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You can find the current article at its original source at http://www.guardian.co.uk/commentisfree/2013/jun/04/michael-douglas-oral-sex-hpv-vaccine
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| HPV prevention: vaccination works | HPV prevention: vaccination works |
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| No one wants to become infected with human papilloma virus, commonly known as HPV. Not Michael Douglas, who has recently talked to the media about his HPV-induced oral cancer and how he thinks he caught it. Not Jade Goody or Anita Mui, two celebrities who died young of cervical cancer, which is entirely attributable to HPV. And not the estimated 600,000 men and women worldwide who each year develop a cancer linked to one of the 10 varieties of HPV infection that are spread through sexual intercourse, and promote genital and oral cancer. | |
| More than half of them will die of their cancer, many in the developing world and without receiving any treatment. | More than half of them will die of their cancer, many in the developing world and without receiving any treatment. |
| HPV infection is incredibly common. More than 50% of men and women catch the virus within three years of becoming sexually active. Fortunately, the infection will clear in up up to 98% of cases; this occurs during the first few years after they catch HPV, and most of those affected never even know they had the infection in the first place. However, 2% of infected people stay infected, and remain at risk of cancer throughout their lifetime. Cancers most commonly develop after 20 to 40 years after catching the virus. | HPV infection is incredibly common. More than 50% of men and women catch the virus within three years of becoming sexually active. Fortunately, the infection will clear in up up to 98% of cases; this occurs during the first few years after they catch HPV, and most of those affected never even know they had the infection in the first place. However, 2% of infected people stay infected, and remain at risk of cancer throughout their lifetime. Cancers most commonly develop after 20 to 40 years after catching the virus. |
| We can screen for persisting HPV infection through pap smear programs, and hence stop cervical cancer before it gets a chance to develop. However, detecting persisting HPV infection at other sites has not proven practical, and we don’t know whether a patient will be unable to clear it when they get it. So we need to prevent the infection from happening in the first place. | We can screen for persisting HPV infection through pap smear programs, and hence stop cervical cancer before it gets a chance to develop. However, detecting persisting HPV infection at other sites has not proven practical, and we don’t know whether a patient will be unable to clear it when they get it. So we need to prevent the infection from happening in the first place. |
| Fortunately, we now have not one but two vaccines (of which I am the co-creator) which can reduce the risk of cervical cancer by preventing HPV infection. These were developed in the 1990s, and have proven safe and effective through extensive clinical trials. They have been available since 2007 in most countries. | Fortunately, we now have not one but two vaccines (of which I am the co-creator) which can reduce the risk of cervical cancer by preventing HPV infection. These were developed in the 1990s, and have proven safe and effective through extensive clinical trials. They have been available since 2007 in most countries. |
| Australia has been an early adopter, introducing a free schools-based HPV vaccination program for 12 year old girls in 2007, with three years of catch up immunisation for women up to 26 years. More than 80% of eligible girls are now immunised annually. One consequence has been a dramatic reduction in genital warts in young women. This is because an HPV virus that causes warts but not cancer is included in one of the available HPV vaccines. The expected reduction in cancer-associated HPVs in pap smears in young women has also been reported recently, meaning that the reduction in cervix cancer precursors seen in the clinical trials will also occur in the vaccinated community. | Australia has been an early adopter, introducing a free schools-based HPV vaccination program for 12 year old girls in 2007, with three years of catch up immunisation for women up to 26 years. More than 80% of eligible girls are now immunised annually. One consequence has been a dramatic reduction in genital warts in young women. This is because an HPV virus that causes warts but not cancer is included in one of the available HPV vaccines. The expected reduction in cancer-associated HPVs in pap smears in young women has also been reported recently, meaning that the reduction in cervix cancer precursors seen in the clinical trials will also occur in the vaccinated community. |
| In Australia, there are more deaths in men than in women from HPV-associated cancers. Many of these are cancers of the oral cavity, similar to the one that Michael Douglas has developed in his tongue. This cancer is becoming increasingly common in many countries. Perhaps this is why the Australia has recently become the first country to offer free HPV vaccine to 12 year old boys. Some reduction in genital warts in men has already been observed although only girls have been immunised to date; it’s therefore reasonable to ask whether immunising boys is necessary. | In Australia, there are more deaths in men than in women from HPV-associated cancers. Many of these are cancers of the oral cavity, similar to the one that Michael Douglas has developed in his tongue. This cancer is becoming increasingly common in many countries. Perhaps this is why the Australia has recently become the first country to offer free HPV vaccine to 12 year old boys. Some reduction in genital warts in men has already been observed although only girls have been immunised to date; it’s therefore reasonable to ask whether immunising boys is necessary. |
| Herd immunity is the likely reason for the reduction in wart disease in men. It relies on a high participation rate in the vaccine program to reduce the burden of infection in the community. While the vaccination rate in Australia is currently good, history tells us that this may be difficult to maintain. We don’t yet know the fraction of the community that need to be immunised to stop the spread of HPV. For highly infectious viruses like measles, 95% need to be immunised, but for less infectious viruses, lower percentages seem to work. Infected people carry HPV (and therefore likely are infectious) for up to five years, so it will probably be desirable to keep a high rate of protection through vaccination. | Herd immunity is the likely reason for the reduction in wart disease in men. It relies on a high participation rate in the vaccine program to reduce the burden of infection in the community. While the vaccination rate in Australia is currently good, history tells us that this may be difficult to maintain. We don’t yet know the fraction of the community that need to be immunised to stop the spread of HPV. For highly infectious viruses like measles, 95% need to be immunised, but for less infectious viruses, lower percentages seem to work. Infected people carry HPV (and therefore likely are infectious) for up to five years, so it will probably be desirable to keep a high rate of protection through vaccination. |
| More practically, men as well as women will want to ensure that they are personally protected, as oral cancer gives few early warning signs and HPV-associated genital cancers at sites other than the cervix are not so easy to cure as cervical cancer. | More practically, men as well as women will want to ensure that they are personally protected, as oral cancer gives few early warning signs and HPV-associated genital cancers at sites other than the cervix are not so easy to cure as cervical cancer. |
| Michael Douglas likely wishes that HPV vaccines had been around when he was 12. He might also be interested in the immunotherapies that are now under development to attack HPV-associated cancers, with some encouraging results recently reported from early clinical trials. Knowing that a virus can cause cancer is not necessarily bad news. | Michael Douglas likely wishes that HPV vaccines had been around when he was 12. He might also be interested in the immunotherapies that are now under development to attack HPV-associated cancers, with some encouraging results recently reported from early clinical trials. Knowing that a virus can cause cancer is not necessarily bad news. |