tag:theconversation.com,2011:/global/topics/gardasil-6183/articlesGardasil – 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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<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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<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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<img src="https://counter.theconversation.com/content/90922/count.gif" alt="The Conversation" width="1" height="1" />
<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/540772016-10-14T01:55:21Z2016-10-14T01:55:21ZWe could prevent millions of cancer deaths each year with knowledge we already have<p>Vice President Joe Biden’s <a href="http://www.cancer.gov/research/key-initiatives/moonshot-cancer-initiative/blue-ribbon-panel">Cancer Moonshot Blue Ribbon Panel</a> has released 10 recommendations to accelerate a new national effort “<a href="https://www.whitehouse.gov/the-press-office/2016/06/28/fact-sheet-cancer-moonshot-summit-vice-president-biden-announces-new">to end cancer as we know it</a>.” These initiatives, focused mainly on the U.S., will almost certainly extend the lives of some cancer patients in the future. </p>
<p>However, cancer deaths worldwide are estimated to increase by over <a href="http://www.cancer.org/research/cancerfactsstatistics/global">50 percent</a> between 2015 and 2030, mainly due to expanding and aging populations. We already have the knowledge and technology to reduce this toll for future decades without waiting for new breakthroughs. </p>
<p>About <a href="http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027766.pdf">half of cancer cases and deaths worldwide are preventable</a>. For instance, lung and liver cancer are the most common causes of cancer deaths around the world and cervical cancer is the fourth leading cause among women. And we already know how to prevent almost all of them. </p>
<p>Like many of my colleagues who study cancer prevention, I believe that scaling up existing preventive interventions and already available treatments over two to three decades could save millions of lives around the world.</p>
<h2>Cut the number of lung cancer deaths globally</h2>
<p>Lung cancer is the most <a href="http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx">common cause of cancer death</a> <a href="https://www.cdc.gov/cancer/lung/statistics/">in the U.S.</a> and around the world, killing over one and a half million men and women a year. But in American men, lung cancer death rates <a href="http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf">have fallen</a> by about 40 percent over the past 25 years. In women, lung cancer rates have peaked.</p>
<p>That’s because the proportion of adults in the U.S. who smoke has decreased by about <a href="http://www.cdc.gov/tobacco/data_statistics/tables/trends/cig_smoking">50 percent</a> since the 1960s, due to public education, indoor smoking bans and higher prices due to higher tobacco taxes. This reduction happened despite the ongoing, vigorous efforts of tobacco companies to <a href="https://theconversation.com/big-tobacco-aims-its-guns-to-kill-california-tobacco-tax-63750">combat these public health initiatives</a>.</p>
<p>Similar reductions in France and South Africa have been achieved <a href="http://www.nejm.org/doi/full/10.1056/NEJMra1308383">by increasing cigarette prices</a>. However, the number of smokers is still increasing in countries such as <a href="http://www.nytimes.com/2015/10/13/health/study-shows-spread-of-cigarettes-in-china.html">China</a> and <a href="http://www.thejakartapost.com/news/2016/06/01/indonesia-on-track-to-worlds-highest-smoking-rates.html">Indonesia</a> as tobacco companies seek new markets, and a demographic bulge of younger potential smokers enters adolescence. </p>
<p>The World Health Organization <a href="http://www.who.int/fctc/en/">Framework Convention on Tobacco Control</a> is the international blueprint on policies to reduce the uptake of smoking and encourage current smokers to quit.</p>
<p>The United States is one of only seven countries that has signed but not ratified the Framework Convention on Tobacco Control. If our country is serious about cancer control, we should join the <a href="http://www.who.int/fctc/signatories_parties/en/">180 countries that</a> have ratified the convention. </p>
<h2>Liver cancer: Focus on vaccines and curing hepatitis C infections</h2>
