Cancer Centers urge increase in HPV vaccinations

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|

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|

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

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|

Three things you might not know about HPV

Author: Sunnybrook Health Sciences Centre

April 26 to May 2 is National Immunization Awareness week in Canada. One immunization known for raising a lot of questions is the Human Papillomavirus (HPV) vaccination, provided free of charge in Ontario to girls in grades 8-12, and following provincial schedules across the country.


While there is lots of information online, at school and at the doctor’s office about HPV, there is still a lot of confusion about what it may mean for your loved ones. Dr. Nancy Durand, gynecologist at Sunnybrook, explains three little-known facts about HPV.

1) HPV causes cancer in men, too
When Michael Douglas candidly revealed his oral cancer was caused by HPV, many people expressed surprise.

Even though HPV has traditionally been thought of as a disease that affects women and mainly causes cervical cancer, men are actually at higher risk of being diagnosed with certain types of HPV-positive cancers than women.

“It’s not well understood why men are at higher risk for HPV-positive oral cancer, but it does point out that vaccination in men is even more important than we may have previously thought,” says Dr. Durand. Physicians are learning more and more that HPV can also cause other cancers in both women and men, such as anal cancers and head & neck cancers (cancers of the base of the tongue, tonsils and soft palate).

2) Not all HPV infections lead to cancer
You’ve probably read some of the (slightly scary) statistics about HPV: Three in four Canadians will get HPV in their lifetime. It can lead to a variety of cancers and cause genital warts, and there is no cure. But should this keep you up at night, worrying about the potentially deadly consequences of HPV?

Hardly, says Dr. Durand. “Most people who are infected with this virus will clear it — probably 80 per cent of people. It’s the other 20 per cent of people with a persistent infection who may be at risk of cancer, and it’s still only a very small percentage of those people who may go on to develop cancer,” she says.

Many people never even realize they’ve had an HPV infection, as there are usually no symptoms, and the infection often goes away on its own.

3) You’re never too old to get the HPV vaccine
What if you didn’t get the HPV vaccine back in middle school, and now you think it’s too late to get it?

“Regardless of your age and your onset of sexual activity, we can vaccinate both men and women, and we can see a reduction in disease,” says Dr. Durand.

It’s actually not too late — the vaccine can still be effective, even in adults who’ve already been sexually active. “Many people think vaccination can only be done before the onset of sexual activity. But regardless of your age and your onset of sexual activity, we can vaccinate both men and women, and we can see a reduction in disease,” says Dr. Durand.

Anyone, male or female, over the age of nine can be vaccinated. So, if you’ve put off getting the vaccine because you thought you were too old, it’s not too late!

Note: Co-authored by Sybil Millar, Communication Advisor at Sunnybrook Health Sciences Centre

April, 2015|Oral Cancer News|

HPV Related Cancers Increase in Men

Author: Robin Lloyd

A vaccine to protect against the most dangerous strains of human papillomavirus (HPV), which cause almost all cervical cancers, as well as many cases of other cancers and genital warts in both sexes, won the approval of the U.S. Food and Drug Administration nearly nine years ago. The Centers for Disease Control and Prevention now recommends that all boys and girls aged 11 or 12 receive the shots. Vaccination campaigns, aimed largely at girls and women, have fallen short of expectations. By 2013 just over half of U.S. females aged 13 to 17 had received at least one dose of either the Gardasil or Cervarix vaccine. For males, that figure was a disappointing 35 percent. Now head and neck cancers associated with the virus are on the rise, leading some experts to recommend that a gender-neutral or male-centric approach might be more effective.

HPV is the most prevalent sexually transmitted disease in the U.S. and worldwide, infecting just about all men and women at some point in their lives. Although most people clear the virus naturally, persistent infections with some strains can lead to cancer—usually cervical or oropharyngeal (affecting the back of the throat, tonsils and back of the tongue). HPV-associated cancers make up 3.3 percent of all cancer cases among women and 2 percent of all such cases among men annually in the latest available figures, yet the incidence of virally instigated oropharyngeal and anal cancers is increasing.

