If we were told that we could prevent 20,000 cancers every year in the United States, save about 10,000 lives (almost twice the number of people lost in the recent Iraq and Afghanistan wars) and prevent hardships related to treating these cancers (surgery, radiation, chemotherapy), no effort would be spared.
Universal HPV vaccinations can make this a reality, but instead, resistance to this sound medical practice continues. In the midst of our epic war against cancer, the message is lost in ideological skirmishes, misperceptions, presumed differential moral values and often, simple ignorance. So allow me to explain why the HPV vaccine is so important.
First, the medical facts: Human papillomaviruses (HPV) are a group of about 150 related viruses. More than 40 of them can easily spread through direct skin-to-skin contact, for example, during sexual intercourse (vaginal, anal or oral).
HPV infections are now the most common sexually transmitted infections in the United States. They are not related to other sexually transmitted infections, such as the ones that cause AIDS (HIV infections) or genital herpes (herpes simplex). Recent studies show that 40 percent of women have genital HPV infections. Not all lead to clinical problems; most of these infections resolve within 1-2 years either with treatment or with the normal activity of the body’s immune systems.
There are two kinds of sexually transmitted HPV infections: 1) low-risk viruses that cause skin warts (known as condylomata acuminata), and 2) high-risk or cancer-producing viruses. The latter are of serious concern. Two HPV types, HPV-16 and HPV-18, are responsible for most HPV-induced cancers.
These high-risk viruses, HPV-16 and HPV-18, now cause about 5 percent of all cancers worldwide: 100 percent of cervical cancers, 85 percent of anal cancers, and half of vaginal, vulvar and penile cancers. In addition, there is now an alarming rising incidence of oropharyngeal cancers, which occur on the tongue, tonsils or in the back of the throat. This frightening near-epidemic is related to HPV-16. By 2020, HPV will cause more cancers of the oropharynx than cervical cancers in the United States. Most of these cancers take 10 to 20 years to develop, so exposure to HPV raises significant fears and anxieties for many years after exposure.
Considering the latest numbers, it is estimated that 21,000 people every year develop HPV-related cancers, and more than 10,000 die from them. This is a terrible and preventable tragedy, not to mention the huge cost to society. Thus, it is sound medical judgment to prevent the development of these cancers.
Fortunately, there are two vaccines, Cervarix and Gardasil, that protect against the development of genital warts and cancers. Typically, these vaccines consist of three shots that are given over a 6-month period. The Centers for Disease Control recommends the vaccines for all girls and boys aged 11-12, teenagers who have not yet received the vaccine (through ages 21-26), and other sexually active age groups.
Despite the solid scientific evidence, there is significant resistance in the U.S. against broad HPV vaccination. This is mostly based on different perceptions of moral norms, fears of increased sexual promiscuity, common misconceptions, the belief that the vaccine is unnecessary, poor patient education by physicians, and parents’ fears that the HPV vaccines are unsafe or cause side effects. Less than a third of girls aged 13-17 years in the U.S. received all three HPV doses in 2012, compared with 80 percent in Australia and the United Kingdom. The percentage is even smaller for boys — about 7 percent — even though they can transmit HPV and can also get HPV-associated cancers.
The belief that vaccination may promote sexual promiscuity is incorrect. Several studies have shown that HPV vaccines do not alter sexual behavior. Moreover, there is no guarantee that sexual abstinence until marriage or a monogamous relationship would protect people from the risk of HPV. Even abstinent individuals can be at-risk after marriage, due to the previous sexual encounters of their partners. HPV infections do not necessarily reflect moral norms, and the risk of infection is almost universal.
Studies show that nearly all sexually active men and women are exposed during their lifetimes to some form of HPV infection, and can expose their partners. Abstinence until marriage is an individual choice and a right for some people, but given the frailty of human nature, should a single lapse in one’s lifetime be allowed to have such devastating consequences when the danger is so easily preventable? As the saying goes, always pray for the best, but plan for the worst.
Morality aside, the HPV vaccines make sound medical sense. They are safe and effective, and can reduce the world incidence of all cancers by at least 5 percent. It is therefore time to educate U.S. citizens — including parents, adolescents and young adults — about the risk of HPV infections and of cancers, and to encourage universal vaccinations against HPV.
Hagop M. Kantarjian, M.D., is the Baker Institute Scholar in Health Policy. He serves as a professor and chair of the Department of Leukemia at The University of Texas MD Anderson Cancer Center, where he is also the Kelcie Margaret Kana Research Chair and associate vice president for global academic programs.