By Mark Arredondo MD, FACS
The human papilloma virus (HPV) is comprised of 150 various viruses that cause infection. About 75% are skin viruses leading to growths or warts, but other types are known to be responsible for development of cancers. These viruses are transmitted by sexual contact, and while most teenagers or adults will clear the virus, in many, the virus lingers. This can result in cancers of the throat, cervix, and other sexual organs. HPV is the most prevalent sexually-transmitted infection in the U.S. To illustrate, about 10% of American girls are infected by age 15, increasing to about 20% by age 17. Exposure is found in 85% of sexually active U.S. women and 91% of sexually active U.S. men. According to the Centers for Disease Control, almost 31,000 new cancer cases each year from 2008 to 20012 were attributable to HPV, in which case a vaccination could potentially have prevented 29,000 .
Cervical cancer has diminished in the U.S. because of Pap smear detection. It can then be addressed by surgery or cryotherapy, before developing into cancer. In the U.S., women take advantage of the availability of cervical cancer screening. In other parts of the world, such screening is nonexistent and cervical cancer can be the leading cause of cancer deaths. While HPV is responsible for virtually all cervical cancers, it may also contribute to the development of vaginal and vulvar cancers. However, these are less common than cervical cancer.
A peculiar development has been observed in cancers of the throat. Not the smoking-related larynx cancer or mouth cancer, but cancers of the tonsil and base of the tongue. These types of cancers have been associated with HPV. From 1984 through 2004, the association of HPV with these cancers has tripled and now represents over 70% of those cancers, being discovered in younger men and non-smokers. Caused by the HPV virus, it is diagnosed mostly in an advanced stage, commonly without pain, a nagging sore throat and a continual lump in the neck. There may be as many as 10,000 cases expected for 2016, and could possibly surpass cervical cancer at this rate.
In 2006, Gardasil by Merck & Company was the first vaccine was cleared by the FDA. Later, another vaccine became available and was marketed more heavily in Europe. These vaccines are effective when provided prior to an HPV infection, obviously administered prior to sexual contact. The World Health Organization recommended the vaccination as a 2-dose schedule when initiated prior to age 15, and a 3-dose schedule when initiated after the girls’ 15th birthday. While initial interest was for vaccination in girls, the American Cancer Society updated its guidelines in July for HPV vaccination to include males. Timing of the vaccinations can start at age 11 or 12, but as early as 9 years old. While in the U.S., we’ve not been as diligent in providing the three shots (about 1/3 complete all three, compared with 60% in the United Kingdom and 70% in Australia), but the benefits are already evident. For girls vaccinated in the U.S. from 2004 through 2013, the rate of infection with HPV was reduced by 64% in those of ages 14 – 19 years and by 34% in those of ages 20 – 24.
While similar to other vaccinations, the injection site can be briefly sore and there have been reports of other illnesses. As far as vaccinations go, these against HPV are thought to be remarkably safe. The benefits in reducing disease, avoiding treatments for those diseases, and preventing deaths from those diseases is almost unimaginable for someone like me, a cancer surgeon.
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