tag:theconversation.com,2011:/ca/topics/penis-cancer-24512/articlespenis cancer – The Conversation2018-01-30T18:54:47Ztag:theconversation.com,2011:article/909222018-01-30T18:54:47Z2018-01-30T18:54:47ZNew Gardasil 9 vaccine boosts teens’ protection from HPV and cervical cancer by 23%<figure><img src="https://images.theconversation.com/files/203938/original/file-20180130-170439-z90app.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While the previous Gardasil vaccine protected against 70% of cervical cancers, the updated Gardasil 9 version will protect against up to 93% of these.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>As 12 and 13-year-old boys and girls start a new school year, they will have access to the new, improved vaccine to protect against the human papillomavirus (HPV), which causes cervical cancer in women. </p>
<p>While the previous Gardasil vaccine protected against 70% of cervical cancers, the updated Gardasil 9 version will protect against up to 93% of these. And compared to the three doses required with the previous regimen, only two are needed now. </p>
<p>In Australia, around 900 new cases are <a href="https://cervical-cancer.canceraustralia.gov.au/statistics">diagnosed</a> and around 250 women die from the disease each year. But cervical cancer rates have halved in the past 30 years due to the high quality national Pap cytology screening program. </p>
<p>Prevention against cervical cancer is the main aim of the Gardasil 9 vaccine. But HPV is also linked to a large proportion of anal, vaginal and head and neck cancers, and the vaccine offers protection for these too.</p>
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<a href="https://theconversation.com/interactive-body-map-what-really-gives-you-cancer-52427">Interactive body map: what really gives you cancer?</a>
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<h2>What is HPV?</h2>
<p>Genital HPV is a common group of viruses, mainly transmitted through sexual contact, including contact of genital skin to genital skin. Most people are infected with HPV shortly after the onset of sexual activity and most clear the infection on their own. </p>
<p>But for a small number of those infected, the HPV becomes persistent. A proportion of these people will go on to develop abnormal cells that are the precursor to cervical cancer. HPV is the cause of nearly all cervical cancers. But the virus is <a href="http://www.hpvvaccine.org.au/parents/parents-what-is-hpv.aspx?link=home">also linked</a> to 90% of anal cancers, 65% of vaginal cancers, 50% of vulva cancers and 35% of penile cancers and 60% of oropharyngeal cancers (cancers of the back of the throat, including the base of the tongue and tonsils).</p>
<p>The Australian government was one of the first to introduce a free Gardasil vaccine to all female students aged 12 to 13 years in 2007 (with a catch up to the end of 2009 for those up to 26 years of age). This protected against four different strains of HPV. Two of those strains (HPV 16 and 18) cause about 70% of cervical cancers; the other two cause the majority of genital warts (HPV 6 and 11). </p>
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<p>Australia was also one of the first countries to adopt a school-based, gender-neutral vaccine program in 2013, by introducing free, ongoing vaccinations to young boys 12 to 13 years of age.</p>
<h2>What does Gardasil 9 offer?</h2>
<p>The new Gardasil 9 vaccine, available from this week, targets nine strains, seven of which cause around 93% of all cervical cancers (in addition to HPV 6/11 so protects against 90% of genital warts). It includes protection for the five next most common cancer-causing HPVs globally (HPV 31/33/45/52/58).</p>
<p>The new vaccine has been tested in global clinical trials involving more than 14,000 women in 18 countries, aged 16 to 26 years. They received either the new Gardasil 9 vaccine or the original Gardasil vaccine. Published in the New England Journal of Medicine and the Lancet, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31821-4/fulltext?rss%3Dyes">the study</a> looked at the rate of pre-cancerous cell changes in women six years later. </p>
<p>It found the new vaccine was far more effective, targeting an extra five of the most common cancer-causing strains of HPV and potentially preventing 23% more cervical cancers. Thus infection with the new types was markedly reduced too. With a reduction in infection, there is a reduction in the diseases that the HPV can cause.</p>
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Read more:
<a href="https://theconversation.com/weekly-dose-gardasil-9-the-vaccine-that-could-soon-protect-against-cervical-cancer-in-fewer-doses-82826">Weekly Dose: Gardasil 9, the vaccine that could soon protect against cervical cancer in fewer doses</a>
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<p>The common side effects with Gardasil 9 in the clinical trial were the same as with the older Gardasil vaccine. These were pain at the injection site, local swelling in the arm at the injection site and redness. There were no differences between the serious adverse events between the two vaccines.</p>
