tag:theconversation.com,2011:/uk/topics/hpv-vaccine-12435/articlesHPV vaccine – The Conversation2023-11-20T12:19:33Ztag:theconversation.com,2011:article/2179962023-11-20T12:19:33Z2023-11-20T12:19:33ZCervical cancer: NHS pledge to eradicate disease by 2040 can be achieved – here’s how<figure><img src="https://images.theconversation.com/files/560180/original/file-20231117-19-bi3oe1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6720%2C4466&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Around 80% of teenagers in England already receive the HPV vaccine.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-nurse-protective-gloves-making-vaccination-2100651601">Prostock-studio/ Shutterstock</a></span></figcaption></figure><p>The NHS has pledged to <a href="https://www.england.nhs.uk/2023/11/nhs-sets-ambition-to-eliminate-cervical-cancer-by-2040">eliminate cervical cancer</a> in England by 2040. This will be achieved by amping up current vaccination and screening programmes. </p>
<p>While this goal may seem unrealistic or even impossible, there are many reasons to believe it can be achieved, and in the timeframe NHS England boss Amanda Pritchard has set out. </p>
<p>The cornerstone of the NHS’s strategy for eradicating cervical cancer is its vaccination programme. </p>
<p>This programme has been very successful so far. Around 80% of teenagers in England have already receive the human papillomavirus (HPV) vaccine, which significantly reduces the risk of getting cervical cancer. </p>
<p>This is because HPV, a sexually transmitted infection, is a cause of 99% of <a href="https://www.who.int/health-topics/cervical-cancer#tab=tab_1">cervical cancer cases</a>. The vaccine provides effective protection against the most common, <a href="https://www.nejm.org/doi/full/10.1056/NEJMcp2108502">high-risk strains</a> of the virus that cause the cancer.</p>
<p>Targeting adolescents not only ensures a high level of immunity within the population but also a significant reduction in HPV transmission.</p>
<p>Long-term data shows this vaccine has already helped lower the incidence of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02178-4/fulltext">cervical cancer by 87%</a> in women in their 20s who had been offered the vaccine when they were aged 12-13. With more people getting vaccinated for HPV each year, this will mean every year there are fewer cases of HPV and cervical cancer and <a href="https://www.bmj.com/content/375/bmj.n2689">fewer deaths from it</a>.</p>
<p>The vaccination programme’s success lies in its <a href="https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine">accessibility and inclusivity</a>. Schools across the country serve as vaccination hubs, ensuring easy and widespread access for teenagers. </p>
<p>Also, the vaccine is offered for free on the NHS, ensuring that cost is no barrier to protection. The collaborative efforts of healthcare professionals, educators and policymakers have created a comprehensive and efficient vaccination programme. </p>
<p>But vaccination only helps to prevent HPV infections. Another crucial aspect of this elimination pledge will be the UK’s cervical screening programme.</p>
<p>Cervical screening, often referred to as the smear test, is regularly offered to women aged 25 to 64. Screening allows doctors to identify pre-cancerous changes in the cervix caused by HPV.</p>
<p>The programme, which was started in 1964, is estimated to <a href="https://view-health-screening-recommendations.service.gov.uk/cervical-cancer/">save 4,500 lives</a> per year in the UK. Detecting abnormalities early ensures that people with signs of cervical cancer are treated promptly, stopping HPV from progressing to cervical cancer.</p>
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<img alt="A doctor places a smear test swab in a vial while a female patients sits in the background on an examination table." src="https://images.theconversation.com/files/560181/original/file-20231117-23-mo3yq4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560181/original/file-20231117-23-mo3yq4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560181/original/file-20231117-23-mo3yq4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560181/original/file-20231117-23-mo3yq4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560181/original/file-20231117-23-mo3yq4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560181/original/file-20231117-23-mo3yq4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560181/original/file-20231117-23-mo3yq4.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">Cervical screening is thought to save 4,500 lives each year in the UK.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaginal-smear-171518261">Image Point Fr/ Shutterstock</a></span>
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<p><a href="https://www.gov.uk/government/collections/hpv-vaccination-programme">Public awareness campaigns</a> educating people about HPV and cervical cancer have also played a pivotal role in encouraging participation in vaccination and screening programmes and will continue to do so. <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195801">People who are informed</a> are more likely to take preventative measures. </p>
<h2>Potential challenges</h2>
<p>Although England is on track, there are still some areas that will need to be addressed to achieve their elimination target. </p>
<p>Addressing socioeconomic disparities will be important, as people living in certain areas may have <a href="https://pubmed.ncbi.nlm.nih.gov/23028452/#:%7E:text=Interviews%20revealed%20that%20health%20inequalities,to%20ethnicity%20and%2For%20religion.">less access to vaccination</a> and screening services for cervical cancer. Lessons learned from the COVID pandemic may be useful in ensuring equal access to HPV vaccines and screening. </p>
<p>For example, <a href="https://www.england.nhs.uk/gp/case-studies/gp-teams-work-together-with-members-of-health-inequality-groups-to-expand-their-covid-19-vaccine-equity-project/">mobile vaccination units</a>, which were used during the pandemic to expand vaccine access, could be useful.</p>
<p>And, despite high vaccination rates, <a href="https://pubmed.ncbi.nlm.nih.gov/30633623/">vaccine hesitancy</a> remains a challenge. Misinformation, mistrust of health authorities and concerns about vaccine safety can undermine efforts to achieve universal coverage. </p>
<p>Overcoming vaccine hesitancy and increasing access to the vaccine is integral to eliminating cervical cancer in England. The more people who receive the HPV vaccine, the fewer incidences of cervical cancer. </p>
<p>Although it can take several years for these effects to become apparent, data from countries with high HPV vaccination coverage, including Sweden, the US and Australia, have shown a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1917338">substantial decline</a> in the prevalence of HPV infections and cervical cancer. </p>
<p>Another benefit of vaccinating a significant portion of the population is that it contributes to herd immunity. This protects even those who aren’t vaccinated, which will further reduce the overall burden of HPV and cervical cancer.</p>
<p>HPV vaccination can also help prevent vaginal and vulval cancers in women, penile cancers in <a href="https://www.nhs.uk/conditions/penile-cancer/causes/">men</a>, and <a href="https://pubmed.ncbi.nlm.nih.gov/14571196/">anal cancers</a> in both men and women. It can help prevent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8750601/">head and neck cancers</a>, which are often caused by HPV as well.</p>
<p>Addressing vaccine hesitancy through targeted education and communication strategies is crucial.</p>
<p>The UK’s ambitious goal of eradicating cervical cancer by 2040 is within reach, thanks to the concerted efforts in vaccination and screening. While vaccine hesitancy and health inequalities remain challenges to be addressed, the nation’s strong healthcare infrastructure, public awareness campaigns and government commitment will still help it achieve this milestone pledge.</p><img src="https://counter.theconversation.com/content/217996/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nothing to disclose.</span></em></p>Current vaccination and screening programmes mean England is already on track.Justin Stebbing, Professor of Biomedical Sciences, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2020012023-04-10T07:32:28Z2023-04-10T07:32:28ZCervical cancer can be beaten - the key is vaccinating young girls<figure><img src="https://images.theconversation.com/files/518205/original/file-20230329-24-h4txem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The numbers showed a wide variation in coverage in different geographic regions.
