefit.

These are exciting times in the science of HPV and the world can confidently look forward to the virtual elimination of genital warts, recurrent laryngeal papilloma, most genital cancers, and some 60% of head and neck cancers. The interruption of transmission of a major sexually transmitted infection through a public health initiative offers the prospect of substantial cost savings. Countries should consider these data seriously and act decisively.

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


April, 2013|Oral Cancer News|

Emergence of HPV 16 and sexually transmiitted oral cancer

Author: Dr. Ali by Ali Forghani

The human papilloma virus (HPV) is the second leading cause of oral cancer. HPV is certainly not a newcomer to the disease world. It is one of the most common sexually transmitted disease on the planet. As of this writing, over 120 variations of the virus have been discovered, with different strands of HPV affecting different areas of the body. Many people contract HPV daily without realizing they have a virus, as it is very possible to carry a strand while displaying no noticeable symptoms.


HPV 16 Virus

HPV is a virus that is mainly focused on the outer surface of the body, the skin, as well as the mucus secreting areas. The most noticeable effect from certain strands of the virus is the appearance of warts on the skin, mainly concentrated on the arms, legs and hands.

Condylomata acuminatum, also called genital warts, are the strands of this virus found most commonly on individuals and are generally believed to be caused by the HPV strands 6 and 11. These particular strands of HPV are very common and easily treatable.

One of the prime reasons HPV is found so commonly in the world is the ease of transmission of the virus. HPV can be spread simply by contact of the skin, with certain strands branching out to be sexually transmitted.

These particular strands are the strands that should be of the most concern today due to the discoveries being made about the HPV STD strands. HPV 16, 18, 31, and 45 are the current strands associated with cancer and can be identified by the difference in physical markers they cause. These particular strands have growths that are flat and nearly invisible to the eye as opposed to the more conventional warts people are accustomed to recognizing.

The two strands of importance here are HPV 16 and 18, as these two have been determined to be strong causes of many of the cervical cancers of the world. Recent studies have linked HPV 16 to causing oral cancer in ever rising numbers. The oral cancers linked to HPV16 develop tumors in a different set of locations than non-HPV cancers, providing an easy method of identification.

HPV16 is often seen to manifest in the back of the throat, inside the mouth, the tonsillar pillars, and the tonsils themselves. Non-HPV tumors tend to be on the anterior tongue, the floor of the mouth and the mucosa of the cheeks. HPV16 is currently being spoken of as the second primary cause of oral cancer, and likely, will soon overpass alcohol and tobacco as being the primary cause.

There are two alarming concerns with HPV 16: The age of the victims that contract the virus and the method in which it is often transmitted. Oral cancer contracted via the ingestion of alcohol and tobacco is most often associated with individuals who are well into life, often over the age of forty. These people have often been smoking or drinking for the better part of their adult lives, and the cancer has built up over many years.

HPV 16 varies from this immensely as it most often found in people in their 20s with no traces of alcohol or tobacco consumption, although there is an additive link between consumption of these and HPV 16. The ease of which HPV 16 is unknowingly transmitted lies in the fact that it is mainly transmitted by sexual contact. Remember that the virus resides on the skin, and this includes the skin of the anus, vagina and penis.

Often oral contact of these areas allows the HPV to transfer directly to the oral cavity. It is usually the case that the carrier of HPV 16 is not even aware and spreads the virus unknowingly to their partner.

April, 2013|Oral Cancer News|

Calls for teenage boys to be vaccinated against sexually transmitted virus after throat cancer cases double in UK

Author: Charles Walford

Boys must be immunised against the most common sexually transmitted virus, health experts have said. The call comes after figures revealed an alarming rise in cancer linked to oral sex in young men.

Cases of throat cancer have more than doubled to more than 1,000 a year since the mid-1990s. Previously the figure had been stable for many years. More than 70 per cent of cases are caused by human papilloma virus, compared with less than a third a decade ago.

HPV, which can be transmitted during sex and open-mouth kissing, is the main cause of cervical cancer in women, with almost 3,000 women a year in the UK affected.

Since 2008 all girls aged 12 to 13 in the UK have been offered a vaccination to protect them from HPV. The decision not to give it to boys too was heavily criticised at the time. Now specialists are urging the Department of Health to review its immunisation programme and offer boys the vaccine too, the Independent reports. They say this would not only ensure both sexes are protected against throat cancer, but it would help reduce the risk of cervical cancer in girls and of other cancers caused by HPV.

