Girls-Only Vaccine Could Be Best Weapon Against HPV


A new study argues that vaccinating boys against HPV isn’t the best use of resources, since vaccinating more girls will actually lead to a greater reduction in overall infections. However, there are also political implications to consider.

Back in October, I wrote that the rise of HPV-related throat cancer in men was an excellent argument for vaccinating boys against the virus. And later that month, the CDC extended its vaccine recommendation to include boys as well as girls. But now, researchers say that focusing on vaccinating more members of one sex may be more effective than trying to vaccinate both. In a study published in PLoS Medicine, Johannes A. Bogaards used mathematical modeling to determine which vaccination strategy would lead to the greatest reduction in HPV prevalence. They found that increasing the percentage of girls vaccinated would actually have the biggest effect. Bogaards et al write,

“We show that, once routine vaccination of one sex is in place, increasing the coverage in that sex is much more effective in bolstering herd immunity than switching to a policy that includes both sexes. Universal vaccination against HPV should therefore only become an option when vaccine uptake among girls cannot be further increased. Adding boys to current vaccination programs seems premature, because female coverage rates still leave ample room for improvement in most countries that have introduced HPV vaccination. So far, only three countries have achieved a three-dose coverage of 70% or more in females.”

The authors do note that while vaccinating girls and women does offer some protection to men who have sex with men (because some of these men also have sex with women), a supplementary program to vaccinate these men could be a good idea. This might be less than effective in practice — since the vaccine is most effective when given before any HPV exposure, many vaccination programs have targeted children, who may not yet identify with a particular sexual orientation or practice. However, the study authors write that “vaccination of [men who have sex with men] remains cost-effective up to 26 y of age, an age range that might render targeted HPV vaccination acceptable.”

Bogaards et al make a persuasive case that, at least if their models are correct, vaccinating all girls would lead to a greater reduction in HPV than vaccinating some girls and some boys. However, they don’t address the political obstacles to this plan. As long as HPV is perceived as a women’s problem and HPV vaccination as a girls’ issue, it will be subject to the hysteria and moralizing that surrounds women’s and girls sexuality in the United States. This may prevent the US from ever reaching the level of girls’ vaccination that would confer herd immunity. A move to vaccinate boys, however, could increase public support for the project of vaccination in general. Further research needs to look not just at what would reduce HPV prevalence in an ideal world, but at what will work in the sometimes shitty world we actually live in.

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

December, 2011|Oral Cancer News|

UI professors: HPV editorial misses the mark

Source: The Daily Iowan

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

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

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

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

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

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

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

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

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

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

December, 2011|Oral Cancer News|

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


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

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

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

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

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

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

Key Findings

Other findings of this year’s report include:

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

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

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

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

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

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

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

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

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

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

December, 2011|Oral Cancer News|

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|

Although Most Smokers Want to Quit… Only a Fraction Actually Do

Source: The Wall Street Journal
Author: Betsy McKay


More than two-thirds of American smokers want to quit, but only a fraction actually do, underscoring a need for more services, messages, and access to medications to help them kick the habit, according to a new government report out today.

Nearly 69% of adult smokers wanted to quit in 2010 and more than half tried, but only 6.2% succeeded, according to the Centers for Disease Control and Prevention.  Those who try to quit can double or triple their chances with counseling or medications, but most of those who did try to quit in 2010 didn’t use either. Nor did they receive advice on how to quit from a doctor.

The findings suggest more needs to be done to help smokers quit — particularly certain segments of the population with low quit rates, said Tim McAfee, director of the public health agency’s Office on Smoking and Health, in an interview.

Nearly 76% of African-American smokers wanted to quit last year, and 59% tried — well above the national average, said McAfee. But a mere 3.2% succeeded, which is the lowest rate among measured races and ethnicities. American smokers with college degrees had a far higher rate of success at quitting — 11.4% — than smokers with fewer than 12 years of schooling, who had only a 3.2% success rate.

Still, McAfee said, there are some encouraging signs. For example, the percentage of young adults between the ages of 25 and 44 who want to quit has climbed over the past decade. “We think that’s incredibly important and the influence perhaps of large policy shifts in the U.S.” such as smoke-free laws and excise taxes, he said. (By contrast, interest in quitting in some other countries, such as China, is low.)