<p>Liver cancer is the <a href="http://globocan.iarc.fr/old/FactSheets/cancers/liver-new.asp">second most common cause of cancer death worldwide</a>, killing about three quarters of a million people. It is the <a href="http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf">fifth most common cause of cancer death</a> in the U.S. </p>
<p>The most common causes of liver cancer are infection with hepatitis B or hepatitis C virus. In some countries the <a href="http://www.ncbi.nlm.nih.gov/pubmed/11922091">dietary contaminant Aflatoxin</a>, produced by molds that grow on stored grains or nuts, exacerbates the risk that hepatitis B infection will cause liver cancer.</p>
<p>Hepatitis B infection is almost entirely preventable by vaccination in infancy. In fact, an 80 percent decline in liver cancer rates has been observed in Taiwanese birth cohorts <a href="http://www.sciencedirect.com/science/article/pii/S1089326115000021">that have received the vaccination early in life</a>. </p>
<p>While rates of infant hepatitis B vaccination are high around the world, <a href="http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/passive/HepB_map_schedule.jpg?ua=1">many babies are still missing out</a>. Universal vaccination would lead to a further decline in liver disease and liver cancer globally.</p>
<p>Hepatitis C causes about <a href="http://dx.doi.org/10.1093/carcin/bgp263">a quarter of liver cancer</a> deaths worldwide. Curative therapies like the new drug <a href="http://www.nytimes.com/2015/05/20/business/high-cost-of-hepatitis-c-drug-prompts-a-call-to-void-its-patents.html">Sovaldi</a> may be another tool to prevent liver cancer. Researchers think that curing patients of their hepatitis C infection will prevent them from going on to develop liver cancer.</p>
<p>But the current cost of these drugs is a <a href="http://dx.doi.org/10.1056/NEJMp1400160">substantial barrier</a> to their use in both lower-income countries and in the U.S. </p>
<p>However, in Egypt, public-private partnerships have made the drug available <a href="http://www.nytimes.com/2015/12/16/health/hepatitis-c-treatment-egypt.html">at less than 1/100th</a> of their price in the United States. A vigorous international effort to use these new drugs to lower the number of infections would have a substantial impact on liver cancers caused by hepatitis C.</p>
<p>Heavier <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet">alcohol drinking also increases the risk</a> of liver cancer (as well as cancers of the breast, esophagus, pancreas, colon and rectum). According to the World Health Organization consumption has been increasing in the two most populous countries, <a href="http://gamapserver.who.int/gho/interactive_charts/gisah/consumption_change/atlas.html">India and China</a>. </p>
<h2>Cervical cancer: Vaccines and Pap smears</h2>
<p>Cervical cancer kills more than 250,000 women year worldwide, making it the <a href="http://globocan.iarc.fr/old/summary_table_pop-html.asp?selection=224900&title=World&sex=2&type=1&window=1&sort=2&submit=%C2%A0Execute%C2%A0">fourth-leading cause of cancer death among women</a> worldwide. In the U.S., however, <a href="http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf">it is 14th</a>. From 1975 to 2012, the incidence of cervical cancer in the <a href="http://seer.cancer.gov/statfacts/html/cervix.html">U.S. decreased by half</a>, due to Pap smear tests screening and removal of precancerous lesions.</p>
<p>However, almost all cases of cervical cancer are due to infection with the Human Papillomavirus (HPV), and we now have a vaccine against the main strains of HPV. In theory, cervical cancer is almost entirely preventable if HPV vaccination before the onset of sexual activity is followed by screening in adulthood to detect precancerous lesions caused by virus strains not covered by the vaccine. Yet the vaccine is not available <a href="http://www.gavi.org/uploadedImages/Types_of_support/NVS/HPV/HPV-vaccine-infographic-1600_source.jpg">to most girls in the world</a>.</p>
<p>The World Health Organization’s <a href="http://www.who.int/immunization/programmes_systems/supply_chain/benefits_of_immunization/en/">Expanded Program on Immunization</a> ensures that 85 percent of the world’s young children now receive at least DPT vaccine against diptheria, pertussis and tetanus. This program created new distribution channels for vaccine and could be a model for increasing the number of prepubertal girls who receive the HPV vaccine. </p>
