Last week, Michael Douglas claimed his throat cancer was caused by the ubiquitous virus, HPV. He also smoked and drank, which are two risk factors for throat cancer, but the question is: Is it possible that his cancer was caused by HPV, that notorious sexually transmitted virus that is more notable for causing cervical cancer and genital warts in women? The answer is a whopping YES! Promiscuity can be fun, but it definitely has its drawbacks in the Infectious Disease department.
Historically, HPV (Human Papilloma Virus) has plagued mostly women. HPV can be transmitted in other ways aside from sexual encounters, but the focus of this blog will be on the cancers that can and do arise from sex. And it will be a grossly simplified blog at that. I’m not including my sources, but I have them available and will pass them along upon request.
In the USA, HPV currently infects 20 million Americans, and there are approximately 6 million HPV infections newly diagnosed per year, making it the most common STD. The chances of acquiring a genital HPV infection are highest among sexually active adolescent girls between the ages of 11 and 12, when the epithelialization of the cervix becomes active, and sexually active teenage women between the ages of 15 and 19. Alarmingly, according to the Center of Disease Control (CDC), at the current rate of pathogenesis, at least 80% of all women will have acquired a genital HPV infection by age 50. Though many other sexually transmitted diseases are prevented with proper condom usage, HPV is not, and may still be transmitted via skin to skin contact, which makes it a more formidable public health threat. That said, condoms do decrease the risk of transmission, but definitely not 100%.
HPV represents a family of viruses with over 100 strains. Most of those strains cause genital warts, a relatively benign condition, however 10 strains have been linked to cervical cancer. In both females and males, HPV-6 and HPV-11 are found in most cases of anogenital warts and in females, HPV strains 16 and 18 are found in 70% of cervical intraepithelial neoplasias (cancers) and vaginal neoplasias. It should be noted that viral strains HPV-16 and 18 are implicated in anal cancer and oropharyngeal cancers in both men and women, so addressing the link between HPV and cancer should not be limited to females. ( Michael Douglas is correct!)
In early 2012, the American Cancer Society (ACS) predicts 12,170 new cases of invasive cervical cancer per year and of those cases, 4,220 women will die from it. The ACS’s latest statistics on cervical cancer show the prevalence rate to be highest in Hispanic women, followed by African-American women, Asians, Pacific Islanders and then Whites.
What’s up with HPV causing cancer in guys??
Sorry guys, but it’s true. Up until this point, you had all the fun, but now the prevalence of HPV-induced cancers is now increasing in men. And it ain’t pretty. I know I’m the ultimate buzz kill, but read on and learn how to protect yourself.
Research shows 80% of males are infected with HPV at some point in their lives. It’s well known that HPV infects males, even though they may be asymptomatic, and males can also be carriers of HPV and become vectors for transmitting HPV to their female sexual partners. Early in 2012, the CDC and the American Academy of Pediatrics officially recommended boys between the ages of 11 or 12 receive the HPV vaccine, and the catch-up vaccination series ( or vaccines for those who did not receive the 3-dose series) was recommended for males between the ages of 13 and 21. As Dr. Brady, chairman of the American Academy of Pediatrics Committee on Infectious Disease states, “Currently, our approach isn’t effective from a public health perspective since males are also participants in the transmission of HPV. If we include both girls and boys, we could have a potential impact on HPV transmission.” So parents, I suggest vaccinating your sons, too.
The CDC’s recommendation also occurred at a time when the prevalence of HPV-induced anal and oral cancers in men significantly increased and was shown to vary with male sexual behaviors. For example, in one study conducted by Nyitray et al., it was shown that the prevalence of anal cancer was 12.2% among men who had sex with women and 47.2% among men who had sex with men. Men at greatest risk of contracting HPV-induced cancers in both groups were men with multiple sexual partners, men with previous Hepatitis B diagnosis, men of younger age, and men who never used a condom for anal sex.
A 2012 study conducted by the National Cancer Institute shows that HPV-positive tongue and throat cancers increased by 225% from 1987 to 2004, are mostly found in men, and at the current rate of diagnosis, the prevalence of HPV-positive oral cancers among men will increase 30% by 2020, which will be a higher number than females diagnosed with cervical cancer. (Yikes!) Specifically, 6,700 HPV-positive throat cancers were diagnosed in men in 2010 and the number is expected to rise to 8, 500 by 2020.