State Medicaid programs are now required as part of health reform to pay for smoking cessation services for pregnant women, and the federal government also now allows states to provide coverage for medicines and counseling for other Medicaid recipients.

But “we lost some momentum” in enacting smoke-free laws, McAfee said. Twenty-five states and Washington, D.C., have comprehensive smoke-free laws in place but none has been added to the list so far in 2011. The most recent state to go smoke-free was South Dakota, last November.

A court-ordered temporary halt earlier this week to a government plan to put graphic warning labels on cigarette packs could also set back efforts to get people to smoke, McAfee said.

That’s not only because the images — such as one of a man exhaling cigarette smoke through a hole in his throat — are meant to discourage smoking, but the planned labels also include telephone quitline information. A federal judge ordered the temporary halt after tobacco companies argued it would violate their constitutional right to free speech.

November, 2011|Oral Cancer News|

HPV Vaccine Recommended for Boys aged 11 to 12 Years


The CDC’s Advisory Committee on Immunization Practices today approved routine recommendation in favor of administering the quadrivalent HPV vaccine for boys aged 11 to 12 years.

Committee members decided that the vaccine (Gardasil, Merck) was safe, efficacious and cost-effective enough to warrant routine usage in this population. The recommendation issued in 2009 was permissive, meaning providers could give the vaccine to boys, but it was not routinely administered. This change would put the HPV vaccine into the regular vaccination schedule. The three-vaccination series can start as early as age 9 years.

“The committee recommended that routine vaccination of males aged 11 or 12 years with three doses of quadrivalent vaccine be given to prevent HPV infection and HPV-related disease,” Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a phone call with reporters. “Boys and young men 13 to 21 years of age who have not already received the vaccine should be vaccinated.”

Anne Schuchat, MD
Anne Schuchat, MD

Insurance companies typically cover HPV vaccine in boys, but that is not necessarily the case for a permissive recommendation, according to Schuchat, who said a routine recommendation for a vaccine usually translates into coverage without co-pays.

The committee voted 8-5 with one abstention in favor of recommending vaccination for young men up to age 21 years with permissive recommendation for men aged 22 to 26 years. The committee considered recommending vaccination up to age 26 years, which would have harmonized recommendations for men and women, but concluded that the vaccine was not cost-effective in men aged older than 21 years.

According to the committee, in extending the quadrivalent vaccine to young men, the vaccine was 89% effective against genital warts and 75% effective against precancerous anal intraepithelial neoplasia. Schuchat said the number of girls receiving vaccinations has been disappointing, and there is hope that vaccinating boys will protect both young women and young men.

“HPV vaccination for males offers an opportunity to decrease the burden of HPV-related disease in both males and females,” Schuchat said. “So in addition to providing direct benefit to boys by preventing future genital warts or anal cancer, there’s the potential that vaccinating boys will reduce the spread of HPV from males to females and reduce some of the HPV-related burden women suffer from.”

About 20 million Americans currently have an HPV infection. According to the CDC, an estimated 7,080 men and 14,720 women develop cancers associated with HPV types 16 and 18 every year. An estimated 80% of anal cancers, 65% of vaginal cancers, 50% of vulvar cancers, 35% of penile cancers and nearly all cervical cancers are HPV-related. Roughly 60% of oropharyngeal cancers are associated with HPV, and HPV-related disease costs an estimated $8 billion annually.

Committee staff said vaccinating boys aged 11 to 12 years would cost $24,000 to $62,000 per quality-adjusted life year and would become more expensive per quality-adjusted life year as more girls are vaccinated.

The recommendation will now go to the full CDC. Schuchat said the agency will likely vote on the recommendation in a few months.

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


October, 2011|Oral Cancer News|

CDC Committee Recommends Boys Receive HPV Vaccine


A federal government advisory committee voted Tuesday to recommend that boys and young men, from ages 11 to 21, be vaccinated against the human papilloma virus, commonly referred to as HPV.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices says the vaccine series can be started as early as age 9.

Twelve members of the committee voted in favor of a recommendation that 11- and 12-year-old boys be vaccinated; one member abstained.