Research suggests boys are more prone to get throat cancer from oral sex because the virus is found in higher concentrations in the female genital tract. Cancer typically takes 20 to 30 years to develop and the rise in HPV-related throat cancer is being seen as the legacy of the sexual revolution that began in the 1960s.

The typical victim has also changed from older patients in lower socio-economic groups who smoked to those who are younger and middle class.

Experts say oral sex is seen by teenagers as safer than sexual intercourse as carrying no risk of pregnancy or infections.

The Department of Health requested the latest figures from Professor Hisham Mehanna, director of the Institute of Head and Neck Studies in Coventry, who has surveyed the incidence of HPV-related oropharyngeal (throat) cancer in the UK and other countries.

Professor Mehanna said: ‘We are experiencing a very significant rise in oropharyngeal cancer. It used to be rare in our practice – now it is the most common [head and neck] cancer we see. All the studies show there is a strong association with oral sex.’ He added: ‘What is striking about the cancer is that we are seeing it in younger patients. We regularly get people of 45 and sometimes in their 30s.

‘Oropharyngeal cancer was stable until 1996 – then it very definitely took off. This tumour takes 20 to 30 years to develop – it is probably linked to the sexual revolution.’

In the mid-2000s The Department of Health decided to limit HPV vaccination to girls on the basis of the best estimates of HPV-related cancers at the time. But many argued that giving it to boys would reduce the prevalence of the infection by increasing ‘herd’ immunity, offer added protection to girls, and prevent genital warts and anal cancer in both sexes. The department said vaccinating boys could not be justified on cost-benefit grounds – but that was before the scale of the rise in HPV-related throat cancer was known.

‘They asked for my data so they can look again at their assessment. There is definitely enough evidence to warrant looking at it again. The question is whether the new figures make it cost-effective [to extend the vaccination to boys].’

Professor Andy Hall, chair of the Joint Committee on Vaccination and Immunisation, said he had not seen the latest figures. ‘Clearly a change in cancer is always a concern,’ he said.

Professor David Salisbury, director of immunisation at the Department of Health, said: ‘We asked the Health Protection Agency to look at HPV-related oral and throat cancers in 2011. ‘The conclusions continued to support the vaccination of females but not males. Any new information would be considered by the JCVI.’

January, 2012|Oral Cancer News|

Success of HPV vaccination is now a matter of coverage

Source: The Lancet Oncology, Volume 13, Issue 1, Pages 10-12, January 2012

In a pair of articles in The Lancet Oncology, Lehtinen and colleagues and Wheeler and colleagues present 4-year end of study data from a trial of a prophylactic human papillomavirus (HPV)-16/-18 vaccine (Cervarix, GlaxoSmithKline) in young women aged 15-25 years. From a public-health perspective, these studies have several important contributions.

The results assure us that among HPV-naive women in the 15—25 year age range, Cervarix has extremely high efficacy against HPV-16/-18-associated persistent infection, CIN2, and CIN3 or worse, the best ethical surrogate endpoint for prospective studies of invasive cervical cancer risk. Combined with other trials of Cervarix and Merck’s quadrivalent Gardasil vaccine against HPV-16/-18/-6/-11,3 the evidence is strong for near 100% prophylactic vaccine efficacy in HPV-naive women at any age.

Nonetheless, even with vaccine efficacy near 100% in HPV-naive women, the efficacy in the total vaccinated cohort decreased steeply with increasing age, showing an absence of therapeutic effect against already-acquired infections and associated lesions. We know from natural history studies that new HPV transmission (incidence, not prevalence) decreases with age in most cultures.4 Together, natural history data and results of trials for both vaccines suggest that vaccination before sexual debut, or around the time of menarche, will achieve the greatest reduction in cervical cancer rates.

The 4-year trial data shows no decline in vaccine efficacy in HPV-naive women with time since vaccination.1 We know from other trials of the two vaccines that the duration of protection is several years longer than that shown in the present trial.5 Sustained increased antibody titres and absence of breakthrough HPV-16/-18 outcomes in progressively longer follow-up of vaccinated cohorts are encouraging signs; even without boosters, protection for 10—15 years after primary immunization would prevent HPV-16/-18 infection at its peak incidence, lead to a sharp reduction in the secondary peak incidence of precancers, and eventually provide a proportional reduction in cancer. Life-long immunity is not a requirement for vaccine success, in view of the typically long latency between HPV acquisition and cancer outcome. With current vaccines administered at perimenarche, protection against HPV infection might last long enough to prevent most cervical cancers in that birth cohort.