Ohio State University medical oncologist and epidemiologist Maura Gillison has studied men with oropharyngeal cancer in three different decades. She and other colleagues first noticed an odd shift in patient profiles in the late 1990s: younger men were showing up in her clinic, often with no significant history of smoking or heavy drinking, which are risk factors for head and neck cancers. She later found that whereas from 1984 to 1989 in the U.S. only 16 percent of oropharyngeal cancers tested positive for HPV, by 2005 that figure had skyrocketed to 73 percent. By 2020 experts project that such cancer diagnoses will exceed those for cervical cancer in the U.S., shifting the burden of HPV-associated cancers from women to men. Gillison reported these findings in October 2014 at the annual ScienceWriters meeting.

Based on these data, Gillison thinks that the female-centric approach to HPV-related cancers in the U.S. should switch to focus on both men and women. Nobel laureate Harald zur Hausen, who discovered 30 years ago that HPV causes cervical cancer, has gone further, saying that males should get the vaccine if only one sex were the focus. The vaccine is currently voluntary in most U.S. states, and only a smattering of vaccination coverage campaigns exist, such as those launched by the New York City Department of Health and the Minnesota Department of Health in the past year. Public health messages and even research literature often fail to mention male vaccination prominently or at all. Unfounded fear of vaccines and claims that the HPV shots would provoke early teen sexuality have hindered efforts to vaccinate broadly in much of the U.S.

No data exist to prove that the vaccines protect against HPV-positive oropharyngeal cancer. But such coverage is probable given that the same strains that cause most cervical, vaginal and vulval cancers also cause most head and neck cancers. If a shift in public health policy were to result in an increase in male vaccinations, experts say, at the very least rates of females’ HPV-associated cancers would decrease as a result of fewer infections acquired from men. And the rise in HPV-associated cancers in men would most likely decelerate, plateau or even reverse. A win for all of us.

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

HPV vaccination does not increase promiscuity among adolescents: It’s a vaccine against sexually transmitted cancer

Author: Ronald Bailey

On February 3, 2015, libertarian radio host Andrew Wilkow invited me to discuss the risks and benefits of vaccination. We disagreed: Mr. Wilkow is considerably more worried about the risks than is warranted by the scientific evidence. During the segment, Mr. Wilkow stated that he did not plan to have his two-year old daughter vaccinated against the human papilloma virus (HPV).

Infection with human papilloma virus is responsible for about 11,967 new cases of HPV-associated cervical cancer and for about 2,370 new cases of HPV-associated oropharyngeal cancers in women and nearly 9,356 new cases in men each year in the United States. During the radio segment, I mentioned that a male friend had recently died of HPV-associated head-and-neck cancer. I failed to mention that another male friend is being treated for that cancer now.

Mr. Wilkow argued that since the vaccine immunizes against a sexually transmitted disease that he saw no reason to have his daughter vaccinated against it. The series of three HPV injections is recommended to start after age 9, so Mr. Wilkow has time to reconsider.

Mr. Wilkow is, however, not alone in his opposition to HPV vaccination. A 2014 study in Clinical Pediatrics reported the results of a survey of parents’ actions regarding HPV vaccination. The researchers found:

A significantly higher proportion of parents of girls who were non-Hispanic white, lived in households with higher incomes, and had mothers with higher education levels, delayed and/or refused vaccination.

Another of the early concerns by some opponents of HPV vaccine is that it might encourage sexual promiscuity by lessening adolescent fears of getting sexually transmitted diseases. Several studies have looked at this issue and all have found no such link. The latest study just published in the journal JAMA Internal Medicine is reassuring on that account. The researchers compared the sexually transmitted disease incidence (STI) among vaccinated and unvaccinated adolescent females. The study found:

Human papillomavirus vaccination was not associated with increases in STIs in a large cohort of females, suggesting that vaccination is unlikely to promote unsafe sexual activity.

If you could immunize your kids against breast or prostate cancer you would, wouldn’t you? So why not vaccinate against these cancers?