A separate vote involving males age 13 to 21 was split. Eight voted for it; five voted against, and one abstained. The same recommendation said males age 22 through 26 may be vaccinated.

HPV is the No. 1 sexually transmitted disease in the United States. At least 50% of sexually active people will get it at some point in their lives.

Study: Males should get HPV vaccine too

The HPV votes took place as part of the advisory committee’s meeting in Atlanta, Georgia.

The HPV vaccine is already recommended for females between the ages of 9 and 26 to reduce the risk of cervical cancer. The CDC recommends girls get the vaccine at age 11 or 12.

The FDA approved the first HPV vaccine, Gardasil, back in 2006. The second vaccine, Cervarix, was approved in 2009.

The vaccine is given in three doses. Gardasil also protects against most genital warts and has been shown to protect against anal, vaginal and vulvar cancers, all of which are associated with HPV, according to the CDC.

Although the vaccine has been approved for males since 2009, it hasn’t been as heavily promoted for them.

Increase in oral cancers linked to HPV

One reason for the push now is that girls aren’t getting vaccinated in the numbers doctors expected. “If the boys are also immunized, it reduces the transmission back and forth,” said Dr. William Schaffner, chairman of the Department of Preventative Medicine at Vanderbilt University, who attended the CDC meeting as an adviser but not a voting member.

By receiving the vaccine, boys will also be protected against cancers of the penis and rectum. Also, there is growing evidence of HPV causing the recent increase in head and neck cancer. A study released earlier this month found approximately 70% of all oropharyngeal cancers are caused by HPV infection. The HPV vaccine protects against both, according to Schaffner.

Earlier this year, the American Academy of Pediatrics began including the HPV vaccine on its list of recommended vaccines for boys.

The HPV vaccine became a political hot potato when Republican presidential contender Michele Bachmann was critical of fellow Republican contender and Texas Gov. Rick Perry’s support of the vaccine for girls. In 2007, he signed an executive order that required Texas schoolgirls to receive vaccinations against HPV, although it wasn’t implemented.

The CDC notes that the Food and Drug Administration has licensed the vaccines as safe and effective. “Both vaccines were tested in thousands of people around the world. These studies showed no serious safety concerns. Common, mild adverse events reported during these studies include pain where the shot was given, fever, dizziness, and nausea,” according to the CDC website.

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

October, 2011|Oral Cancer News|

Rate of HPV Vaccination in Teens Lagging

Source: The Associated Press
Author: Staff


Only about half of the teenage girls in the U.S. have rolled up their sleeves for a controversial vaccine against cervical cancer — a rate well below those for two other vaccinations aimed at adolescents.

The vaccine hit the market in 2006. By last year, just 49 percent of girls had gotten at least the first of the recommended three shots for human papilloma virus, or HPV, a sexually-transmitted bug that can cause cervical cancer and genital warts. Only a third had gotten all three doses, the Centers for Disease Control and Prevention said Thursday.

In contrast, the CDC said about two-thirds of teens had gotten the recommended shot for one type of bacterial meningitis and a shot for meningitis and tetanus, diphtheria and whooping cough.

Granted, it can take many years for a new vaccine to catch on and reach the 90 percent and above range for many longstanding childhood vaccines. But use of HPV vaccine has been “very disappointing” compared to other newer vaccines, said the CDC’s Dr. Melinda Wharton.

“If we don’t do a much better job, we’re leaving another generation vulnerable to cervical cancer later in life,” said Wharton.

Why aren’t more girls getting HPV shots? The vaccine can be very expensive, and it can be a bit of a hassle. It takes three visits to the doctor over six months.

But sex no doubt has something to do with it, experts said.

Girls are supposed to start the series when they are 11 or 12 before most girls become sexually active. The vaccine only works if a girl is vaccinated before she’s first exposed to the virus.

But some parents may misunderstand, thinking their daughters don’t need it at such a young age because they aren’t sexually active. Others may believe that it would require a discussion about sex and sexuality a talk they may not feel ready to have, some experts said.

The government needs to be more aggressive about changing those perceptions with a major education campaign, Jeff Levi, executive director of the Trust for America’s Health, a Washington, D.C.-based research group, said in a statement.

