June 07, 2018
By Greg Peters
|Roy Jensen, M.D.|
The University of Kansas Cancer Center is joining forces with a host of the nation's top cancer centers to focus the spotlight on eliminating human papillomavirus (HPV)-related cancers in the United States.
The KU Cancer Center is partnering with the other 69 National Cancer Institute (NCI)-designated cancer centers in urging an increase in HPV vaccinations and screenings in the hope of ridding the country of HPV-related cancers, beginning with cervical cancer. With the incidence of HPV-related cancers on the rise in both men and women during the last two decades, these institutions are collectively calling on doctors, health professionals, parents and guardians to take action against this public health risk by increasing HPV vaccinations and screenings across the country.
"Having all 70 centers sign the endorsement will hopefully jumpstart the effort to eliminate more than 40,000 HPV-related cancer cases each year," said Roy Jensen, M.D., director of the KU Cancer Center and vice president of the Association of American Cancer Institutes.
The World Health Organization reports there are more than 100 types of HPV, of which, at least 13 are known to cause cancer. Every year, nearly 80 million Americans are infected by HPV, and more than 31,000 will be diagnosed with an HPV-related cancer. Cancers that have been linked to HPV include cervical, throat, tonsil, tongue, anal, penile, vulvar, vaginal and oropharynx.
While HPV infections occur mostly in the late teens and early 20s, the cancers generally don't start showing up for decades. Experts say the incidence of HPV-related cancers has been on the rise, particularly in young men.
"According to the Kansas Cancer Registry, the incidence of HPV-associated oropharyngeal cancer — a type of head and neck cancer — has significantly increased in the past 20 years, especially among men," said Hope Krebill, the executive director of the Midwest Cancer Alliance and co-chair of the Missouri Cancer Consortium's HPV Workgroup. "In the next two years, it is estimated that HPV-related oropharyngeal cancers in the United States will outnumber HPV-related cervical cancers."
A growing need
The HPV vaccine was introduced in 2006, but vaccination rates remain below 50 percent in the U.S. among age-appropriate candidates, according to the Centers for Disease Control and Prevention. Healthy People 2020, an initiative by the U.S. Department of Health and Human Services, calls for 80 percent of 13- to 15-year-olds to be vaccinated by 2020; 93 percent of age-eligible women to be screened for cervical cancer; and prompt treatment for women who test positive for high-grade, precancerous cervical lesions.
CDC data from 2016 show 49.5 percent of girls and 37.5 percent of boys ages 13-17 in the United States had completed their vaccination series. In Kansas, the most recent data (2016) show 45.6 percent of girls and 26 percent of boys were up to date with their vaccine by their 17th birthday, ranking the state 41st nationally. Missouri had 38 percent of the girls and 33 percent of the boys covered in 2016. While still too low, the numbers show a significant increase from 2014 when both Kansas and Missouri ranked among the states with the lowest vaccination rates.
"HPV vaccination rates are low in both Kansas and Missouri, for males and females," said Krebill. "Although HPV-associated cancers are rising in men, our rate for male vaccinations is much lower than for females."
"In our region, we don't have a good uptake of the vaccine," added Kevin Ault, M.D., professor in the KU Department of Obstetrics and Gynecology. "In Kansas, Oklahoma and Missouri we have some of the lowest vaccination rates in the country so I think it's a great thing that KU Cancer Center, as the leading cancer center in our region, is taking this on as a project and endorsing this National Cancer Institute-sponsored statement."
Since the vaccine's introduction, more than 100 million doses have been distributed domestically and more than 270 million worldwide. The CDC recommends all children between 9 and 13 compete the vaccine series — two doses for youths under 15 and three for those older than 15. The CDC recommends vaccinating men up to age 21 and women up to 26.
As a result of increased vaccinations, the United States has already seen a 64 percent drop in the four HPV types in teenage girls 14-19 and a 34 percent in young women 20-24. Analyses of effectiveness using data from multiple countries shows a clear connection between HPV vaccination and the reduction in precancerous cervical lesions and the prevalence of HPV infection. A study in Finland showed a 0 percent rate of HPV infection among vaccinated women.
HPV vaccinations have not been without skeptics. Early on, critics were quick to point out that Merck, the maker of Gardasil, used overly aggressive and at times heavy-handed marketing and lobbying campaigns after the drug had received fast-track FDA approval in 2006. In addition to initial concerns about side effects, questions have been raised about the ethics of drug manufacturers engaging in public health lobbying, especially efforts to sway Congress in favor of compulsory vaccination laws.
Ault was an investigator on a multi-year study recently published in the journal The Lancet that supported the HPV vaccine as a safe and effective prevention for HPV-related cancers. The study examined more than 14,000 women, ages 16 to 26, in 18 countries who used Gardasil 9, a vaccine that prevents against nine types of HPV and is currently the only HPV vaccine available in the U.S.
"We have more than a decade of experience with this vaccine, and there are studies that have literally a million people in them that show the vaccine has a good safety profile," Ault said.
Over the years, HPV vaccines have proven effective with minimal side effects. The CDC reports the most common side effects are swelling where the shot was given, fever, headache, tired feeling, muscle and joint pain, and on rare occasions, fainting. The CDC says there is no evidence to suggest a causal link between Gardasil and any reported deaths. And of the 29 million doses of Gardasil 9 given out in the U.S. between 2014 and 2017, there are only four confirmed reports of Guillain-Barré syndrome.
"I think one of the potential problems is that if you look at some of the autoimmune and neurological diseases, they are fairly common in (all) adolescents," Ault said. "Just by coincidence some adolescents will develop a problem around the time they get an HPV vaccination."
The front line of defense
Physicians, parents and guardians are on the front line of defense when it comes to getting children vaccinated. The CDC recommends doctors talk to parents about the HPV vaccination the same day they discuss other adolescent vaccines.
Doctors and family health care providers are strongly encouraged to recommend the HPV vaccinations for their patients and not shy away from conversations about the necessity and safety of the vaccines at an early age. "This is critical," Jensen added. "Health care providers need to be advocating for the patients to get vaccinated to prevent cancer."
"I think one of the hard things about this for pediatricians is they don't generally deal with HPV-related cancers," Ault added. "It's something you get infected with in your late teens and early 20s, but you don't get cancer until you're 30, 40 or 50. We don't have a lot of vaccines that work like that, and so that makes it a hard thing to think about with this particular vaccine."
"Most parents understand that the HPV vaccine is cancer prevention, plain and simple," said Krebill. "HPV vaccination is the best thing parents can do to protect their children from cancers caused by HPV. The immune response to the HPV vaccine is greatest at the ages set forth in guidelines from the Centers for Disease Control, which are the ages of 11 to 12."
Cost, however, should not be a prohibiting factor. In the U.S., many insurance companies pay for the vaccinations. For adolescents without insurance or whose insurance won't cover the cost, the Vaccines for Children program may be able to help.