February, 2015|Oral Cancer News|

Oral cancer on rise in young people

Author: Jaclyn Kelley

Alex Dupuy is like most 15-year-old boys, except for one very special talent. Last year he stole the headlines during a bowling tournament for bowling a perfect 300. But that high wouldn’t last long.

“My son came to us one day and said I have an ulcer, and we thought, OK, let’s gargle with some salt water and we kept checking on it and it never went away,” said Nancy Dupuy, Alex’s mother.

When the sore on Alex’s tongue never cleared up, but instead started growing, his mother became concerned and took him to see the doctor.

“It has grown so rapidly that I would really like to have the tumor or whatever it was removed,” she said.

Alex was taken to Children’s Hospital for surgery, and doctors removed the sore and 30 percent of his tongue. Three days later test results came back confirming the Dupuy’s worst fears: It was cancer.

“The word aggressive stuck out to me,” Nancy Dupuy said. “The type of cancer that my son presented with was an adult cancer. It’s not usually diagnosed in young children.”

The doctors said Alex had a rapid form of squamous cell carcinoma of the tongue. Four days later he and his parents were on a plane to MD Anderson Cancer Center in Houston.

Through it all, Alex managed to stay positive.

“I felt nervous, I felt scared and I told myself, I’ll be alright,” Alex said.

In Houston Alex would have yet another surgery before starting six weeks of intense radiation.

“We would wrap his neck because the neck would be burned. The skin, the tissue was burned when it would start to break down,” Nancy Dupuy said.

Dr. Paul Friedlander, the chairman for Tulane’s ear, nose and throat department, said the number of young people with oral cancer is on the rise.

“Most of the cancers we saw were smoking, alcohol related,” Friedlander said. “Right now we’ve seen an increase in a number of people who have not been exposed to cigarettes and alcohol that have these cancers.”

And he said that’s because of the human papaloma virus, or HPV. It’s an orally transmitted virus that he says is easy to get.

“These can be transmitted through oral sexual contact or something as innocuous as an open-mouth kiss,” Friedlander said.

Friedlander said early detection is key.

“If one does have a sore on their mouth, difficulty with swallowing, hoarseness or a neck mass that persists after two or three weeks, it’s a good idea to see your local doctor,” he said.

He recommends parents consider getting their teens the HPV vaccination, which doctors say can help prevent oral cancer.

It’s something Nancy Dupuy did with Alex and his brothers after his diagnosis.

“In our case it wasn’t HPV, but just the thought of oral cancer and that there is maybe something that could have prevented it is just really worth it in the end,” she said.

Several weeks of radiation would take its toll on Alex, but his family says it’s bowling that got him through it.

“On the good days, Alex would bowl and Alex would be in a world that was just perfect, and to me that was the most important thing that helped him get through six weeks of radiation,” Nancy Dupuy said.

Thank to early detection, Alex is now in remission.

“I always thank God I am cancer free.”

December, 2014|Oral Cancer News|

Three shots that could stop cancer

Author: Meredith Wadman

Not so long ago, when my sons still had smooth cheeks and children’s voices, I had them vaccinated against human papillomavirus, the most common sexually transmitted disease. It was late 2011, and the Centers for Disease Control and Prevention had just recommended that boys join girls in being vaccinated at age 11 or 12. I was certainly receptive: HPV, as it’s commonly called, causes cervical cancer, cancer of the tonsils, cancer of the back of the tongue and, less often, cancers of the vulva, vagina, anus and penis. It seemed important to ensure that my kids were protected.

Yet numbers released last month by the CDC show that my sons, now 14 and 15, are among a small minority of adolescent males who have been vaccinated. In 2013, just 14 percent of American boys ages 13 to 17 had received all three recommended doses of the HPV vaccine. (The CDC also recommends “catch-up” vaccination for males up to age 21.)

Not that parents are rushing to have their girls vaccinated either, even though the CDC first recommended the vaccine for prepubescent girls in 2007 and virtually all insurers pay for it. In 2013, fewer than 38 percent of American girls between 13 and 17 had received the full three-dose course.