<p>Making sure that more women around the world receive the decades-old Pap smear testing or introducing the new HPV tests would also help reduce cervical cancer incidence.</p>
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<img alt="" src="https://images.theconversation.com/files/134685/original/image-20160818-12295-170ty8h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134685/original/image-20160818-12295-170ty8h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134685/original/image-20160818-12295-170ty8h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134685/original/image-20160818-12295-170ty8h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134685/original/image-20160818-12295-170ty8h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134685/original/image-20160818-12295-170ty8h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134685/original/image-20160818-12295-170ty8h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Chemotherapy saves many lives and could save more.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-154905602/stock-photo-infusion-pump-feeding-iv-drip-into-patients-arm-focus-on-needle.html?src=zo7sMOyCUrlIlC0YJ1iIzA-1-5">Infusion pump image via www.shutterstock.com.</a></span>
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<h2>We can also tackle childhood leukemia and breast cancer</h2>
<p>In developed countries, the most common form of childhood leukemia, acute lymphocytic leukemia, is cured by conventional chemotherapy in over <a href="http://www.cancer.org/cancer/leukemiainchildren/detailedguide/childhood-leukemia-survival-rates">80 percent of affected children</a>. These life-saving, relatively inexpensive drugs have been available in the U.S. for decades. Yet in other parts of the world, most children with leukemia die because they do not receive treatment. </p>
<p>Drugs like <a href="https://www.cancer.gov/types/breast/research/10-years-tamoxifen">Tamoxifen</a> and <a href="https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet">aromatase inhibitors</a> have decreased mortality from estrogen-fueled breast cancers in the developed world. Yet most women in the developing world with these cancers do not receive these inexpensive medications. </p>
<p>While leukemia and breast cancer require relatively sophisticated diagnostic and treatment infrastructure, they don’t require new treatments. The still-missing piece is the political will and funding to expand access to these long-established treatments.</p>
<h2>Optimizing the technology and knowledge we already have</h2>
<p>Pinning our hopes on new technologies isn’t the only way to reduce cancer deaths worldwide. A moonshot-level impact could be guaranteed just by ensuring the interventions and treatments we already know to be effective are deployed around the world. </p>
<p>Critically, we already have models that show how this can be done. Programs, such as <a href="http://www.pepfar.gov/">The President’s Emergency Fund for AIDS Relief</a> and the <a href="http://www.theglobalfund.org/en">Global Fund for HIV, TB and Malaria</a> made lifesaving antiretroviral drugs available to millions of HIV patients by negotiating much lower drug prices. The programs also helped countries establish the necessary infrastructure to deliver the drugs and monitor patients.</p>
<p>There is much more we can do to prevent cancer in the U.S. Although smoking rates have done down, <a href="http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/">17 percent of adults still smoke</a>. Less than half of our teenage girls and boys received the recommended three doses of the <a href="https://www.cdc.gov/media/releases/2011/p0825_hpv_vaccine.html">HPV vaccine</a>. Racial disparities <a href="http://www.cancer.gov/research/areas/disparities">still exist</a> in access to early detection and treatment of cancers. </p>
<p>For the cancers we cannot prevent, we will always need new and better therapies. But we should not wait for future cures to do what we can to prevent cancer deaths around the world. </p>
<p>We can choose to prevent many cancers and cancer deaths globally. In the words of <a href="https://www.nasa.gov/centers/johnson/about/history/jsc40/jsc_gallery_people_image29.html">President John F. Kennedy</a> in launching the first moonshot:</p>