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>In 2020 the World Health Organization introduced a plan to eliminate cervical cancer as a public health threat by <a href="https://www.who.int/initiatives/cervical-cancer-elimination-initiative#cms">2030</a>. The first step towards this goal is to have 90% of girls fully vaccinated against human papillomavirus (HPV) by the age of 15 years. Gynaecological oncologist Lynette Denny spells out how much progress still needs to be made, and what hurdles need to be overcome.</em></p>
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<h2>How big a threat is cervical cancer in sub-Saharan Africa?</h2>
<p>Cervical cancer is one of the most common cancers in women. Sub-Saharan Africa has the highest <a href="https://www.thelancet.com/action/showPdf?pii=S2214-109X%2822%2900501-0">cervical cancer diagnoses</a> worldwide. Cervical cancer mortality rates in the region are <a href="https://www.thelancet.com/action/showPdf?pii=S2214-109X%2822%2900501-0">three times higher</a> than the global average. The burden of HIV in sub-Saharan Africa contributes to the disparity. In 2021, in southern Africa, <a href="https://www.thelancet.com/action/showPdf?pii=S2214-109X%2820%2930459-9">63.8%</a> of women with cervical cancer were living with HIV, as were 27.4% of women in eastern Africa. </p>
<p>Most cases of cervical cancer are caused by the human papillomavirus (HPV), which is transmitted through skin to skin contact, including sexual activity.</p>
<h2>How do countries compare in meeting the WHO target?</h2>
<p>By <a href="https://www.sciencedirect.com/science/article/pii/S0091743520304308?via%3Dihub">June 2020</a>, more than half of the WHO member states – that’s 107 out of 194 – had introduced HPV vaccination nationwide or partially.</p>
<p>The numbers showed a wide variation in coverage in different geographic regions. High-income countries such as Australia and New Zealand had the highest complete coverage with HPV vaccination at 77%. Low- and middle-income countries lagged far behind – only 41% had introduced HPV vaccination by the end of 2019. Only 20% of the eligible population in sub-Saharan Africa has been vaccinated. </p>
<p>Levels of vaccination matter because, with wide coverage of the appropriate age group, over time it is theoretically possible to eliminate HPV as a human pathogen. This was the case with <a href="https://www.who.int/health-topics/smallpox#tab=tab_1">smallpox</a>.</p>
<p>Most (90%) of low- and middle-income countries deliver vaccination through schools and facility-based vaccination. The two-dose schedule is the most common. When the HPV vaccine was initially approved for use, it was given to girls aged 9-13 in three doses. Dose one intially; dose two at one or two months after the first dose; and a third dose six months later. </p>
<p>It later became evident that two doses gave the same level of immunity as three doses. </p>
<p>It is now recognised that one dose is as good as three doses in preventing HPV infection in the general population. In <a href="https://www.nitag-resource.org/sites/default/files/2022-12/grade-evidence-profile-single-dose-hpv-vaccine-vs-no-vaccination.pdf">April 2022</a> the WHO Strategic Advisory Group of Experts on Immunisation concluded that a single-dose HPV vaccine delivers “solid protection against HPV, that is comparable to two-dose schedules”. However, they recommended that people living with HIV continue to receive three doses where feasible, and if not, at least two doses, due to the limited evidence. </p>
<p>The lower number of doses has important cost and logistical implications. Administering one dose may be a game changer in widening the coverage of eligible girls. In South Africa, the <a href="https://immunizationdata.who.int/pages/coverage/hpv.html?CODE=ZAF&ANTIGEN=&YEAR=">dropout rate</a> from the vaccination programme after the first vaccination in 2014 was 18% and it increased to 26% in 2018 and 2019. The equivalent dropout rate in high-income countries averages 11%. </p>
<p>In <a href="https://www.sciencedirect.com/science/article/pii/S0091743520304308?via%3Dihub">2019</a>, 33 of the 107 HPV vaccination programmes were gender neutral – both girls and boys were being vaccinated. Vaccinating both boys and girls will increase what is known as herd immunity, which means that the prevalence of HPV in the population will decrease. In addition, boys will be protected from HPV associated anal, penile and oro-pharyngeal cancers. However, including boys in vaccination programmes when most girls aren’t vaccinated is not cost-effective. </p>
<p>Globally, it was estimated in 2019 that 15% of girls and 4% of boys were vaccinated. </p>
<h2>What’s the surest way of achieving the WHO goal?</h2>
<p>There are many important steps. </p>
<p>A critical starting point is to gain political support for HPV vaccination. There needs to be high level collaboration between the ministries of health, education, social development and existing immunisation programmes. </p>
<p>The most successful programmes have used school-based facilities for vaccination. But this excludes adolescents who are not in the school system, hence the need to create facility-based programmes. </p>
<p>Widespread information and population education is critical - education campaigns should include parents, the general population, teachers and healthcare workers.</p>
<p>An adequate supply of vaccine is crucial and the vaccine administration infrastructure must be robust. All the logistics of vaccine implementation, such as distribution, cold chain management, waste control and clinical care must be attended to. Good statistics and information should be maintained and monitored regularly. </p>
<p>Anti-vaccination programmes need to be monitored and their allegations responded to promptly and with cultural sensitivity. </p>
<h2>What are the hold-ups?</h2>
<p>COVID has had a major impact on many HPV vaccination programmes. Low- and middle-income countries were particularly hard hit. As an example, the South African programme <a href="https://immunizationdata.who.int/pages/coverage/hpv.html?CODE=ZAF&ANTIGEN=&YEAR=">coverage reduced</a> from 85% when introduced in 2014 to 3% in 2020. The programme is still trying to recover.</p>
<p>Along with the impact of COVID on immunisation practices, the recommendation to include boys and older women in vaccination programmes resulted in a worldwide shortage of HPV vaccines. The shortage was recognised in 2020 and was <a href="https://ipvsoc.org/wp-content/uploads/2021/05/IPVS-Statement_HPV-vaccine-shortage.pdf">predicted</a> to last three to five years. A statement released by the International Papillomavirus Society recommended that gender neutral vaccination as well as that of older women be temporarily suspended. And that, during the supply constraint, HPV vaccination should be reserved for girls aged 9 to 14. </p>
<h2>What should countries be focused on?</h2>
<p>Current commercially available HPV vaccines are prophylactic. They will protect individuals who have never been exposed to HPV infection from being infected, and prevent <a href="https://www.who.int/publications/i/item/9789240014107">70%-90%</a> of all cervical cancers. (No vaccine is 100% effective.) </p>
<p>I have spent the past <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00120-4/fulltext">30 years</a> researching safe, feasible and effective alternatives to the <a href="https://www.cdc.gov/cancer/cervical/basic_info/screening.htm">Pap smear</a> for the prevention of cervical cancer. When I began this work in 1995, the HPV vaccine had not yet been produced. Its arrival made the possibility of ending cancer associated with HPV infection a reality.</p>
<p>Who gets vaccinated should depend on age, gender and resources. Girls aged 9-14 years should be prioritised. As resources increase, girls aged 15-18 years should be included. Thereafter, women aged 19-26 years should be included. Vaccinating boys should go ahead only once at least 90% coverage has been achieved in girls aged 9-14 years.</p>
<p>Vaccinating older women, most of whom would already have been exposed to HPV infection (even if subsequently cleared) should be reserved for high resource settings that have reached widespread vaccination coverage. </p>