THE GOOD NEWS:
Multiple studies have shown that most HPV infections are asymptomatic and transient, and 91% of infections are cleared by our immune systems within 2 years of being infected. A healthy immune system is key, so whatever you do, boost your immune system: Eat right, sleep the right amount of hours, don’t smoke and reduce the stress in your life.
Also, females who regularly get pap smears can catch HPV-induced cervical cancer ( a slow-growing cancer) and prevent it from spreading.
Your Immune System Sucks or You want another solution?
A VACCINE FOR BOTH BOYS AND GIRLS:
In 2006, Merck created the first vaccine, Gardasil, a quadrivalent vaccine, which means it targets four viral strains: HPV6, 11, 16 and 18. In 2007, GlaxoSmithKline created Cervarix, a bivalent vaccine, or one that targets two viral strains ( HPV16 and HPV18). Both vaccines have highly efficacious results in controlled clinical trials and both have been approved by the United States Food and Drug Administration (FDA) for the prevention of cervical cancer. In addition, Gardasil is FDA approved for the prevention of external genital warts and anal cancerous lesions. The vaccines have proven efficacious. In two large randomly controlled trials, Gardasil reduced the incidence of HPV infection in women between the ages of 16 and 23 by 90% and 99%, and it increased the level of protective antibodies to HPV significantly above the level of natural exposure to HPV. Both vaccines were shown to be more efficacious when administered in boys and girls in the 10-15 age group with an immune response that is 1.7 to 2.7 times higher than in the young women and men in the 16 to 23 age group. An important distinction is that the vaccine is only effective when given prior to being infected with HPV, which is why the CDC, as well as the Advisory Committee on Immunization Practices (ACIP) recommends the vaccine for boys and girls between the ages of 11 and 12, prior to the onset of sexual activity. The CDC also recommends the vaccine for females ages 13 through 26 and males between the ages of 13 and 26 if they did not receive the vaccine during the optimal ages of 11 and 12. Both vaccines are administered in 3 doses, with the second inoculation recommended for 1 month after the first inoculation and the 3rd inoculation 6 months after dose 1.
You can’t pay for the vaccine or it costs too much?
The vaccine is friggen expensive, but in the long term, it’s proven to be cost-effective.
( If you’re a numbers person, thinking about not getting the vaccine because of the cost, interested in healthcare costs, or just a finance nerd, read the next section. If you’re not, skip it, or you’ll fall asleep. To make it easier to understand, a QUALY is just another way of measuring the cost/benefit of an intervention. It stands for Quality-Adjusted Life Years, and takes into account how much “quality life” you’ll gain if you get the intervention.)
Presently, the estimated cost of quadrivalent HPV vaccine is $360 for a 3-course series, making it among the most expensive of all vaccines. Both companies that produce the vaccines say their prices reflect a major investment in research and development and relatively complex manufacturing processes. Jennifer Allen, a spokesperson for Merck stated: “HPV-related diseases cost the U.S. health-cares [sic] system about $5 billion dollars every year, and we took that into consideration.”
Translation: Big Pharma will never take an altruistic paycut. 😉 And until we can address the ridiculous cost of healthcare, we have to make decisions based on current prices.
Also, the question of whether booster vaccinations will be needed remains to be determined, leaving the possibility that the price of full HPV protection via vaccination could increase. Other costs incurred via a mandatory vaccination program are vaccine administration costs, (estimated at $15 per shot), parent work time and wages lost due to accompanying a child to the doctor’s office, and transportation costs for 3 visits to a doctor’s office. Though insurance companies typically cover child vaccinations that are recommended by the CDC, 13 % of children are still uninsured. Also, as previously mentioned, the vaccine does not eliminate the costs of bi-annual recommended pap tests, as pap tests are still needed in spite of the HPV vaccine.