<h2>Who should get the new vaccine?</h2>
<p>Australia was one of the first countries to adopt an HPV vaccination program and has one of the <a href="http://www.hpvregister.org.au/research/coverage-data">highest coverage rates</a>, with around 79% of girls and 73% of boys having received the Gardasil vaccine.</p>
<p>Those who have already had the original vaccine have excellent protection from HPV, so we are not recommending they should go back for the new vaccine.</p>
<p>The new vaccine is free to 12- to 13-year-olds as part of the <a href="http://www.immunise.health.gov.au/">National Immunisation Program</a>. It’s also available at a cost to adults and has been shown effective in protecting against HPV in people up to the age of 45 years. </p>
<p>Those who have not been infected by the strains of HPV gain the most benefit from the vaccine. However, the vaccine boosts the immune response in sexually active individuals who have been infected previously with any of these HPV strains targeted by the vaccine, should they come into contact with the virus again.</p>
<h2>Regular screening important</h2>
<p>It’s important women continue to have regular screening to avoid abnormal cells developing into cervical cancer, even if they have had the vaccine. In December 2017, Australia’s screening program changed. The Pap test was replaced by a cervical swab testing for HPV DNA. This is a more sensitive test to detect underlying cellular abnormalities than the Pap test.</p>
<p>A <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002388">five year study involving 5,000 women</a> found the new HPV test was far more effective in detecting high grade pre-cancerous changes to the cervix compared to the traditional Pap test. It has the potential to prevent 30% more cervical cancers.</p>
<p>Women will now have their first test at age 25 instead of 18. After their first HPV test, women will be tested every five years instead of every two years. They will be tested up to age 74, and, in an important development, self-collection will be an option for some women who may have difficulty with a vaginal test.</p>
<p>We are already seeing the benefit of the original Gardasil vaccine on rates of HPV. With high coverage of the new Gardasil 9 vaccine, and adoption of the new HPV screening test it is predicted we will see a rapid decline in the cervical cancer rate in Australia in the coming years.</p>
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<p class="fine-print"><em><span>Suzanne Marie Garland has received advisory board fees and grants from CSL and the GSK group of companies, and lectures fees from Merck, the GSK group of companies and Sanofi Pasteur. In addition, she received funding through her institution to conduct HPV vaccines studies for MSD and the GSK group of companies. She is a member of the Merck Global Advisory Board as well as the Merck Scientific Advisory Committee for HPV.</span></em></p>Prevention against cervical cancer is the main aim of the Gardasil vaccine. But HPV is also linked to a large proportion of anal, vaginal and head and neck cancers.Suzanne Marie Garland, Professor, Melbourne University, The Royal Women's HospitalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/587722016-10-05T19:15:27Z2016-10-05T19:15:27ZBoys should also get the HPV vaccine to protect themselves from oral and genital cancers<p>The human papillomavirus (HPV), which causes cervical cancer in women, is also responsible for many cancers in men. It causes most cancers of the tonsils (known as oropharyngeal cancers), which are more common in men than women. HPV is also to blame for cancers of the anus, vulva, vagina and penis. </p>
<p>Oral cancers – which include those of the tonsils, mouth and tongue – affect more than 300,000 people globally each year. A person living in Australia has a one in 49 estimated risk of <a href="https://head-neck-cancer.canceraustralia.gov.au/statistics">being diagnosed with head and neck cancer</a> by their 85th birthday, which includes oral cancers.</p>
<p>The chance is higher in males (one in 32) than females (one in 98). An estimated 769 males will die from head and neck cancer in Australia in 2016, compared to 247 females.</p>
<p>The best way to prevent these cancers is to get the HPV vaccine, which is available for free under <a href="http://www.hpvvaccine.org.au/the-hpv-vaccine/how-when-where-vaccine-given.aspx">Australia’s National HPV Vaccination Program</a> to boys and girls aged 12 and 13. Those over 14 can obtain the vaccine from their GP or local immunisation provider, but they will need to pay for it.</p>
<h2>What is the human papillomavirus (HPV)?</h2>
<p>Most of us (<a href="http://www.hpv.com.au/">around 80%</a>) will acquire an infection from a virus in the human papillomavirus family at some point in our lives – usually without knowing it, as there are often no symptoms. HPV infections <a href="https://www.ncbi.nlm.nih.gov/pubmed/25392180">are transmitted through vaginal and oral sex</a>, and even kissing.</p>