<p>There are many advantages to vaccinating boys, particularly in preventing HPV-associated cancers in men and in men who have sex with men, as well as increasing herd immunity. However, expanding the programme to include men has implications for resource distribution and possible exclusion of other vulnerable groups.</p><img src="https://counter.theconversation.com/content/202001/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynette Denny receives funding from National Institutes of Health, USA</span></em></p>Cervical cancer is one of the most common cancers in women. Mortality rates in sub-Saharan Africa are three times higher than the global average.Lynette Denny, Professor, Special Projects, Obstetrics & Gynaecology, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1970032023-01-17T13:33:25Z2023-01-17T13:33:25ZModerna’s experimental cancer vaccine treats but doesn’t prevent melanoma – a biochemist explains how it works<figure><img src="https://images.theconversation.com/files/503900/original/file-20230110-22-kni45q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2120%2C1414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Moderna is testing an mRNA vaccine in combination with pembrolizumab to treat melanoma.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mrna-vaccine-vial-for-cancer-immunotherapy-on-blue-royalty-free-image/1311515350">Javier Zayas Photography/Moment via Getty Images</a></span></figcaption></figure><p><a href="https://www.washingtonpost.com/health/2022/12/13/experimental-cancer-vaccine-messenger-rna-melanoma/">Media</a> <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/moderna-merck-vaccine-combo-cut-melanoma-recurrence-by-44-study-2022-12-13/">outlets</a> have reported the encouraging findings of clinical trials for a new experimental vaccine developed by the biotech company <a href="https://investors.modernatx.com/news/news-details/2022/Moderna-and-Merck-Announce-mRNA-4157V940-an-Investigational-Personalized-mRNA-Cancer-Vaccine-in-Combination-with-KEYTRUDAR-pembrolizumab-Met-Primary-Efficacy-Endpoint-in-Phase-2b-KEYNOTE-942-Trial/default.aspx">Moderna</a> to treat an aggressive type of skin cancer called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/melanoma">melanoma</a>. </p>
<p>Although this is potentially very good news, it occurred to me that the headlines may be unintentionally misleading. The vaccines most people are familiar with prevent disease, whereas this experimental new skin cancer vaccine treats only patients who are already sick. Why is it called a vaccine if it does not prevent cancer?</p>
<p>I am a <a href="https://scholar.google.com/citations?user=iAbB1kMAAAAJ&hl=en">biochemist</a> and <a href="https://medicine.buffalo.edu/faculty/profile.html?ubit=mrobrian">molecular biologist</a> studying the roles that microbes play in health and disease. I also teach cancer genetics to medical students and am interested in how the public understands science. While preventive and therapeutic vaccines are administered for different health care goals, they both train the immune system to recognize and fight off a specific disease agent that causes illness.</p>
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<a href="https://images.theconversation.com/files/503907/original/file-20230110-26-2w4dwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of melanoma" src="https://images.theconversation.com/files/503907/original/file-20230110-26-2w4dwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503907/original/file-20230110-26-2w4dwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503907/original/file-20230110-26-2w4dwp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503907/original/file-20230110-26-2w4dwp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503907/original/file-20230110-26-2w4dwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503907/original/file-20230110-26-2w4dwp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503907/original/file-20230110-26-2w4dwp.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"></a>
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<span class="caption">Melanoma is an aggressive form of skin cancer.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/melanoma-skin-cancer-royalty-free-image/1134489746">Callista Images/Image Source via Getty Images</a></span>
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<h2>How do preventive vaccines work?</h2>
<p>Most vaccines are administered to healthy people before they get sick to prevent illnesses caused by viruses or bacteria. These include vaccines that prevent polio, measles, COVID-19 and many other diseases. Researchers have also developed vaccines to <a href="https://www.cancer.org/healthy/cancer-causes/infectious-agents/infections-that-can-lead-to-cancer/viruses.html">prevent some types of cancers</a> that are caused by such viruses as the human papillomaviruses and Epstein-Barr virus.</p>
<p>Your <a href="https://www.niaid.nih.gov/research/immune-system-overview">immune system</a> recognizes objects such as certain microbes and allergens that do not belong in your body and initiates a series of cellular events to attack and destroy them. Thus, a virus or bacterium that enters the body is recognized as something foreign and triggers an immune response to fight off the microbial invader. This results in a <a href="https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book%3A_Anatomy_and_Physiology_(Boundless)/20%3A_Immune_System/20.6%3A_Humoral_Immune_Response/20.6D%3A_Immunological_Memory">cellular memory</a> that will elicit an even faster immune response the next time the same microbe intrudes.</p>
<p>The problem is that sometimes the initial infection causes serious illness before the immune system can mount a response against it. While you may be better protected against a second infection, you have suffered the potentially damaging consequences of the first one.</p>
<p>This is where preventive vaccines come in. By introducing a harmless version or a portion of the microbe to the immune system, the body can learn to mount an effective response against it without causing the disease.</p>
<p>For example, the <a href="https://www.cdc.gov/vaccines/vpd/hpv/public/index.html">Gardasil-9 vaccine</a> protects against the human papillomavirus, or HPV, which causes cervical cancer. It contains protein components found in the virus that cannot cause disease but do elicit an immune response that protects against future HPV infection, thereby preventing cervical cancer. </p>
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<figcaption><span class="caption">The HPV vaccine can prevent cervical cancer.</span></figcaption>
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<h2>How does the Moderna cancer vaccine work?</h2>
<p>Unlike cervical cancer, skin melanoma isn’t caused by a viral infection, according the <a href="https://doi.org/10.1002/jmv.27924">latest evidence</a>. Nor does Moderna’s experimental vaccine prevent cancer as Gardasil-9 does.</p>
<p>The Moderna vaccine trains the immune system to fight off an invader in the same way preventive vaccines most people are familiar with do. However, in this case the invader is a tumor, a rogue version of normal cells that harbors abnormal proteins that the immune system can recognize as foreign and attack.</p>
<p>What are these abnormal proteins and where do they come from?</p>
<p>All cells are made up of proteins and other biological molecules such as carbohydrates, lipids and nucleic acids. Cancer is caused by mutations in regions of genetic material, or DNA, that encode instructions on what proteins to make. Mutated genes result in abnormal proteins called <a href="https://www.ucir.org/therapies/neoantigen-based-therapy">neoantigens</a> that the body recognizes as foreign. That can trigger an immune response to fight off a nascent tumor. However, sometimes the immune response fails to subdue the cancer cells, either because the immune system is unable to mount a strong enough response or the cancer cells have found a way to circumvent the immune system’s defenses.</p>
<p>Moderna’s experimental melanoma vaccine contains genetic information that encodes for portions of the neoantigens in the tumor. This genetic information is in the form of <a href="https://theconversation.com/what-is-mrna-the-messenger-molecule-thats-been-in-every-living-cell-for-billions-of-years-is-the-key-ingredient-in-some-covid-19-vaccines-158511">mRNA</a>, which is the same form used in the Moderna and <a href="https://www.pfizer.com/products/product-detail/pfizer-biontech-covid-19-vaccine">Pfizer-BioNtech</a> COVID-19 vaccines. Importantly, the vaccine cannot cause cancer, because it encodes for only small, nonfunctional parts of the protein. When the genetic information is translated into those protein pieces in the body, they trigger the immune system to mount an attack against the tumor. Ideally, this immune response will cause the tumor to shrink and disappear. </p>
<p>Notably, the Moderna melanoma vaccine is tailor-made for each patient. Each tumor is unique, and so the vaccine needs to be unique as well. To customize vaccines, researchers first biopsy the patient’s tumor to determine what neoantigens are present. The vaccine manufacturer then designs specific mRNA molecules that encode those neoantigens. When this custom mRNA vaccine is administered, the body translates the genetic material into proteins specific to the patient’s tumor, resulting in an immune response against the tumor.</p>
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<figcaption><span class="caption">Identifying the neoantigens of a tumor can help researchers personalize cancer vaccines.</span></figcaption>