The substantial cross-protection Cervarix provides against some other oncogenic types, especially against HPV-31/-33/-45, increases its effectiveness for prevention of pre-cancer and cancer, beyond the more limited cross-protection reported for Gardasil. The optimistic predictions about HPV vaccination are confirmed: we now know that Cervarix and Gardasil can have substantial public-health benefit. High coverage with Cervarix or Gardasil vaccination would probably prevent a substantial numbers of cancers, as the investigators note for Cervarix. Data from randomised trials and post-licensure monitoring support decisions by public-health agencies that both vaccines are generally safe and effective, although more extensive safety data to rule out rare or late adverse events are needed and pending. Either vaccine will likely not only prevent cervical cancer, but also a substantial proportion of vulvar and vaginal cancer, anal cancer,6 and possibly oropharyngeal cancer.

Now that Cervarix and Gardasil are proven effective, licensed, and in broad use, what remaining HPV-vaccine-related public health questions are most important? The choice of vaccine might be more of a commercial battle than a crucial public-health issue. The two vaccines are slightly different in preparation and activity. On the one hand, possibly because of its novel adjuvant, Cervarix shows increased cross-protection and generates higher antibody titres than Gardasil after vaccination. We are not sure whether higher titres immediately after vaccination lead to longer duration of protection, and do not know if cross-protection will last as long as protection against the targeted HPV types. On the other hand, Gardasil provides important population coverage against genital warts. Both vaccines are beneficial and it is difficult to decide between them. Universal uptake of vaccination with Cervarix, the present version of Gardasil, or a nine-type version of Gardasil that is in final trials, which protects against seven oncogenic types (HPV-16/-18/-31/-33/-35/-52/-58) plus HPV-6/-11, would likely prevent more than two-thirds of cervical cancers.

Accordingly, we believe that increasing coverage, particularly of sexually-naive adolescent females, is now the most important public-health issue in HPV vaccine efforts. Based on the aggregate data, including those presented by Lehtinen and colleagues and Wheeler and colleagues, we advocate focusing vaccination efforts in this core population to reduce cervical (and other) cancers. The irrefutable public-health benefit from a concerted effort to vaccinate adolescent females need not await resolution of contentious questions of whether to initiate catch-up or mid-adult female vaccination, or a decision on whether Gardasil is cost-effective for adolescent males, among whom vaccination might reduce HPV-related oropharyngeal, penile, and anal cancers.

We are particularly concerned about low vaccination rates in areas where cervical cancer incidence and mortality are high because of inadequate alternative prevention through effective cervical screening, and where nine of 10 cervical cancer deaths occur. Needed new developments that would promote vaccine coverage in these areas, and globally, include an inexpensive HPV vaccine, a formulation that does not require a cold chain to keep the vaccine frozen until administration, or a vaccine that requires only a single dose. The current vaccines are too expensive and difficult to deliver for many low-resource regions. Based on strong immunogenicity in younger adolescents, some regions in Canada and Mexico have decided to administer only two doses of vaccine, with plans to evaluate ongoing efficacy 5—10 years later. New evidence suggests that two doses of Cervarix provide adequate protection against HPV-16/-18 for at least 4 years; comparable data for Gardasil have not yet been presented.

Long-term proof of the safety of HPV vaccines is a public-health priority; uptake will increase as public trust in vaccine safety increases. One safety issue that would benefit from more data (currently being collected) is whether there is any link between vaccination during early pregnancy and miscarriage.
The exciting proof-of-principle phase of vaccine development is over. The practical aspects of vaccine uptake are now the most important issue in HPV vaccine research from a public-health perspective. Increasing uptake through further technological refinements and adaptations to regional circumstances will be the most effective ways to achieve wide-scale high coverage and fulfill the promise of HPV vaccination.

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













January, 2012|Oral Cancer News|

Boys need the cervical cancer jab, too

Author: Max Pemberton

Few politicians will ever admit they are wrong, so I salute health ministers who have finally capitulated to medical opinion and last month announced a U-turn on the cervical cancer vaccine that is given to 12- and 13-year-old girls.

Until now, Cervarix, which protects against two strains of the human papilloma virus (HPV) that are a factor in at least 70 per cent of diagnoses, has been the NHS vaccine of choice. However, another vaccine, Gardasil, also protects against a further two strains of HPV which cause genital warts, the most common sexually-transmitted infection, requiring costly and unpleasant treatment.