It is heartbreaking to watch a safe, effective vaccine go unused. Consider this: The CDC estimates that increasing the vaccination rate of American girls to 80 percent would prevent 53,000 cervical cancers during the lifetimes of girls who are now 12 and younger.

When I had my sons vaccinated, it was partly with girls in mind. After all, if fewer young men are infected, fewer young women will be exposed to the virus that causes cervical cancer — currently the most common cancer prevented by the vaccine. But now I am realizing that HPV poses a growing risk to boys.

A new breed of cancer of the back of the tongue and tonsils, caused by HPV, is rising in incidence — likely caused, researchers suspect, by increases in premarital sex and oral sex over the past several decades. These cancers afflict men far more often than women, and at relatively younger ages than do other head and neck cancers, which typically appear in men older than 60. Middle-aged men who don’t die from their HPV-linked cancer often must live for years with the side effects of intensive chemotherapy and radiation delivered to the back of the throat. These can include the permanent inability to swallow and the appearance later of new, aggressive, radiation-induced cancers.

If this trend continues, we are going to see more cancer of the back of the tongue and the tonsils caused by HPV. One recent analysis of 30 studies, conducted by University of Wisconsin researchers, found that the proportion of such cancers caused by HPV rose from 21 percent before 1990 to 65 percent after 2000. Anil Chaturvedi of the National Cancer Institute and his colleagues have estimated, based on recent trends, that by 2020 there will be more new cases of these HPV-induced throat cancers in the United States each year than new cervical cancer cases.

So the actor Michael Douglas did us all a service when he was so frank with Britain’s Guardian newspaper last year. When asked if his throat cancer had been caused by heavy drinking and smoking, which are also risk factors for the disease, the actor replied: “No. I mean, without getting too specific, this particular cancer in tests is caused by something called HPV, which actually comes about from cunnilingus.”

Many parents don’t like to think of their 11- and 12-year-olds as sexual creatures. Ironically, the CDC recommendation assumes not that kids are sexually active at this tender age but rather that they are not: The point of vaccination is to close the door before the horse is out of the barn.

It’s no use telling yourself that your child isn’t “that kind” of kid. The fact is, HPV is so common that almost all sexually active adults are infected at some point. Last year, the CDC estimated that about 79 million Americans were infected, most of them in their late teens and early 20s.

Most people who get HPV have a transient infection that their immune system clears with no lasting damage. But in some people, the virus takes up residence and goes on to cause cancer. I am grateful that, thanks to the HPV vaccine, I will never have to find out if my sons fell into that second, unlucky group.

August, 2014|Oral Cancer News|

President’s panel calls for more girls, boys to get HPV vaccine

Author: Government news release

Too few American girls and boys are getting vaccinated against the cancer-causing human papillomavirus (HPV), the President’s Cancer Panel reported Monday.

HPV is linked to cervical cancer as well as penis, rectal and oral cancers. One in four adults in the United States is infected with at least one type of HPV. Increasing HPV vaccination rates could prevent a large number of cancer cases and save many lives, the panel said.

“Today, there are two safe, effective, approved vaccines that prevent infection by the two most prevalent cancer-causing types, yet vaccination rates are far too low,” Barbara Rimer, chair of the President’s Cancer Panel, said in a panel news release.

“We are confident that if HPV vaccination for girls and boys is made a public health priority, hundreds of thousands will be protected from these HPV-associated diseases and cancers over their lifetimes,” she added.

Currently, the U.S. Centers for Disease Control and Prevention is recommending that girls aged 11 and 12 receive either the Cervarix or Gardasil vaccines, and Gardasil is recommended for boys of similar age.

In 2012, only a third of girls aged 13 to 17 got all three recommended doses of HPV vaccine, CDC data shows. That’s much lower than the federal government’s goal of having 80 percent of girls aged 13 to 15 fully vaccinated against HPV by 2020, the report said.

The picture is even more disappointing for boys. Less than 7 percent of males aged 13 to 17 completed the recommended HPV vaccination series in 2012. The vaccine was recommended for boys more recently.

Boosting HPV vaccination rates to 80 percent would prevent 53,000 future cervical cancer cases among girls who are currently aged 12 or younger, according to the CDC.