</figure>
<h2>Combining vaccination with immunotherapy</h2>
<p>Vaccines are a form of <a href="https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy.html">immunotherapy</a>, because they treat diseases by harnessing the immune system. However, other immunotherapy cancer drugs are not vaccines because, while they also stimulate the immune system, they do not target specific neoantigens.</p>
<p>In fact, the Moderna vaccine is co-administered with the immunotherapy drug <a href="https://www.cancer.gov/about-cancer/treatment/drugs/pembrolizumab">pembrolizumab</a>, which is marketed as Keytruda. Why are two drugs needed?</p>
<p>Certain immune cells called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/t-cell">T-cells</a> have <a href="https://doi.org/10.21037/aob-21-3">molecular accelerator and brake components</a> that serve as checkpoints to ensure they are revved up only in the presence of a foreign invader such as a tumor. However, sometimes tumor cells find a way to keep the T-cell brakes on and suppress the immune response. In these cases, the Moderna vaccine correctly identifies the tumor, but T-cells cannot respond to it. </p>
<p>Pembrolizumab, however, can bind directly to a brake component on the T-cell, inactivating the brake system and allowing the immune cells to attack the tumor.</p>
<p>Although pembrolizumab is <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2021/adjuvant-pembrolizumab-early-stage-melanoma">currently used by itself</a> to treat melanoma, recent clinical trials show additional benefits when combined with the Moderna vaccine. In those studies, the company reported that administering the mRNA vaccine with pembrolizumab <a href="https://investors.modernatx.com/news/news-details/2023/Moderna-and-Merck-Announce-mRNA-4157-V940-an-Investigational-Individualized-Neoantigen-Therapy-in-Combination-with-KEYTRUDAR-Pembrolizumab-Demonstrated-Superior-Recurrence-Free-Survival-in-Patients-with-High-Risk-Stage-IIIIV-Melanoma-Following-Comple/default.aspx">reduced the risk of recurrence or death by 44%</a> compared to pembrolizumab alone in melanoma patients who were at high risk of recurrence. </p>
<h2>Not a preventive cancer vaccine</h2>
<p>So why can’t the Moderna vaccine be administered to healthy people to prevent melanoma before it arises? </p>
<p>Cancers are highly variable from person to person. Each melanoma harbors a different neoantigen profile that cannot be predicted in advance. Therefore, a vaccine cannot be developed in advance of the illness.</p>
<p>The experimental mRNA melanoma vaccine, currently still in early-phase clinical trials, is an example of the new frontier of personalized medicine. By understanding the molecular basis of diseases, researchers can explore how their underlying causes vary among people, and offer personalized therapeutic options against those diseases.</p>
<p><em>This article was updated to note new clinical trial findings presented on April 16, 2023.</em></p><img src="https://counter.theconversation.com/content/197003/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark R. O'Brian receives funding from the National Institutes of Health.</span></em></p>Preventive and therapeutic vaccines both train the immune system to fight disease, but they are used in different ways.Mark R. O'Brian, Professor and Chair of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1699132022-05-31T12:12:43Z2022-05-31T12:12:43ZWhat are HeLa cells? A cancer biologist explains<figure><img src="https://images.theconversation.com/files/465571/original/file-20220526-14-aez4rh.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1022%2C771&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cancer-causing viruses like HPV can cause cells to divide indefinitely and, in the case of Henrietta Lacks, become immortal.</span> <span class="attribution"><a class="source" href="https://flic.kr/p/A5Q7L1">Tom Deerinck/NIH via Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>In an amazing twist of fate, the aggressive cervical cancer tumor that killed <a href="https://www.npr.org/2010/02/02/123232331/henrietta-lacks-a-donors-immortal-legacy">Henrietta Lacks</a>, a 31-year old African American mother, became an <a href="https://osp.od.nih.gov/scientific-sharing/hela-cells-timeline/">essential tool</a> that helped the biomedical field flourish in the 20th century. As a <a href="https://www.researchgate.net/scientific-contributions/Ivan-Martinez-2109620653">cancer researcher</a> who uses HeLa cells in my everyday work, even I sometimes find it hard to believe. </p>
<p>On Aug. 1, 2023, over 70 years after doctors took Lacks’ cells without her consent or knowledge, her family <a href="https://apnews.com/article/henrietta-lacks-hela-cells-thermo-fisher-scientific-bfba4a6c10396efa34c9b79a544f0729">reached a settlement</a> with biotech company Thermo Fisher. Lacks’ descendants had sued the company in 2021 for making billions of dollars off her cells. The family has not been previously been compensated.</p>
<p>Lacks’ cervical cancer cells, called “HeLa” after the first two letters of her first and last name, <a href="https://www.science.org/content/article/art-culture-developing-cell-lines">are immortal</a>, continuing to divide when most cells would die. This ability to survive through endless generations of cells is what makes them invaluable for scientists conducting experiments on human cells.</p>
<h2>Why HeLa cells matter</h2>
<p>Before HeLa cells, scientists wanted a way to grow and study human cells in the lab to conduct studies that are impossible to do in a living person. When Lacks’ cervical cancer cells were <a href="https://osp.od.nih.gov/scientific-sharing/hela-cells-landing/">successfully grown in a petri dish in 1951</a>, scientists now had a source of cost-effective and easy-to-use cells that expanded their ability to conduct research. From <a href="https://doi.org/10.1084/jem.97.5.695">polio</a> and <a href="https://doi.org/10.1016/j.cell.2020.07.024">COVID-19 vaccines</a> to <a href="https://doi.org/10.1002/jcp.22917">cancer research</a> and <a href="https://doi.org/10.1534/g3.113.005777">sequencing the human genome</a>, HeLa cells have played an enormous role in many scientific discoveries and advancements.</p>
<p>Henrietta Lacks’ story is also an <a href="https://www.wgbh.org/news/local-news/2022/05/17/thermo-fisher-seeks-dismissal-of-henrietta-lacks-familys-lawsuit-regarding-sale-of-her-cells">ongoing bioethics case</a>, because these cells were taken from her during a routine cervical cancer biopsy and were then given to researchers without her consent, as was <a href="https://doi.org/10.1146%2Fannurev-genom-083115-022536">common practice</a> at the time. The Lacks family has <a href="https://www.washingtonpost.com/local/legal-issues/henrietta-lacks-family-sues-company/2021/10/04/810ffa6c-2531-11ec-8831-a31e7b3de188_story.html">long attempted legal action</a> against companies they say have unfairly benefited from Henrietta’s cells. A <a href="https://www.npr.org/2010/02/02/123232331/henrietta-lacks-a-donors-immortal-legacy">2010 book</a> by journalist Rebecca Skloot details how HeLa cells affected both science and the Lacks family.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/T3kR2dMCfOM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The Lacks family wasn’t aware that Henrietta’s cells had been harvested until Rolling Stone magazine journalist Michael Rogers contacted them two decades after her death.</span></figcaption>
</figure>
<p>But how did Lacks’ cells become immortal?</p>
<p>Lacks didn’t know that cells in her cervix were infected with a virus that causes one of the most common sexually transmitted diseases: <a href="https://www.cdc.gov/std/hpv/default.htm">human papillomavirus</a>, or HPV. There are more than 150 different types of HPVs, but only a small group are known to cause <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer">cervical cancer</a>. In fact, <a href="https://doi.org/10.1002/(SICI)1096-9896(199909)189:1%3C12::AID-PATH431%3E3.0.CO;2-F">99.7% of cervical cancers</a> are HPV positive. Fortunately, most people infected with high-risk HPVs are able to clear out the virus before it becomes cancerous. <a href="https://www.cdc.gov/vaccines/vpd/hpv/public/index.html">HPV vaccinations</a> can prevent over 90% of HPV-related cancers. But <a href="https://www.cdc.gov/cancer/hpv/basic_info/index.htm">10% of people</a> with HPV infections on their cervix develop cancer. Sadly, Henrietta was one of the unlucky ones.</p>
<p>Her misfortune has helped elucidate how HPV works. Since the <a href="https://www.nobelprize.org/prizes/medicine/2008/hausen/facts/">Nobel Prize-winning</a> 1976 discovery of <a href="http://www.ncbi.nlm.nih.gov/pubmed/175942">HPV’s essential role</a> in cervical cancer, many scientists, including me, have been investigating how HPV <a href="https://www.ncbi.nlm.nih.gov/books/NBK9929/">causes cancer</a>.</p>
<figure>