As doctors have been arguing for some time, this has important public health implications. The current cost to the NHS of treating the 100,000 new cases of genital warts in England each year is £23 million. In several countries, including Australia, where Gardasil has been used in nationwide vaccination programmes, a 75 per cent decrease in the number of new cases of genital warts in the past three years has been reported.

Critics of NHS policy complained that Cervarix was chosen over Gardasil not on the basis of clinical efficacy but because its manufacturers offered it at a discounted price, making it the most cost-effective. Indeed, many doctors have admitted in the medical press that they have bought Gardasil for their daughters privately, while they had to give their patients Cervarix. But ministers have seen sense as now Gardasil will be available on the NHS.

But the battle against HPV has not been entirely won with this volte-face. Many doctors and public health officials believe that it is not only girls who should be protected. Gardasil prevent warts, but there is also emerging evidence to suggest that it can protect against other cancers caused by HPV, such as anal and penile cancers. And a study published in The New England Journal of Medicine showed that those infected with HPV were 32 times more likely to develop oral or throat cancers. This finding dwarfs the increased risk associated with two acknowledged factors for developing these cancers: smoking (three times more likely to develop cancer) and drinking (2.5 times). Research published last month in the Journal of Clinical Oncology found that HPV now accounts for more head and neck cancers than tobacco or alcohol.

December, 2011|Oral Cancer News|

Use and Acceptance of HPV Vaccine Still a Work in Progress

Source: National Cancer Institute

A bellwether moment in the history of cancer prevention came in 2006 when the Food and Drug Administration (FDA) approved the first vaccine to prevent cervical cancer. The vaccine, Gardasil, protects against the two primary cancer-causing, or oncogenic, types of the human papillomavirus (HPV)—HPV-16 and HPV-18. These types are responsible for more than 70 percent of cervical cancer cases worldwide. In 2009, the FDA approved a second HPV vaccine, Cervarix, which also targets HPV-16 and HPV-18.

Gardasil and Cervarix, vaccines that protect against the two primary cancer-causing types of the human papillomavirus (HPV), entail a three-shot regimen, with each dose delivered several months apart.

But what has transpired since these two vaccines received regulatory blessing in the United States has reaffirmed something that cancer and public health researchers have appreciated for some time: The translation of basic research to the clinic doesn’t end with FDA approval of a new drug or treatment. In many respects, FDA approval is just a beginning.

In March 2007, the CDC’s Advisory Committee on Immunization Practices (ACIP) gave its strongest recommendation for HPV vaccination for females ages 9 to 26, which is the FDA-approved indication for Gardasil. Cervarix is approved for females ages 10 to 25. Both vaccines entail a three-shot regimen, with the doses delivered several months apart. According to the most recent data, only 44 percent of adolescent girls 13 to 17 years of age have received at least one dose of the vaccine. Completion rates for the three-shot regimen are substantially lower, with only 27 percent of adolescent girls receiving all three doses.

“Uptake is low because of problems with policy, problems with clinical encounters, and problems with parents’ decisions,” said Dr. Noel Brewer of the University of North Carolina Gillings School of Global Public Health. These obstacles are by no means insurmountable, but addressing each obstacle will take time, patience, and research, say investigators working in this area. And a good bit of that research can be grouped into two categories: missed opportunities and teachable moments.

HPV Vaccines for Boys

Gardasil has also been approved by the FDA for use in boys. The initial approval in boys, in 2009, was for the prevention of genital warts because Gardasil, unlike Cervarix, also protects against two other HPV types—HPV-6 and HPV-11—that are the primary cause of genital warts.

But, in December 2010, the approval was expanded to include the prevention of anal cancer, another disease associated with HPV-16 and HPV-18 infection. Because the approval for boys is so recent, this article focuses only on the uptake of the HPV vaccines by females.

No vaccine has an uptake rate of 100 percent, although when vaccines are mandated, such as those required for school attendance, vaccination rates can reach 80 to 90 percent. Although there has been a flurry of legislative activity at the state level since Gardasil was approved in 2006, only Virginia and Washington, DC, require HPV vaccination for school entry, and Virginia’s law includes a provision that allows parents to opt out of the requirement.

Based on surveys that Dr. Brewer and his colleagues have conducted, concerns that HPV vaccination will encourage sexual activity seem to have had little to do with the lagging vaccination rates. Nor, he continued, has uptake of the vaccines been substantially affected by the antivaccine movement that was spurred by fears raised about the now-discredited links between autism and childhood vaccines.