In an article published in the American Journal of Obstetrics and Gynecology, researchers stated that the annual cost burden of gynecological HPV-related illnesses is between $2.25 and $4.6 billion, and the yearly cost of cervical cancer treatment is between $181.5 and $363 million. Another cost-benefit analysis showed the annual economic burden of HPV-related diseases to be over $5 billion. ( So again, in the end, the vaccine is seemingly more cost-effective.)
Sanders et al. calculated that a vaccine with a 75% probability of immunity against high-risk HPV infection results in a life-expectancy gain of 2.8 days or 4.0 quality-adjusted life days at a cost of $246, relative to current practice. Even if the vaccine efficacy rate were 35%, the cost effectiveness would increase to $52,398/QALY ( Quality Adjusted Life Years). Furthermore, it is important to note that this financial burden does not take into account the emotional, psychological, and physical costs of being diagnosed with HPV-related diseases (e.g., cervical cancer) and suffering potentially permanent devastating consequences such as infertility.
Additionally, Sanders et al. found that vaccinating the present U.S. cohort of 12-year-old girls would avert more than 272,740 cases of HPV, 7,992 cases of cervical cancer, and 3,093 cervical-cancer deaths over the cohort’s lifetime. Furthermore, when cost-effectiveness of male HPV vaccination in the U.S. was assessed, Chesson et al. found that it depended on vaccine coverage of females.
When including all HPV-associated outcomes including cervical intraepithelial neoplasia (CIN), genital warts, cervical, vaginal, vulvar, anal, oropharyngeal, and penile cancers, the incremental cost per QALY gained by incorporating male vaccination to a female-only vaccination program was $23,600 in the lower female coverage scenario (20% coverage at age 12) and $184,300 in the higher female coverage scenario (75% coverage at age 12).
This means, vaccinating all females is better than vaccinating some males and some females.
Will kids see the Vaccine as a green light to start having sex?
The short answer is NO. Parents and Religious folks worry about this all of the time- as if the vaccine is intended to make miniature sex machines rather than protect kids from a very common and potentially dangerous virus. As the Reverend Thomas J. Euteneuer, President of Human Life International, said, “There it is: Vaccinated sex. The layer-upon-layer of sexual backups turns human intimacy into a mechanistic pastime like a video game with a delete protection.”
Ummmm, not really. And he has a really stunted, unrealistic and sex-obsessed view of the world if he only sees the vaccine as a green light for sex and not for the long-term prevention of cancer. Still, many people think like him and are convinced the vaccine will interfere with their abstinence message. That’s a valid concern, but the research proves them wrong.
“Behavioral disinhibition” in the aftermath of a health-related intervention that relates to people having sex is a myth. Conservatives think it happens, but it doesn’t. For example, a large study by Kirby et al. showed that the increased availability of condoms and the morning-after pill in Seattle schools did not result in an increased frequency of risky sexual behavior, thereby weakening the argument for behavioral inhibition. Also, the organization A National Campaign to Prevent Teen and Unplanned Pregnancy concluded after a nation-wide study on abstinence programs: “At present, there does not exist any strong evidence that any abstinence program delays the initiation of sex, hastens the return to abstinence, or reduces the number of sexual partners. In addition, there is strong evidence from multiple randomized trials demonstrating that some abstinence programs chosen for evaluation because they were believed to be promising actually had no impact on teen sexual behavior. That is, they did not delay the initiation of sex, increase the return to abstinence or decrease the number of sexual partners.” Yet, even though abstinence programs are shown to not produce lasting results, abstinence-only-until-marriage initiatives have received a half a billion dollars from the federal government since 1996. I can think of much better ways to use that money. Just sayin’. 😉
So that’s the scoop on HPV, men, women, and the vaccine. I have to thank Michael Douglas for putting a spotlight on the growing prevalence of HPV-related cancers in men, because it is a growing public health threat and one that is easily avoidable. Ultimately the decision to vaccinate kids rests with the parents. That said, I’m not a parent yet, but if I had my own kids, they would all be vaccinated.
P.S. If you have any questions about this blog, just message me.
Also, my next blog will include pictures of interesting things I saw while out running, while in Europe and some more gems. At least they are gems to me.
P.P.S. : Go forth and bloom wellness. 😉