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<figcaption><span class="caption">While some types of HPV cause warts on the skin, certain high-risk ones can cause cancer.</span></figcaption>
</figure>
<h2>Two proteins</h2>
<p>It turns out that the virus’ cancer-causing ability is linked to two proteins it produces. These viral proteins can <a href="https://pubmed.ncbi.nlm.nih.gov/1322242/">target and destroy</a> two major human proteins that protect against cancer, <a href="https://doi.org/10.1038/s41598-019-40094-8">p53 and retinoblastoma (Rb)</a>. P53 and Rb act as sentinels making sure cells don’t accumulate harmful genetic mutations and stop dividing after a set number of cycles. My research has focused on how HPV proteins interact with <a href="https://doi.org/10.1038/s41598-019-40094-8">tumor-suppressing</a> <a href="https://doi.org/10.1073/pnas.1017346108">proteins</a> in different types of human cells, including HeLa.</p>
<p>Most cells divide around <a href="https://doi.org/10.1016/0014-4827(65)90211-9">40 to 60 times</a> before they become too old to function properly and are naturally killed off. But HPV can allow cells to divide forever, because they attack the sentinels keeping uncontrolled division in check. After Lacks was infected with <a href="https://doi.org/10.1128/JVI.01747-15">HPV 18</a>, the second-most-common high-risk type of the virus, her cervical cells lost the ability to produce these sentinels. Without growth checks in place, her cells were able to divide indefinitely and became “immortal” – living on to this day both in test tubes and the <a href="https://www.immunology.org/hela-cells-1951">70,000 studies</a> they’ve made possible.</p>
<p><em>This article was updated to note the Lacks family’s settlement with Thermo Fisher on Aug. 1, 2023.</em></p><img src="https://counter.theconversation.com/content/169913/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ivan Martinez receives funding from the National Institute of Health (NIH), the American Cancer Society (ACS), and the National Science Foundation (NSF).</span></em></p>The immortal cancer cells of Henrietta Lacks revolutionized the fields of science, medicine and bioethics. And they still survive today, more than 70 years after her death.Ivan Martinez, Associate Professor of Microbiology, Immunology and Cell Biology, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1760412022-02-02T14:35:26Z2022-02-02T14:35:26ZCervical cancer is a disease of inequity: here’s how to save 60 million lives<figure><img src="https://images.theconversation.com/files/443740/original/file-20220201-19-1lp3oar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People in the world's poorest countries have not benefited equally from the recent advancements made in cancer.</span> <span class="attribution"><span class="source">Jonathan Torgovnik for The Hewlett Foundation/Reportage by Getty Images</span></span></figcaption></figure><p><em>The World Health Organization <a href="https://www.who.int/health-topics/cancer#tab=tab_1">estimates</a> that cancer a leading cause of death around the world. The cancer burden is on the rise, putting more pressure on already strained systems in low- and middle-income countries. These regions are <a href="https://www.who.int/news-room/fact-sheets/detail/cancer">least prepared</a> to deal with the growing number of cancer patients. People in the world’s poorest countries have not benefited equally from the recent advancements made in cancer screening, prevention and treatment. Inequity also exists between patient profiles and within countries, even wealthier ones – not everyone gets the same chance at a good outcome. <a href="https://www.spotlightnsp.co.za/2021/11/25/face-to-face-prof-lynette-denny-reflects-on-an-extraordinary-life-of-service/">Lynette Denny</a> is a global expert on cervical cancer – the <a href="https://www.who.int/news-room/fact-sheets/detail/cervical-cancer">fourth most common</a> cancer among women. She spoke to The Conversation Africa about the drivers of cervical cancer and how to close the care gap.</em> </p>
<hr>
<h2>Most (90%) new cervical cancer cases and deaths are in low- and middle-income countries. What are the key factors driving this?</h2>
<p>Cancer of the cervix is a disease of <a href="https://www.tandfonline.com/doi/full/10.1016/S0968-8080%2808%2932397-0">inequity</a> of access to healthcare. It is an almost entirely preventable disease. Here’s why.</p>
<p>The natural history of cervical cancer begins with infection of the cervix with certain types of human papillomavirus (HPV). Over 200 types of HPV have been described over the last 40 or so years. About 40 are associated with infection in the genital tract of men and women. Of these 40 types, about 14 types are associated with cancers of the anus or genitals, particularly cervical cancer. These are known as the high-risk types. Types 16 and 18 of HPV are the most common and account for over <a href="https://www.who.int/news-room/fact-sheets/detail/cervical-cancer">70%</a> of cervical cancers globally.</p>
<p>The majority of people who acquire HPV infection won’t have any symptoms and will get over the infection without any serious problem. But they can still pass the infection on to others. </p>
<p>In a minority of cases the HPV infection becomes persistent. And over time, this infection causes changes in the cells of the cervix. These are known as precancerous changes. Left untreated or undetected, they will progress to invasive cervical cancer over time – ranging from five to 20 years.</p>
<p>If these precancerous changes can be detected, though, they can be removed surgically and this prevents progression to cervical cancer. Detecting them is what the Pap smear has done since the <a href="https://www.ncbi.nlm.nih.gov/books/NBK470165/">1940s</a>. Where implemented in national programmes, at 3-5 yearly intervals in all women in society over the age of 25-30 years, there has been a dramatic <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762353/">decrease</a> in cervical cancer incidence and death.</p>
<p>But providing the Pap smear to all women requires a complex infrastructure. It requires ability to perform the Pap smears, to transfer the smears to the laboratory, where they need to be prepared and interpreted by laboratory technicians and from there returned to the patients. These requirements have made Pap smear-based cervical cancer screening programmes prohibitively expensive in low- and middle-income countries. The failure to establish these programmes is the major cause of the high incidence of and mortality from cervical cancer in these settings. Where screening does exist, it is opportunistic and confined mainly to urban areas and to women who have health insurance.</p>
<h2>What are the most effective and affordable ways of preventing cervical cancer?</h2>
<p>The ideal would be to test at least 70% of women between 25-30 years old, through a system with adequate human and consumable resources, excellent infrastructure, built-in quality control and robust referral systems. The Pap smear is affordable and cost-effective in most high-income countries but not in low- and middle-income countries. </p>
<p>Preventing HPV infection is tricky. The most effective method is vaccination against HPV. The other is total abstinence from any sexual activity (not very realistic). There is however some protection provided by condom use (at every sexual encounter), which is estimated to be <a href="https://pubmed.ncbi.nlm.nih.gov/24488594/">around 70%</a> (compared to over <a href="https://data.unaids.org/publications/irc-pub06/jc941-cuttingedge_en.pdf">90%</a> protection against HIV transmission through correct use of condoms).</p>
<p>HPV vaccination was introduced in the year <a href="https://pubmed.ncbi.nlm.nih.gov/23199957/">2006</a>. There are currently three vaccines against various types of HPV. The current WHO <a href="https://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-guide/en/">recommendations</a> for preventing cervical cancer encompass vaccination against HPV in girls (and boys if resources allow) aged 9-12 years, combined with effective screening of women aged 30-49, at least twice in a lifetime using a high quality screening test. </p>
<p>The tests currently recommended are those that are able to detect HPV DNA on the cervix. These tests detect precancerous lesions of the cervix. A doctor can take the sample or women can be taught to <a href="https://pubmed.ncbi.nlm.nih.gov/33105451/">take their own sample</a> and deliver it to their nearest clinic for evaluation. </p>
<p>Services for the early detection and treatment of cervical cancer are essential, along with provision of palliative care for those with advanced disease. </p>
<p>The treatment of early stage cervical cancer is removal of the womb and if appropriate, removal of the upper vagina and removal of the pelvic lymph nodes. For more advanced cancers, the treatment of choice is chemo-radiation to the pelvic area.</p>