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<p>“because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone.”</p>
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<p class="fine-print"><em><span>David Hunter receives funding from the U.S. National Institutes of Health.</span></em></p>Developing brand new treatments and cures isn’t the only way to achieve a major reduction in cancer deaths worldwide.David Hunter, Vincent L. Gregory Professor of Cancer Prevention, Harvard T.H. Chan School of Public Health, Harvard UniversityLicensed 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>
<span class="attribution"><span class="source">from shutterstock.com</span></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>
<figure class="align-center zoomable">
<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/151782013-06-25T20:59:35Z2013-06-25T20:59:35ZFour things you should know about HPV vaccinations<figure><img src="https://images.theconversation.com/files/26155/original/448phyg7-1372141408.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The benefits of the human papillomavirus vaccine far outweigh risks.</span> <span class="attribution"><span class="source">VCU CNS/Flickr</span></span></figcaption></figure><p>The human papillomavirus (HPV) vaccine has attracted attention in the past week for two contradictory reasons: the Japanese government has <a href="http://ajw.asahi.com/article/behind_news/social_affairs/AJ201306150057">withdrawn its recommendation</a> for the shot, while public health officials in the United States have attributed a <a href="http://www.nytimes.com/2013/06/20/health/study-finds-sharp-drop-in-hpv-infections-in-girls.html?nl=todaysheadlines&emc=edit_th_20130620&_r=1&">massive drop in the prevalence</a> of the virus among teenage girls to its use. </p>
<p>The Japanese government’s decision is the result of 1,968 reported cases of possible side effects, 43 of which have been examined by a health ministry task force. Since 2010, 3.28 million Japanese women have received the human papillomavirus vaccination. </p>
<p>In the United States, on the other hand, there’s good news with virus thought to be half as common as it used to be, despite only about a third of young women receiving the full vaccine course of three shots. </p>
<p>So, what are we to make of the vaccine? Here are answers to four common questions about it, based on <a href="http://www.infectagentscancer.com/content/8/1/22/abstract">a research paper</a> I recently published with two co-authors. </p>
<h2>Does the vaccine prevent infection with the virus?</h2>
<p>Both the human papillomavirus vaccines (<a href="http://www.ncbi.nlm.nih.gov/pubmed/17494925?dopt=Abstract&holding=f1000,f1000m,isrctn">Gardasil</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/15541448?dopt=Abstract&holding=f1000,f1000m,isrctn">Cervarix</a>) have been shown to reduce the virus infection rate by over 90%. This reduction is maintained for at least five years. </p>
<p>The catch (and there’s always a catch) is that for the vaccine to be this effective, it has to be given to people who have not been exposed to the virus. </p>
<p>This is why the vaccine is given to 12 to 13-year-olds in <a href="http://www.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-hpv">Australia</a> and 14 to 19-year-olds in the United States. </p>
<h2>Will the vaccine cause a rise in other HPV types?</h2>
<p>The human papillomavirus vaccines available in Australia target two (types 16 and 18) of the 15 high-risk virus strains associated with cancer. </p>
<p>Questions have been <a href="http://www.hpv.org.nz/patient/myths.htm#top">asked</a> about whether one or more of the remaining 13 cancer-causing virus types will become more common to “fill the gap” left by their reduction. </p>
<p><a href="http://www.infectagentscancer.com/content/8/1/22">Clinical trials</a> have shown that both HPV vaccines provide significant protection against five other oncogenic types: 31, 39, 45, 59, and 86. And the Cervarix vaccine also protects against types 33 and 52. </p>
<p>The vaccine’s strength and duration of effect on other non-vaccine HPV types is still being studied.</p>
<h2>Does the vaccine prevent cervical cancer?</h2>
<p>This is a harder question to answer because human papillomavirus vaccines have only been widely used in Australia since 2007, and internationally since 2006. </p>