The agency also estimates that increased vaccination would prevent thousands of cases of other HPV-associated cancers in both females and males, the report added.

A number of things need to be done to increase HPV vaccination rates, the panel said. These include public education and other efforts to increase teens’ and parents’ acceptance of the vaccines; encouraging doctors and other health care providers to recommend and give vaccinations; and making sure that the vaccines are available where teens receive health care.

Source: President’s Cancer Panel, news release, Feb. 10, 2014

February, 2014|Oral Cancer News|

Concerned About HPV-Related Cancer Rise, Researchers Advocate Boosting HPV Vaccination Rates

By: Anna Azvolinsky
Source: JNCI Journal of the National Cancer Institute Advance Access
Published:  August 29, 2013


Deaths from the major cancers—lung, colorectal, breast, and prostate—continue to decline, a trend that started in the early 1990s. Cancer incidence is also declining, if slightly, for both sexes. That’s the good news from the annual Report to the Nation on the Status of Cancer, a joint research effort by the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries (J Natl. Cancer Inst. 2013;105:175–201).

But the study also shows an uptick in rates of anal and oropharyngeal cancer, a type of head and neck cancer related to infection with the human papillomavirus (HPV), in the 10-year period ending in 2009. Cancer of the oropharynx increased among white men and women (3.9% and 1.7%, respectively). Anal cancer also increased in both sexes, with the greatest increase among black men (5.6%) and white women (3.7%). Rates of vulvar cancer, another HPV-related cancer, also increased among women despite continued lower rates of cervical cancer.

Researchers attribute this rise in HPV related cancers to more HPV infections. “We think that increases in oral–genital sexual practices and increasing number of sexual partners that occurred some 30 years ago as part of the sexual revolution may be implicated in part of the increase in cancer rates we are seeing today,” said Edgar P. Simard, Ph.D., M.P.H., senior epidemiologist of surveillance research. Although rates of HPV infection from three decades ago were not available in the joint report, a trend exists of men and women now in their 50s and 60s having the highest rates of both oropharyngeal and anal cancers.

To directly relate HPV infection with cancer development later in life, epidemiologists are attempting to understand how HPV, the most common sexually transmitted infection in the U.S., is spread and which populations are most at risk. HPV infection of the cervix increases with number of sexual partners and younger age of first sexual experience. Studies now show similar trends for oral HPV infection rates, which can lead to oropharyngeal cancer.

More than 100 strains of the virus are passed through skin contact. Most cause benign warts on the genitals, hands, or face, but about 15 strains can cause cancer of the cervix, vagina, vulva, penis, anus, and oropharynx (tonsils, back of the throat, and base of the tongue). Most people with HPV clear the infection, but those with persistent infection for many years or decades are at risk for these cancers, depending on the site of viral infection.

Screening for Noncervical HPV-Related Cancers

The Pap smear screening test has drastically reduced both cervical cancer incidence rates and deaths. Screening methods for other HPV-related cancers are not so straightforward. “Right now, it is just cervical cancer screening and some anal cancer screening that is done for certain individuals who are high risk,” said Simard. HPV causes an estimated 90% of anal cancers. Anal cancer screenings are offered to HIV-positive men who have sex with men, but not enough research has yet occurred to adapt this type of screening for other cancer sites.

HPV infection causes approximately 60% of oropharyngeal cancers, but screening remains problematic. “We have a serious problem trying to screen for oropharyngeal cancer because we have not clearly identified a premalignant lesions that can be used for screening,” said Douglas R. Lowy, M.D., chief of the NCI Laboratory of Cellular Oncology, who works on HPV. This type of cancer has been studied for a relatively short time, and more research is needed to fully understand whether premalignant lesions caused by HPV could be identified early.

Oropharyngeal Cancer–HPV Link

Oropharyngeal cancers were seen predominantly in older men who had comorbidities and who tended to have a history of drinking or smoking. “What we see now is still more men than women, but these men are younger, in their 40s and 50s, and they don’t have the comorbidities from smoking and drinking and in general are more healthy,”said Everett E. Vokes, M.D., head and neck expert at the University of Chicago.