<h2>What is getting in the way of implementing these interventions?</h2>
<p>The most important obstacles to establishing national cervical cancer programmes include:</p>
<ul>
<li><p>Failure of healthcare sectors of government to prioritise cervical cancer and therefore failure to allocate resources.</p></li>
<li><p>Competing health needs among women in low- and middle-income countries. Maternal mortality and high incidence of HIV, malaria and tuberculosis divert funding away from cervical cancer prevention. Other basic needs to be met include safe drinking water and proper sanitation. Civil strife and widespread poverty also stand in the way of meeting people’s needs. </p></li>
<li><p>Lack of political will and lack of understanding of the impact on individuals, families, communities and society as a whole of women dying prematurely. This has widespread <a href="https://pubmed.ncbi.nlm.nih.gov/18850430/">socio-economic costs</a> at a national level.</p></li>
<li><p>There is a powerful investment <a href="https://www.who.int/initiatives/cervical-cancer-elimination-initiative">case</a> being developed urging governments to prioritise cervical cancer prevention and to eliminate it by at least 2030. If all countries join in the effort, it is <a href="https://www.who.int/publications/i/item/9789240014107">estimated</a> that over 60 million women’s lives will be saved.</p></li>
</ul><img src="https://counter.theconversation.com/content/176041/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynette Denny does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People in the world’s poorest regions have not benefited equally from the recent advancements made in cancer screening, prevention and treatment.Lynette Denny, Chair and Professor of Obstetrics & Gynaecology, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1708872021-11-04T15:10:35Z2021-11-04T15:10:35ZHPV vaccine cuts cervical cancer cases by almost 90% – but one in ten girls still haven’t been vaccinated<figure><img src="https://images.theconversation.com/files/430332/original/file-20211104-19-ssnszg.jpg?ixlib=rb-1.1.0&rect=49%2C8%2C5472%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The HPV vaccine protects against cervical cancer.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/teenager-asian-woman-showing-off-orange-2046010967">KT Stock photos/ Shutterstock</a></span></figcaption></figure><p>A vaccine to protect against human papillomavirus (HPV) has been found to cut cases of cervical cancer by <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02178-4/fulltext">nearly 90%</a>, according to a recent study published in The Lancet. </p>
<p>Cervical cancer, which can be caused by HPV, is one of the few cancers that can be prevented by a vaccine. This is why the HPV vaccination programme was introduced in UK schools in 2008, offered to girls aged 12-13. The programme has been <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/858872/hpr0220_HPV_2018.pdf">extremely successful</a> in the UK, with over 80% of eligible girls having received it to date. But <a href="https://pubmed.ncbi.nlm.nih.gov/34419303/">our research</a> has shown that there are still gaps in the vaccination programme. </p>
<p>HPV is one of the <a href="https://www.cdc.gov/std/hpv/stdfact-hpv.htm%20%20please%20replace%20with%20this%20reference%20https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer">most common</a> sexually transmitted infections in the world. While, in most cases, people can get over an HPV infection without treatment, it can sometimes turn into genital warts or even cervical cancer. </p>
<p>The HPV vaccination programme was introduced to vaccinate girls against HPV before they’re likely to become infected by it. But our research found that around one in ten girls in the UK hadn’t received the vaccination. We wanted to find out why these gaps exist. </p>
<p>To conduct our study, we used information from the Millennium Cohort Study – a UK-wide research study that contains detailed data on the health, social, economic and educational circumstances of children born in 2000-2002. As part of this study, at age 14 the parents of nearly 6,000 girls were interviewed and asked whether their daughters had had the HPV vaccine – and if not – the reasons they hadn’t. </p>
<p>From these interviews, we found that girls who hadn’t been vaccinated against HPV were more likely to live in the most disadvantaged areas of the UK, be home-schooled, temporarily or permanently excluded from attending school – for example, because of behavioural issues – or to be from a black or other minority ethnic background. </p>
<figure class="align-center ">
<img alt="A teen girl and her mom speak with their male GP." src="https://images.theconversation.com/files/430283/original/file-20211104-13-ugx59q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430283/original/file-20211104-13-ugx59q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430283/original/file-20211104-13-ugx59q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430283/original/file-20211104-13-ugx59q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430283/original/file-20211104-13-ugx59q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430283/original/file-20211104-13-ugx59q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430283/original/file-20211104-13-ugx59q.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">
<figcaption>
<span class="caption">Offering the vaccine through GPs may help improve uptake.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-doctor-mom-502228270">Andrey_Popov/ Shutterstock</a></span>
</figcaption>
</figure>
<p>There were many reasons girls weren’t vaccinated, according to their parents. About half said either they or their daughter didn’t want the vaccine or they were scared of the vaccination procedure. Others said their daughter had not been offered the vaccine in school, or had not been at school on vaccination day. We also found that girls living in the most disadvantaged areas were 56% less likely to have received the HPV vaccine than those in the most advantaged areas.</p>
<h2>Preventing cancer</h2>
<p>The UK’s school HPV vaccination programme has been very successful in reducing the number of young women who are <a href="https://doi.org/10.1016/S1473-3099(17)30468-1">infected with the virus</a>. The vaccination programme in the UK has also been shown to reduce the number of cases of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02178-4/fulltext">cervical cancer</a> by nearly 90%. </p>
<p>The HPV vaccine currently offered protects against two strains of HPV that cause cancer, and two strains that cause genital warts. This year, a newer vaccine will be introduced that will provide young people with protection against a further five cancer-causing HPV strains. </p>
<p>Though this is great news, our research shows that there are still gaps in the vaccination programme that need to be addressed to ensure as many young women are being protected against HPV and cervical cancer as possible and that all benefit equally. While school immunisation teams already work hard to ensure all girls and their parents know about the vaccine – and sometimes even offer it outside of school settings – more needs to be done to improve vaccine uptake.</p>
<p>One way of improving uptake may be to involve family doctors in offering the vaccine to children who have missed out. This would allow families to discuss the vaccine with their GP and ask them any questions they may have. Some people may also feel more comfortable having the vaccine administered at their GP surgery. This may help reduce inequalities in vaccine uptake. </p>
<p>Since 2019, boys have also been included in the UK HPV vaccination programme. This is because boys can pass HPV infections on and can also develop cancers from HPV. The pandemic has had a major impact on the HPV vaccination programme and we now need a concerted effort across schools and with GPs to ensure all young people are protected against HPV.</p><img src="https://counter.theconversation.com/content/170887/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carol Dezateux receives funding from NIHR, Barts Charity, the Wellcome Trust, MRC.</span></em></p><p class="fine-print"><em><span>Helen Bedford receives funding from ESRC and is a member of the National Institute for Health and Care Excellence's committee developing guidelines in improving vaccine uptake. </span></em></p><p class="fine-print"><em><span>Nicola Firman receives funding from Barts Charity.</span></em></p>Addressing these gaps in the vaccination programme will ensure more people are being protected against the type of cancer.Carol Dezateux, Professor of Clinical Epidemiology and Health Data Science, Queen Mary University of LondonHelen Bedford, Professor of Children's Health, UCLNicola Firman, PhD Researcher, Health Data Science, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1648272021-08-09T12:26:52Z2021-08-09T12:26:52ZShutting down school vaccine clinics doesn’t protect minors – it hurts people who are already disadvantaged<figure><img src="https://images.theconversation.com/files/414824/original/file-20210805-13-9sbvnr.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C3982%2C2556&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A high school student gets his COVID-19 shot at a pop-up vaccine clinic at a public charter school in Los Angeles.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/year-old-aaron-delgado-receives-his-pfizer-covid-vaccine-news-photo/1234436892">Al Seib / Los Angeles Times via Getty Images</a></span></figcaption></figure><p><a href="https://www.newspapers.com/image/119585257/">A 1918 newspaper article</a> captures public attitudes toward a typhoid vaccine clinic at the Oakdale schoolhouse in Louisville, Kentucky. “Everybody comes – railroad men, children, young girls, old people, housewives,” it reads, “all with sleeves that roll up and arms ready for the brief stick with the fine needle.” </p>
