Sharp rise in head and neck cancers begs question of vaccine for males

By Brian Alexander

Men’s Health, msnbc.com

A huge spike in the number of head and neck cancers linked to HPV over nearly two decades is raising alarms about the risk of the sexually contracted infections in a whole new population: men.

Between 1988 and 2004, head, neck and throat cancers that tested positive for the human papilloma virus rose an astounding 225 percent, according to a new study in the Journal of Clinical Oncology.

Within the next decade, the study authors argue, the incidence of such cancers — which are almost always contracted as a result of oral sex — will surpass that of cervical cancer, and the majority of those cases are going to be in men.

That’s a point often missed in public talk about HPV infection — and the vaccine that can prevent it.

In the recent controversy over comments made by presidential candidate Michele Bachmann about the HPV vaccine, the focus was squarely on young women and cervical cancer. But HPV, mainly a strain called HPV-16, also causes oropharyngeal and anal cancer, a fact not often publicized because medical organizations, the government, and academics would rather not step into any debates about sex practices.

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Until recently, head and neck cancers were primarily diagnosed in older people, with an average age of 60, said Dr. Gregory Masters, an expert with the American Society of Clinical Oncology. Those cancers were usually caused by smoking or drinking too much booze, exposures that take 20 years or more to trigger disease. And, they typically didn’t test positive for HPV markers. In fact, the incident of HPV-negative head and neck cancers declined by more than 50 percent during the 16-year study period, mostly because of declines in smoking and other tobacco use.

Now, however, oncologists like Masters, who is affiliated with the Helen F. Graham Cancer Center in Newark, Del., are seeing the average age of head and neck cancer diagnoses drop as younger people develop HPV-caused cancers resulting from sexual exposure.

The study authors collected their data from the three states that participate in a government cancer incidence database for oropharyngeal cancer: Hawaii, Iowa and Louisiana. They determined the HPV status of 271 tumors and found that the prevalence of HPV-related cancers increased from 16.3 percent during 1984-1988 to 71.7 percent from 2000 to 2004.

An accompanying commentary noted that “we can expect some 10,000 to 15,000 patients with (the cancers) per year in the United States, with the great majority having HPV-positive (cancers).”

Consultants to drug companies that make HPV vaccines are represented among the study’s authors; clearly the companies have an incentive to suggest that males be vaccinated. But in many cases, health experts believe that economics and health are aligned on this issue and that boys and young men ought to be receiving the HPV vaccine right now. For instance, Dr. James Turner, a past president of the American College Health Association and a liaison to the Advisory Committee on Immunization practices has long advocated vaccinating all boys against HPV.

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Yet neither the Centers for Disease Control and Prevention nor medical organizations such as ASCO have recommended it, although the vaccines are approved for use in males. The reason, suggested Masters, is squeamishness. “When we get more comfortable as a society with the whole discussion of sexually-related cancer, then you will, I think, see us saying it makes a lot of sense for all boys and girls to get vaccinated … I am not, as a representative of ASCO, saying we recommend it, but I think (such recommendations) are forthcoming.”

Meanwhile, suggested a commentary accompanying the study, “patients should be encouraged to minimize behaviors that put them at risk.”

That, of course, would mean reducing oral and anal sex, two activities now firmly entrenched in the American mainstream. According to the National Survey of Family Growth issued last March by the National Center for Health Statistics, about 90 percent of both men and women have engaged in oral sex with an opposite-sex partner, and 36 percent of women and 44 percent of men have had anal sex.

Statistics like that, and the new study’s findings on head and neck cancer rates may combine to make a broader vaccine recommendation more urgent.