<p>It takes between 10 and 20 years from initial infection to the <a href="http://www.cancer.gov/cancertopics/factsheet/Risk/HPV">development of cancer</a>. So the direct effect of the vaccination on cervical cancer rates is currently difficult to assess. </p>
<p>But we can glean an effect by looking at the early warning signs of cervical cancer – pre-cancerous lesions called cervical intraepithelial neoplasia (CIN). CIN grade 2 and grade 3 lesions are considered good surrogate markers of cervical cancer because they’re likely to progress to disease <a href="http://www.ncbi.nlm.nih.gov/pubmed/8463044?dopt=Abstract&holding=f1000,f1000m,isrctnhttp://example.com/">5% and 12% of the time</a>, respectively. </p>
<p>The vaccine reduces these two grades of pre-cancerous lesion by over <a href="http://www.infectagentscancer.com/content/8/1/22/table/T2">99%</a>. And the two HPV types covered by the vaccine are linked to approximately 70% of cervical cancers. </p>
<p>This suggests that a significant decline in cervical cancer will be observable within the next decade. Human papillomavirus infection has also been linked to a number of other cancers such as those of the penis (40% are HPV-associated), vulva or vagina (40%), anus (90%), mouth (3%) and oropharynx (12%).</p>
<h2>Is the vaccine safe?</h2>
<p>This is probably the most often asked question due, in part at least, to certain (online) organisations using scare tactics against the vaccine (particularly Gardasil). </p>
<p>Like any medical procedure, these vaccines can have side effects. But these are overwhelmingly (more than 93%) <a href="http://www.ncbi.nlm.nih.gov/pubmed/19690307?dopt=Abstract&holding=f1000,f1000m,isrctn">minor</a>, and are largely injection site reactions (redness, swelling and pain where the injection was given). </p>
<p>Some other minor self-limiting reactions, which go away without treatment, such as fainting, headache and nausea have also been reported. </p>
<p><a href="http://www.infectagentscancer.com/content/8/1/22/table/T3">Clinical trials</a> involving over 44,000 women showed no differences in serious side effects between the human papillomavirus vaccines and control groups. But monitoring the safety of the vaccines doesn’t stop when these trials are finished. <a href="http://ncirs.edu.au/surveillance/index.php">Post-marketing surveillance</a> continues to examine possible vaccine side effects.</p>
<p>It’s sometimes claimed that the human papillomavirus vaccine is associated to premature death. These claims are inevitably linked to reports of deaths on the <a href="http://vaers.hhs.gov/index">US Vaccine Adverse Event Reporting System</a> (VAERS). As this is an open system where any member of the public can enter information, it’s difficult to analyse such claims without further investigation. </p>
<p>When such reported deaths are <a href="http://www.ncbi.nlm.nih.gov/pubmed/19690307?dopt=Abstract&holding=f1000,f1000m,isrctn">investigated</a>, they are found to not occur any more in vaccinated people than in those who haven’t been vaccinated.</p>
<p>There’s also <a href="http://www.ncbi.nlm.nih.gov/pubmed/19690307?dopt=Abstract&holding=f1000,f1000m,isrctn">no evidence</a> of a link between human papillomavirus vaccination and autoimmune conditions.</p>
<h2>And for the future…</h2>
<p>The rapidly growing body of research from fields including <a href="http://www.ncbi.nlm.nih.gov/pubmed/23632723">immunology</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23722024">virology</a>, <a href="http://jid.oxfordjournals.org/content/early/2013/06/18/infdis.jit192.abstract">public health and epidemiology</a>, among others, should help the community, including doctors and parents, to be confident about the benefits of the human papillomavirus vaccine. </p>
<p>These benefits far outweigh its risks, and mechanisms are in place to continue monitoring any future adverse events. </p><img src="https://counter.theconversation.com/content/15178/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dave Hawkes is currently supported by funding from the National Health and Medical Research Council.</span></em></p>The human papillomavirus (HPV) vaccine has attracted attention in the past week for two contradictory reasons: the Japanese government has withdrawn its recommendation for the shot, while public health…Dave Hawkes, Postdoctoral Researcher (Viral tools and Neuropeptides), Florey Institute of Neuroscience and Mental HealthLicensed as Creative Commons – attribution, no derivatives.