In general, concerns about safety and other issues with vaccines “are not specific to the HPV vaccine,” said Dr. Gregory Zimet of the Indiana University Melvin and Bren Simon Cancer Center. “There is a general vaccine hesitancy that affects a lot of parents.”

The Power of Physician Recommendations

Factors affecting vaccination rates have “definitely been a mixed bag,” agreed Veronica Chollette, who oversees a portfolio of HPV vaccine-related research in NCI’s Division of Cancer Control and Population Sciences. Cultural issues, lack of awareness, and, initially, reimbursement issues that limited the amount of vaccine physicians were willing to keep in stock have all played a role, she noted.

Physician encounters have also had an effect in an entirely different way. In a study published last year, less than 60 percent of pediatricians reported that they strongly recommended HPV vaccination for their 11- to 12-year-old patients. Another study of women ages 19 to 26 showed that, among women whose doctors did not recommend HPV vaccination, only 5 percent were vaccinated. Among those who did receive a recommendation, 85 percent were vaccinated.

“Pediatricians and family physicians are missing a lot of opportunities when patients come in for office visits,” said Dr. Brewer. Part of the problem, he added, is a systemic issue: health care providers are not flagging the charts of patients who are eligible for the vaccines or using reminder systems in electronic medical records, for example.

Interactions with the health care system drop precipitously once kids reach adolescence, he continued. “So it’s a big deal to miss those chances.”

Sociocultural factors are also important to consider. A study conducted in Appalachia, for example, found that conservative religious beliefs and a mistrust of outside influences played a prominent role in the vaccines’ acceptability. Meanwhile, studies of college-age women have shown that, even when receipt of the initial HPV vaccine dose was similar among white and black women, completion rates for all three doses were substantially lower among black women.

The disparity is noteworthy, Chollette stressed, because black women and Hispanic women have significantly higher cervical cancer incidence and death rates than white women.

In some cases insurance status can affect vaccine uptake and adherence. But, because federal and state-level programs, such as the Vaccines for Children program, make the vaccines available for free or for a minimal charge to low-income children, it may not contribute as much to the disparities in vaccination rates, said Dr. Ruth Carlos of the University of Michigan Medical Center. In fact, a higher percentage of 13- to 17-year-old girls from families below the poverty line have received at least one dose of the vaccine compared with girls from families above the poverty line (52 percent versus 42 percent). Also, a provision in the federal health care reform law requires private insurers to cover all ACIP-recommended vaccines with no co-pay requirements.

It’s a complex problem, acknowledged Dr. Zimet. For example, based on studies he has done involving the hepatitis B vaccine, he explained, “practical obstacles, like transportation to the clinic and how many children the mom is taking care of at home” can have an impact, particularly on adherence to the three-shot regimen.

A variety of approaches are being tested to increase vaccination rates, many of which are focused on moments or interactions that can influence awareness and decision making. Drs. Zimet and Brewer lead initiatives in their respective states that are part of the national Cervical Cancer-Free America campaign. In North Carolina, Dr. Brewer said, they are focusing their efforts on school-located health centers, where many children already receive other vaccines.

Other studies and programs are testing whether social media and text messaging can be used as educational platforms and reminder systems for adolescents and women.

A Mother’s Attitude Is Key

For younger girls, the available data strongly indicate that a single factor heavily influences whether they get vaccinated: their mother. “The gateway to adoption of the vaccine[s] is through the parents,” Chollette stressed. In particular, she continued, mothers are the key. “The mother’s values play a prominent role in whether girls go to the doctor and get all three doses according to schedule.”

Dr. Carlos and her colleagues are attempting to use cancer screening appointments as “teachable moments” for mothers of adolescent girls. In two separate studies, women undergoing breast and cervical cancer screenings who have adolescent daughters will receive tailored information about cervical cancer and the HPV vaccines. The studies will test different means of providing the information, including using a Web-based platform, and vaccination rates will be tracked via electronic medical records.

“From a public health perspective, it makes perfect sense to target mothers who come in for cancer screening,” Dr. Carlos said. Women undergoing their own cancer screenings “may be more receptive to acting on educational information about HPV prevention,” she continued. “Part of what this study is doing is encouraging this receptivity after being screened, and using that to encourage them to get their daughters vaccinated. The message is: ‘You’ve done something to protect yourself against cancer, so why not protect your daughter against HPV?’”

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

November, 2011|Oral Cancer News|