Researchers now distinguish two types of oropharyngeal cancers—those related to HPV infection, which generally have a better prognosis, and those related to tobacco and alcohol use. At the molecular level,  HPV-related cancers are not only positive for HPV DNA but also express the human p16 gene, induced by the virus’s oncoproteins. Most HPV-positive patients also have detectable antibodies against HPV.

HPV Vaccine Reaching Broader Population

Current HPV vaccination rates will at least partly influence the cancer statistics that will emerge in 20–30 years as a result of current HPV infection rates. Over time, “prevention is the key, and prevention is either abstinence or vaccination,” said Vokes.

The HPV vaccine can reduce the risk of HPV-related cancers that in 10–30 years could affect people who are now teenagers. The vaccine, a series of three shots, is recommended for girls aged 11 or 12 years (with catch-up until age 26 years) and boys aged 11 or 12 years (with catch-up until age 21 years), to protect against HPV infection and HPV related diseases, including cancer. Researchers initially developed the vaccine to protect against cervical cancer and genital warts, and the U.S. Food and Drug Administration has now approved it to protect against anal, vaginal, and vulvar cancers. In principle, the vaccine should also protect against HPV-positive oropharyngeal cancer because as many as 90% of cases are attributed to the two HPV strains that the vaccine targets.

“A critical aspect of the HPV vaccine is that it should reduce the risk of all cancers caused by the HPV types targeted by the vaccine, not just cervical cancer, for which we don’t have another public-health intervention,” said Lowy.

Yet uptake of the vaccine in the U.S. remains low: Only 35% of girls aged 13–17 years were fully vaccinated as of 2011, compared with 18% in 2008—considerably short of the 80% goal of the Healthy People 2020 program.

Studies indicate that physician recommendation is a main determinant of whether a teen will receive the vaccine. Susan T. Vadaparampil, Ph.D., associate member of the Health Outcomes and Behavior Program at the Moffitt Cancer Center in Tampa, Fla., who studies trends in HPV vaccination, said that pediatricians are more likely than family physicians to offer the vaccine (Cancer 2013;119:621–8). Her study also showed that physicians who care primarily for minority groups are more likely to administer the vaccine to these patients. Cost is not necessarily a deterrent because children from families who cannot pay can receive the vaccine free through Medicaid or the Vaccines for Children program.

These findings are consistent with results of a national survey that Vadaparampil conducted to compare rates of physicians’ HPV vaccine recommendations for girls aged 11–12 years from 2010 and 2011. Recommendation rates increased little, and another study focusing on low-income families showed that despite free programs and recommendations, vaccination rates for girls remained low.

“There has been very poor and slow uptake compared with the meningococcal and Tdap [combined tetanus–diphtheria– pertussis] vaccines given to teens,” said Robert M. Jacobson, M.D., a pediatrician at the Mayo Clinic. Jacobson recently found that the number of parents who opt out of vaccinating their teens against HPV is increasing nationally despite recommendations (Pediatrics 2013;131:645–51). “The most alarming finding, frankly more disturbing than the poor uptake, is the increasing concern of parents regarding safety issues and the decreasing number of parents who say they will vaccinate their daughters,” said Jacobson.

To better understand how to improve physician–parent communication, Jacobson and colleagues will, as part of a large national study, go directly to physicians’ offices to analyze the conversations physicians are having with parents and teens. “We need to find out what is being said and, perhaps more important, what is not being said.”

CDC and other organizations are leading campaigns to increase HPV vaccination rates. According to Simard, the campaigns underscore the vaccine’s anticancer function. As for the scientifically unfounded safety concerns, “we need to continue to communicate the scientific rationale for HPV vaccines to the public and underscore that all of the data support the conclusions that the vaccines are safe and efficacious,” said Simard. “We are confident in that, but we do need additional ways to combat people’s misperceptions about the HPV vaccine.”

© Oxford University Press 2013. DOI:10.1093/jnci/djt260

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

September, 2013|Oral Cancer News|