Millions of Americans women and men become infected with HPV each year, though most show no symptoms and clear the virus on their own. But some strains persist and can cause genital warts and cancer. About 12,000 women are diagnosed with cervical cancer each year, and about 4,000 die from it, according to CDC statistics.

The new study was based on a 2010 telephone survey of the parents of more than 19,000 adolescents ages 13 to 17, who allowed researchers to check their kids’ vaccination records.

Rhode Island and Washington had the highest HPV vaccination rates, both around 70 percent for at least one shot. Idaho had the lowest rates, at about 29 percent.

The study was published online in a CDC publication, Morbidity and Mortality Weekly Report.

August, 2011|Oral Cancer News|

Are lozenges and other smokeless products safer alternatives to smoking?

Source: Pennsylvania’s Fox News

Tobacco company rep David Howard waxes enthusiastic when he talks about a new product his employer, R.J. Reynolds Tobacco Co., has developed: a pellet of finely cured tobacco, binders and flavoring that dissolves in the mouth in 10 minutes.

Under test market in two U.S. cities — Denver and Charlotte, N.C. — Camel Orbs will join two dissolvable tobacco lozenges already on the market if it graduates to broader distribution. And Howard is optimistic it will.

“These products provide smokers with an option to enjoy the pleasure of nicotine without bothering others,” Howard said. “No secondhand smoke. No spitting. No cigarette butt.”

Dissolvable tobacco consists of small pieces of compressed, finely ground tobacco powder, binders and flavorings that are shaped into pellets, sticks or strips. When placed in the mouth, they dissolve within minutes, providing a nicotine hit.

The tobacco industry says that the products contain far fewer cancer-causing chemicals such as tobacco-specific nitrosamines and are a “harm reduction” strategy that, like electronic cigarettes, might help people turn to less risky tobacco habits or eventually quit smoking.

But public health officials and anti-smoking advocates fear that the products will help initiate a new generation of smokers. The flavoring and packaging appeal to children, they argue, and teenagers will gravitate toward a product they can easily hide.

On Thursday, the Food and Drug Administration will take up the issue with an advisory committee hearing on the effect of dissolvable tobacco products on public health.

“Tobacco companies are always one step ahead of the sheriff,” said Sen. Sherrod Brown (D-Ohio), one of several senators who asked the FDA to review the products. “They have found ways to evade the rules and regulations and public health warnings.”

The first dissolvable tobacco product, a lozenge called Ariva, debuted in 2001. But in the last year the number of products on sale or in test marketing has jumped and major tobacco companies have entered the arena. Reynolds is market-testing two other products, Camel Strips and Camel Sticks, in addition to Camel Orbs. Philip Morris is test marketing a dissolvable tobacco stick.

At the same time, use of smokeless tobacco — snuff, chew, electronic cigarettes and, increasingly, dissolvable tobacco — is growing at a rate of about 7% per year, according to a 2010 report by Research and Markets, an international market research and data company.

In some states, use of smokeless tobacco products among men is almost as high as the national prevalence of cigarette smoking among adults, which stands at 20.8%, according to the Centers for Disease Control and Prevention. Across the U.S., 7% of U.S. adult males use smokeless tobacco, the CDC said.

Use among children is growing too. According to a 2010 survey by Monitoring the Future, an annual nationwide study funded by the National Institute on Drug Abuse, 8.5% of 12th-graders said they had used a smokeless tobacco product in the last 30 days compared with 6.7% in 2003.

“Because it has a mild taste, we’re concerned dissolvable tobacco will be a starter product for kids,” said Matthew Myers, president of the Washington-based anti-smoking group Campaign for Tobacco-Free Kids. “Traditionally, girls have not used smokeless tobacco products. But this product does not have a substantial smell or require spitting. There is a real concern that this product will appeal to adolescent girls, particularly those concerned about weight.”

Public health officials also have expressed concern about the effect on teeth and gums of holding the product in the mouth for 10 to 20 minutes and the effect on the stomach from swallowing the tobacco chemicals.

Few studies have been done specifically on the potential health risks of dissolvable tobacco.

One study, published in March in the Journal of Agricultural and Food Chemistry, tested four dissolvable tobacco products, three of which were being test-marketed, and found they contained mostly nicotine and a variety of flavorings, sweeteners and binders.