<p>Until recently, school-located vaccination clinics, or SLVs, have been applauded, or <a href="https://doi.org/10.1177/1059840510369231">simply taken for granted</a>. That changed in mid-July of 2021, when Tennessee <a href="https://www.tennessean.com/story/news/health/2021/07/13/tennessee-halts-all-vaccine-outreach-minors-not-just-covid-19/7928701002/">halted COVID-19 vaccination clinics on school property</a>. The decision was part of a broader effort to cease vaccine messages geared toward children and adolescents. The pause lasted only 10 days and has since been <a href="https://www.tennessean.com/story/news/health/2021/07/23/tennessee-restart-vaccine-outreach-paused-amid-gop-pressure/8043482002/">somewhat reversed</a>, limiting vaccine promotion to messages geared at parents and holding some vaccine events on school property.</p>
<p>Those who want to eliminate school-located COVID-19 vaccination clinics say the sites exist to immunize children without parental consent. However, even before the Food and Drug Administration expanded eligibility to include 12-to-15-year-olds, school-located sites offered COVID-19 vaccines to school staff and other eligible adults.</p>
<p>I am an <a href="https://scholar.google.com/citations?user=KeAdSmgAAAAJ&hl=en">expert on the history of epidemics</a>, and my research shows that this current move is an unprecedented detour from schools’ historical promotion of routine vaccines. Preventing school vaccination clinics does not keep waves of teenagers from getting immunized without consent. Rather, it penalizes those who want to get vaccinated but struggle with access. </p>
<h2>Partisan divide</h2>
<p>Tennessee’s “pause” stemmed from the <a href="https://www.kff.org/policy-watch/the-red-blue-divide-in-covid-19-vaccination-rates-is-growing/">Republican Party’s resistance</a> to publicly embracing COVID-19 vaccination, paired with overhyped attention to the <a href="https://www.tn.gov/content/dam/tn/health/documents/Mature_Minor_Doctrine.pdf">Mature Minor Doctrine</a>. </p>
<p>The Mature Minor Doctrine is a Tennessee law allowing “medical treatment and vaccinations to patients as young as 14,” enabling adolescents to make <a href="https://mckinneylaw.iu.edu/ihlr/pdf/vol13p1.pdf">decisions</a> about their own health. It is especially useful for those who don’t live with their parents, are in situations of neglect or abuse or face emergency circumstances. However, it also covers preventive health care and treatment including vaccinations. Many states hold similar consent exceptions.</p>
<p>Whether minors can get the COVID-19 vaccination without parental approval has <a href="https://www.kff.org/policy-watch/covid-19-vaccination-and-parental-consent/">varied by city and state</a>. After the Pfizer vaccine’s emergency authorization expanded to include ages 12 to 15, <a href="https://www.nytimes.com/2021/06/26/health/covid-vaccine-teens-consent.html">news coverage</a> called attention to teenagers receiving COVID-19 vaccines without consent, in some cases questioning the practice without addressing its prevalence or the <a href="https://www.tennessean.com/story/news/american-south/2021/08/04/teen-covid-19-vaccinations-fight-continues-increase-rate-schools-reopen/5430513001/">risk of not immunizing this age group</a>. In Tennessee, the public health department has stated that only <a href="https://www.tennessean.com/story/news/health/2021/07/23/tennessee-restart-vaccine-outreach-paused-amid-gop-pressure/8043482002/">eight adolescents</a> had received a COVID-19 vaccine without parental consent. Furthermore, no evidence has suggested that SLVs have contributed to these cases. </p>
<p>In other words, misplaced ideology, not data on teenagers getting vaccinated without consent, has been the driving force against SLVs, including COVID-19 vaccine clinics at schools. </p>
<h2>From smallpox to HPV</h2>
<p>Since the mid-19th century, schools have been common sites for vaccine clinics to respond to outbreaks and also provide catch-up immunizations. </p>
<p>In 1875, <a href="https://doi.org/10.1177/1059840510369231">17,505 children</a> were immunized against smallpox in New York City school clinics. Temporary <a href="https://www.newspapers.com/image/66584082/">typhoid vaccine clinics</a> emerged in the 1910s and 1920s across the U.S. And the 1954 polio vaccine field trials took place at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804435/">15,000 public schools</a> across 44 states. </p>
<figure class="align-center ">
<img alt="Nurse puts arm around boy as another nurse administers a polio vaccine shot" src="https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/414832/original/file-20210805-27-9nnji6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A boy is injected with polio vaccine at a school, circa 1955.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/boy-grimaces-while-being-injected-with-polio-vaccine-news-photo/587497982">USC Libraries/Corbis Historical Collection via Getty Images</a></span>
</figcaption>
</figure>
<p>Even before Jonas Salk’s polio vaccine received approval in April 1955, <a href="https://www.newspapers.com/image/359079723/">SLVs were scheduled in anticipation</a>. They became the main locations for children to receive their vaccines. In the 1960s, SLVs across the country hosted “Sabin Sundays,” providing the oral polio vaccine developed by Albert Sabin to any unvaccinated <a href="https://ohiomemory.org/digital/collection/p267401coll36/id/19113">adult or child</a>. During this time, school campaigns also expanded to offer immunizations against <a href="https://www.newspapers.com/clip/82726551/schools-to-provide-free-vaccine-1971/">rubella and measles</a>. </p>
<p>Since then, SLVs have continued to be used for public health outreach, protecting children against hepatitis B, seasonal influenza and HPV. Many sites emerge for a short window each year, <a href="https://www.newspapers.com/image/523426147/">providing catch-up immunizations</a> for kids who are behind on other vaccines as well as shots against seasonal flu. Others spring up as needed, as demonstrated with H1N1 immunizations in 2009. Even the pop-up clinics at schools typically require parental consent for participation. </p>
<p>Moreover, SLVs are often available to whole communities – not just school attendees. They are widely effective in addressing <a href="https://www.doi.org/10.2105/AJPH.2009.176628">disparities in immunization</a> linked to income and insurance status. Like other mass vaccination sites, SLVs can immunize large numbers of people in a short period of time and <a href="https://doi.org/10.1371/journal.pmed.1003238">reduce disease in a community</a>. </p>
<p>They have <a href="https://www.cdc.gov/vaccines/covid-19/planning/school-located-clinics.html">additional benefits</a>, too. SLVs are convenient for families and school staff, provide a large, temperature-controlled space, create awareness of the importance of vaccines and <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00032366.htm#00000621.htm">boost rates of completion</a> for vaccines given in a series.</p>
<h2>Pandemic disruptions</h2>
<p>The COVID-19 pandemic caused global disruptions in children’s vaccinations. In 2020, <a href="https://www.who.int/news/item/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19">routine vaccinations decreased</a> because of stay-at-home orders, <a href="https://www.who.int/news/item/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19">delay or cancellation of immunization programs</a> and other reasons connected to the global health crisis. </p>
<p>For the diphtheria, tetanus and pertussis vaccines, known as DTaP, New York City experienced a decrease of <a href="https://www.nytimes.com/live/2021/06/10/world/covid-vaccine-coronavirus-mask">16% for children under 2 and 60% for ages 2 to 6</a>. Researchers estimate that routine vaccinations need to increase <a href="https://doi.org/10.1016/j.vaccine.2020.11.074">as much as 15%</a> for vaccine rates to return to pre-pandemic levels. </p>