<p>HPV is a group of viruses <a href="https://www.ncbi.nlm.nih.gov/pubmed/174077">first identified in the mid-1970s</a>. There are <a href="https://www.ncbi.nlm.nih.gov/pubmed/23683837">now more than 170 known types</a>, which <a href="http://cmr.asm.org/content/16/1/1.short">can infect</a> the skin and live in the genital tract and on the lining inside our mouth. </p>
<p>When they live on your skin, <a href="http://www.hpv.com.au/what-is-hpv.aspx">they manifest into the common wart</a>. The viral culprits responsible are usually the “low risk” HPV types: 6, 11, 13 and 32.</p>
<p>But when the virus invades the lining of the mouth, throat, respiratory tract and genitals, the infection can lead to cancer. Long-term infection with “high risk” HPV types such as 16, 18, 31, 33, 45, 52 and 58 are major risk factors for cervical cancer, cancer of the anus, genitals and oropharyngeal cancers.</p>
<p>The oropharynx is <a href="http://onlinelibrary.wiley.com/doi/10.1002/hed.20460/full">the middle part of the throat</a> which includes the base of the tongue, tonsils, the soft palate and the walls of the pharynx.</p>
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<a href="https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=535&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=535&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=535&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=672&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=672&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=672&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The oropharynx is the middle part of the throat.</span>
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<p>A <a href="http://jnci.oxfordjournals.org/content/107/6/djv086.abstract">recent study</a> showed HPV was present in 91% of cervical and anal cancers, 75% of vaginal cancers, 69% of vulvar cancers, 63% of penile cancers and 70% of oropharyngeal cancers.</p>
<p>HPV 16 is the main virus responsible for mouth infections; and both men and women are equally affected by the virus. </p>
<p>There is no medical treatment for the virus itself but the <a href="http://www.jci.org/articles/view/57149">body will often clear the virus</a>, usually within two years of detection. However, the virus can live in some people for years, with visible symptoms only appearing ten to 20 years after the first infection. </p>
<p>When the virus causes oropharyngeal cancer, patients with early-stage tumours are treated with radiation therapy or the tumour is removed surgically. These patients have a 90% survival rate past five years and most live a normal life. </p>
<p>Unfortunately, most patients will <a href="https://www.ncbi.nlm.nih.gov/pubmed/25255960">present with late-stage disease</a> where the five-year survival rate is 40%. The grim prognosis for patients with advanced oropharyngeal cancer <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124330/">has not changed in the last decade</a> despite vast improvements in treatment techniques. </p>
<p>While the population incidence of oropharyngeal cancer is relatively low, it is rising exponentially. In the United States, the incidence of HPV 16-positive oropharyngeal cancers has <a href="https://www.ncbi.nlm.nih.gov/pubmed/21969503">increased by 225%</a> between 1988 to 2004 (from 0.8 per 100,000 people to 2.6 per 100,000). </p>
<p>If these trends were to continue, the annual number of HPV 16 positive oropharyngeal cancers would surpass the annual incidence of cervical cancers (<a href="http://seer.cancer.gov/statfacts/html/cervix.html">currently 7.5 per 100,000 people</a>) by the year 2020.</p>
<h2>The HPV vaccine</h2>
<p>The HPV vaccine was developed by <a href="https://home.cancerresearch/10th-anniversary-of-worlds-first-hpv-vaccine/?mkt_tok=eyJpIjoiTm1NNE1UazJaak5tWmpGbSIsInQiOiIrRjJ3TlZmUFBZQUFuK0lvZWN2bExkWjFcL3hJSzFIRHhoOWJ5dHVUVm1rZmZcL3A3SlZjZ1RxWml6SlphMWdHV0J3RHBraTc0TUVlV05wMXNTRmlyNnROUm1NVXI4RUltUUs0VFp2R2VBQVhRPSJ9?mkt_tok=eyJpIjoiTm1NNE1UazJaak5tWmpGbSIsInQiOiIrRjJ3TlZmUFBZQUFuK0lvZWN2bExkWjFcL3hJSzFIRHhoOWJ5dHVUVm1rZmZcL3A3SlZjZ1RxWml6SlphMWdHV0J3RHBraTc0TUVlV05wMXNTRmlyNnROUm1NVXI4RUltUUs0VFp2R2VBQVhRPSJ9">Australian scientists</a> in 2006 to protect women from cervical cancer. In 2007, Australia was one of the first countries to implement a secondary high school HPV vaccination program for girls, which was then extended to include boys in 2013. </p>
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<a href="https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=284&fit=crop&dpr=1 600w, https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=284&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=284&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=357&fit=crop&dpr=1 754w, https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=357&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=357&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Gardasil can protect men and women from oropharyngeal cancers.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/neofedex/3447506652/in/photolist-6fDnBS-nzdi73-3wC83r-5JAu1B-49RPnG">FedEx/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Although initially intended as a preventative vaccine against cervical, anal and genital cancers, the vaccine can <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0068329">also protect men and women from oropharyngeal</a> cancers. The two HPV vaccines available in Australia (<a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home%7Ehandbook10part4%7Ehandbook10-4-6#4-6-4">Cervarix and Gardasil</a>) are licensed for males aged nine to 26 and females aged nine to 45.</p>