Some products contained coumarin, which has been banned as a flavoring agent in foods because of its link to liver damage, said study author John V. Goodpaster, an assistant professor in the forensic and investigative sciences program at Indiana University-Purdue University Indianapolis.

Studies on other smokeless tobacco products show they are considerably less risky than smoking cigarettes and cigars, which raises the risk of lung and a variety of other cancers, respiratory illness and heart disease. However, smokeless products still increase the risk of oral, pancreatic and esophageal cancer as well as heart disease. They can cause gum disease and can be unsafe for a fetus, health experts say.

The lowered risks of dissolvable products should be seen as a positive development, said Brad Rodu, a professor of medicine and chairman of tobacco harm reduction research at the University of Louisville in Kentucky.

“One cannot call any tobacco product absolutely safe,” said Rodu, who said he received funds from tobacco companies to do his research but had no personal ties to any company. “But the health risks of using smokeless tobacco products over the long term are so low that they are barely measurable by modern epidemiological evidence.”

Rodu added that smoking-cessation aids such as nicotine gum and the medication Chantix have limited success and that people who can’t quit should be urged to try safer products.

“We have 45 million smokers in the United States,” he said. “If we had almost any other activity in society that was this dangerous, we would welcome products that were safer.”

Sara Troy Machir, vice president of communications and investor relations at Star Scientific Inc., maker of Ariva and another dissolvable tobacco product called Stonewall, said the Glen Allen, Va.-based company is developing two new products, Ariva BDL and Stonewall BDL, with lower levels of tobacco-specific nitrosamines (BDL stands for “below detection limits”).

Machir said the company was founded with the mission of reducing harms associated with tobacco use and that “we have absolutely no interest in recruiting another generation of tobacco users.”

Star Scientific applied to the FDA last year for approval to market its two new products as “modified risk tobacco products.” To the chagrin of anti-smoking advocates, the FDA announced in March that the products were not subject to regulation under the 2009 Family Smoking Prevention and Tobacco Control Act, which gives the agency the authority to regulate tobacco products.

Twelve senators, including Brown, Jeff Merkley (D-Ore.) and Barbara A. Mikulski (D-Md.), have asked the FDA to reverse its decision.

In April, the FDA announced it was developing a strategy to regulate additional categories of tobacco products and that it would review information on dissolvable tobacco from published studies, manufacturers’ research and the advisory committee meeting this week. The agency is expected to eventually close any loopholes that might prevent dissolvable tobacco products from escaping its jurisdiction.

“It’s very clear dissolvable products are here to stay, and I believe the FDA will have to deal with them,” Rodu said.

Oral Cancer…what does sex have to do with it?


The answer is … plenty! This issue will focus on oral cancer awareness. While there are many topics we can delve into regarding this dreadful disease, we will focus on a few topics.

We will share two personal and very poignant stories. Kim Anzalotti, Bill Wislon, and Eva Grayzel impart information that will move you and make you think about your daily in-office procedures. JoAnn Gurenlian, RDH, PhD, will share insights on the human papillomavirus, or HPV, a sexually transmitted virus, and its relationship to oral cancer. And last, but certainly not least, Jamie O’Day, Treatment Facilities Coordinator, The Oral Cancer Foundation Inc., The Bruce Paltrow Oral Cancer Fund, will share her insight on oral cancer screening and the need for a thorough examination.

One personal story is shared by Eva Grazel, an international motivational speaker, author, performer, and cancer survivor. I had the pleasure of meeting Eva a number of years ago. In 1998 at age 33, Eva, a non-smoker, saw a number of dentists and physicians for over two years for an “ulcer” on her tongue that became larger and more painful, without any resolution. She was finally diagnosed with advanced oral cancer, Stage IV squamous cell carcinoma, on the lateral border of her tongue.

After the many missed opportunities for diagnosis, Eva was given a 15% chance of survival. While her late stage diagnosis is not uncommon, her recovery was unique, as she beat the odds. After diagnosis, Eva underwent a partial tongue reconstruction, a modified radical neck dissection, and a maximum dose of radiation therapy. The good news is that Eva is very much alive today, and helps to motivate professionals and patients about oral cancer examinations and risk factors. She also authored the Talk4Hope book series, written to inspire children and parents who have a family member with cancer.This Family Book Series helps families cope with their feelings about cancer, enlightens parents on how to communicate with their children, and creates special moments to cherish. Read Eva’s contribution in this eVillage FOCUS issue.

For the 12th year in a row, April was the official oral cancer awareness month in the U.S. Oral cancer awareness means raising public awareness through group collaboration to ensure that oral cancers get the national media attention necessary to highlight risk factors and oral cancer screening. Free oral cancer screenings were held throughout the country. But it does not have to be a special month to conduct oral cancer screenings in the community. There are a variety of forms for editable press releases for events. Conduct your community activity when it is convenient for you.

Rates of oral cancer are on the rise among men, and researchers say the cause is not the use of tobacco and alcohol, risk factors we have been aware of for years. The number of smokers in the U.S. has steadily declined in the past 50 years, according to the CDC, yet the rate of oral cancer has remained relatively steady, and has recently been on the increase. The culprit is the human papillomavirus, or HPV, the sexually transmitted virus responsible for the majority of cases of cervical cancer in women. Approximately 65 percent of oral cancer tumors were linked to HPV in 2007, according to the National Cancer Institute.

The profile of these new cases of oral cancer is non-smokers who are predominantly white, upper middle class, college-educated men. HPV-16, the strain of the virus that causes cervical cancer in women, has become the leading cause of oral cancer in non-smoking men. Oral HPV infection was strongly associated with oropharyngeal cancer among subjects with or without the established risk factors of tobacco and alcohol use in this case-controlled study. An even greater than-additive risk has been reported, although inconsistently, for patients exposed to both HPV and tobacco and those exposed to both HPV and alcohol.

A University of North Carolina (UNC) study found the incidence of oral tongue cancer increasing in young, white females, even though overall, incidence of oral cavity squamous cell carcinoma (OCSCC) was decreasing for all ages. The increasing incidence was most dramatic for white females ages 18 to 44. They had a percentage change of 111 percent.

Interestingly, the incidence decreased for African American and other racial groups. They analyzed incidence and survival data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1975 to 2007 for OCSCC and oral tongue squamous cell carcinoma (OTSCC).


There is an enormous effort to vaccinate girls and women between the ages of 11 and 26 against HPV, and according to experts, should have included boys and men from the beginning. Gardasil (Merck), one of the two major vaccines used to prevent HPV infection, wasn’t approved for use in males in the United States until 2009, three years after it was approved for women. Men have a greater chance of contracting the HPV virus from oral sex than women do from the same behavior, though researchers are not clear on the reason for this phenomenon. For CDC information on HPV vaccines, visit their website.


The other vaccine is Cervarix (GlaxoSmithKline). According to the CDC, both vaccines are very safe, and are made with very small parts of the human papillomavirus (HPV) that cannot cause infection. As with any pharmaceuticals, there can be side effects. For a recently updated Q & A page on these vaccines, visit the CDC website.

In girls and young women ages 9 to 26, Gardasil® helps protect against two types of HPV that cause about 75% of cervical cancer cases, and two more types that cause 90% of genital warts cases. In boys and young men ages 9 to 26, Gardasil helps protect against 90% of genital warts cases. Gardasil also helps protect girls and young women ages 9 to 26 against 70% of vaginal cancer cases and up to 50% of vulvar cancer cases.

While the vaccines available are not approved for prevention of oral cancer, the impact the vaccines may have on oral cancer should be considered. The Oral Cancer Foundation believes that elimination of a causative agent (HPV16), by preventing infection from it by use of a vaccine, will subsequently prevent any disease that agent may have produced in the protected individual. This is simple scientific extrapolation, and a view shared by many in the science community. Makes sense to me!

Oral cancer has a low survival rate because it is generally not discovered until it has spread to other areas, according to the CDC. Only half of people who’ve been diagnosed with oral cancer will live longer than five years. Prevention is the name of the game. Do not use tobacco products, use alcohol in moderation, limit the number of sexual partners and use protection, and screen (or be screened) annually for oral cancer. Anyone old enough to have engaged in sexual behaviors which are capable of transferring the HPV needs to be screened annually for oral cancer. There are many cancer screening protocols available. Education, prevention, screening and early intervention can save lives.