<p>A decade has now passed since the initial administration of HPV vaccines in certain countries to pre-adolescent girls. As of January 2016, one of the four branded vaccines, Gardasil, has been administered in more than 200 million doses worldwide. </p>
<p>In Australia and the United States, infections with HPV types 6, 11, 18 and 16 have reduced by 87%. There was a 85% <a href="http://cid.oxfordjournals.org/content/early/2016/06/14/cid.ciw354.abstract">reduction in high-grade cervical abnormalities</a> in Australia, Europe, North America, and New Zealand. </p>
<p>The impact of the vaccine in preventing mouth cancer can’t yet be accurately assessed, as the average age of disease is 56 years, and the girls vaccinated haven’t yet reached that age. However, the reduction in HPV infections worldwide due to the vaccine would suggest a future decrease in all HPV associated cancers.</p>
<p>In Australia, 83% of girls aged 15 <a href="http://www.hpvregister.org.au">were vaccinated with HPV in 2015</a>, compared to 70% of males. Only 55% of females between 18 and 24 years were vaccinated. These figures suggest that between 20% to 30% of young males and females are not protected against HPV infection.</p>
<p>Modern medicine has delivered the opportunity to prevent HPV-related cancers. If international health organisations can implement a global immunisation program to high-, middle- and low-income countries, these cancers will become rare events and no longer pose a threat for future generations.</p>
<p><em>*Since publication, Samantha Khoury has been added as a co-author.</em></p><img src="https://counter.theconversation.com/content/58772/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The best way to prevent head and neck cancers, which are more common in men, is to get the HPV vaccine. It’s free for boys and girls aged 12 and 13.Nham Tran, Laboratory Head and Senior Lecturer, University of Technology SydneySamantha Khoury, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/524272016-03-06T19:06:49Z2016-03-06T19:06:49ZInteractive body map: what really gives you cancer?<figure><img src="https://images.theconversation.com/files/109420/original/image-20160127-26823-10cmjm4.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>There’s abundant advice out there on what you should or shouldn’t eat, drink, swallow, or stand next to, to avoid cancer. But it’s often lacking in evidence and the jumble of messages can be confusing.</p>
<p>This body map brings together the evidence on proven cancer causes. Using credible, scientific sources it answers questions about whether alcohol, red meat or sun exposure increase your cancer risk.</p>
<p><iframe id="tc-infographic-171" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/171/30f81a46480b839121f8fdbb1a104cf6322671ef/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Cancer occurs when <a href="https://theconversation.com/explainer-what-is-cancer-1673">mutations in a cell’s DNA</a> cause it to replicate without control, invading other tissues. Some cancer-causing mutations can be inherited; others induced, by infection with bacteria or viruses; or by environmental factors such as smoking, sun exposure and eating red meat.</p>
<p>This map’s focus is on induced factors. They are considered “modifiable” because avoiding them lessens your chance of cancer.</p>
<p>Choose your gender and click a risk factor to see which body area can be affected. Clicking the body region will show you how much engaging in risks such as drinking alcohol, taking the contraceptive pill, or eating pickled vegetables, will increase your chance of certain cancers.</p>
<p>When reading the map, keep in mind that every body and circumstance is unique; one risk factor cannot be considered in isolation when applied to a real life context. </p>
<p>Also remember the percentages portrayed are “relative risks” which are different to “absolute risks”. The difference is explained in <a href="http://theconversation.com/its-all-relative-how-to-understand-risk-in-the-cancer-map-55494">this accompanying piece</a>, which will help you understand what relative risk really means for your chances of getting cancer.</p><img src="https://counter.theconversation.com/content/52427/count.gif" alt="The Conversation" width="1" height="1" />
This body map brings together evidence on proven cancer causes. Using credible, scientific sources it answers questions about whether alcohol, red meat or sun exposure increase your cancer risk.Emil Jeyaratnam, Data + Interactives Editor, The ConversationSasha Petrova, Section Editor: EducationLicensed as Creative Commons – attribution, no derivatives.