<figure class="align-center ">
<img alt="A toddler sits in chair with sleeve pulled down to receive flu shot" src="https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/414835/original/file-20210805-19-1vmi0re.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A nurse gives a 3-year-old a flu shot at a mobile immunization clinic set up behind John Ruhrah Elementary/Middle School in Baltimore in October 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/nurse-hellen-lougon-gives-a-flu-shot-to-3-year-old-sofia-news-photo/1229662559">Katherine Frey/The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<p>It’s important to remember that vaccine-preventable diseases are not distant memories. Only smallpox has been globally eradicated – polio, diphtheria, rubella and other dangerous viruses still exist.</p>
<p>Vaccination reductions can produce costly community outbreaks. A single measles case in 2018 erupted into <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1912514">over 600 cases</a> in an undervaccinated community in New York, costing US$8.4 million in public health response efforts, medical expenses and productivity loss. Similarly, Washington state’s <a href="https://doi.org/10.1542/peds.2020-027037">2019 Clark County measles outbreak</a> cost an estimated $3.4 million. </p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p>
<h2>SLVs for COVID-19</h2>
<p>Starting in March 2020, schools across the country began offering COVID-19 vaccines – first for staff and community members, and in May for those ages 12 and up. Such sites have been <a href="https://doi.org/10.1177/1942602X21991643">especially important</a> for <a href="https://edsource.org/2021/new-l-a-school-vaccination-sites-to-open-for-families-of-students-in-hard-hit-communities/652263">low-income and other underserved communities</a> significantly affected by the pandemic. </p>
<p>Once the eligible age expands to include children ages 11 and younger, school vaccine clinics can serve entire families. The <a href="https://www.nytimes.com/2021/08/05/us/politics/school-vaccinations-biden.html?smid=tw-nytimes&smtyp=cur">White House has encouraged</a> every school district to host at least one pop-up vaccination clinic. As with the typhoid and polio clinics before them, the intention is to curb the spread of disease and improve overall public health – the message that should underscore all vaccination decisions for this pandemic.</p><img src="https://counter.theconversation.com/content/164827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine A. Foss does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For decades, US schools have been common sites for vaccine clinics to respond to outbreaks and provide catch-up immunizations. So why are they suddenly controversial?Katherine A. Foss, Professor of Media Studies, Middle Tennessee State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1325122020-03-04T11:58:30Z2020-03-04T11:58:30ZA simple way to promote HPV vaccination among Asian American women: Storytelling<figure><img src="https://images.theconversation.com/files/318129/original/file-20200302-18308-n5pkyu.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5000%2C3510&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Rates of HPV screenings and vaccinations remain low for some subgroups of Asian American women.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/schoolgirl-getting-vaccinated-royalty-free-image/871552754?adppopup=true">Getty Images / Peter Dazeley</a></span></figcaption></figure><p>Asian Americans and Pacific Islanders – what demographers call AAPIs – are the nation’s fastest-growing minority. Close to <a href="https://www.diversity.va.gov/programs/aapi.aspx">20 million</a> now live in the U.S. But you wouldn’t know it from our public health data, where AAPIs are underrepresented. Nowhere is that more apparent than in the data on cervical cancer screenings. </p>
<p>In the U.S., AAPI women have the lowest risk of cervical cancer. However, when separating cancer statistics by subgroups, it shows the incidence and mortality rates of cervical cancer are <a href="http://www.aapcho.org/wp/wp-content/uploads/2015/08/Cancer-Facts-Asian-Americans-and-Cancer.pdf">two or three times higher</a> in Cambodian, Hmong, Korean, and Vietnamese women than in non-Hispanic white women. </p>
<p>At the same time, one subgroup, Korean American women, has the <a href="https://doi.org/10.1002/cncr.30391">lowest rates</a> of cervical cancer screening in the U.S. Breaking it down further, English-speaking, college-educated Korean American women have particularly <a href="https://doi.org/10.1007/s10900-019-00634-9">low awareness and knowledge</a> of HPV, the HPV vaccine and cervical cancer. </p>
<p>As a Korean immigrant, and a <a href="https://www.researchgate.net/profile/Minjin_Kim2">transcultural nurse implementation scientist</a>, I want to expand awareness of the need for HPV education among AAPI women. <a href="https://ipvsoc.org/hpv-day/">International HPV Awareness Day</a>, March 4, is perhaps the perfect time to remind all women that the human papillomavirus can cause cancer and that cervical cancer screening and HPV vaccination are the best ways to prevent those cancers. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/318133/original/file-20200302-18287-ul199p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318133/original/file-20200302-18287-ul199p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=724&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318133/original/file-20200302-18287-ul199p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=724&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318133/original/file-20200302-18287-ul199p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=724&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318133/original/file-20200302-18287-ul199p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=909&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318133/original/file-20200302-18287-ul199p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=909&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318133/original/file-20200302-18287-ul199p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=909&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some subgroups of Asian American and Pacific Islander women are reluctant to get the HPV vaccine.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/vaccination-royalty-free-image/184233413?adppopup=true">Getty Images / Peter Dazeley</a></span>
</figcaption>
</figure>
<h2>The cause of cervical cancer</h2>
<p><a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer">Nearly all cervical cancers</a> – over 99% – are caused by HPV infection. <a href="https://www.cdc.gov/std/hpv/stdfact-hpv.htm">HPV is the most common sexually-transmitted infection</a> in the U.S. that
strikes both men and women, and the only STI that causes cancer, including cervical, oral, anal, vulvar and penile cancers.</p>
<p>Studies show HPV infection is more prevalent in men than women. But women are more likely to have persistent, high-risk HPV infection that may lead to cervical cancer, the <a href="https://www.cancer.org/latest-news/facts-and-figures-2020.html">second-leading cause of cancer death</a> among women ages 20 to 39. Currently, cervical cancer is the only HPV cancer with a recommended screening test to detect it an early stage. </p>
<p>After the introduction of the <a href="https://www.cdc.gov/cancer/cervical/statistics/index.htm">Papanicolaou (Pap) test</a>, the incidence and mortality rates of cervical cancer decreased significantly. But not all women are getting regular Pap tests, and not all cervical cancer rates are declining. Moreover, screening alone does not protect against all types of cervical cancer. <a href="https://www.cdc.gov/hpv/parents/vaccine.html">HPV vaccination</a> provides the best protection against cervical and other HPV-associated cancers.</p>
<h2>Prevention is not always a priority</h2>
<p>Why do so many AAPI women know so little about HPV? </p>
<p>We set out to answer this question by interviewing Asian American ethnic groups and conducting surveys. </p>
<p>Our findings suggest their knowledge and attitudes toward HPV prevention <a href="https://doi.org/10.1007/s10900-019-00634-9">are closely tied</a> to health beliefs and cultural or language barriers. What’s more, we discovered preventive health care is not a top priority for immigrant populations. In general, they seek treatment only <a href="https://doi.org/10.1188/17.CJON.E239-E247">when already sick</a>. <a href="https://doi.org/10.1080/13557858.2018.1514455%20%20DOI:%2010.1007/s10900-019-00634-9">Our studies</a> also suggest many of them are skeptical about participating in research.</p>
<p>One woman who participated <a href="https://doi.org/10.1188/17.CJON.E239-E247">in our study</a> said, “Guys don’t have a cervix, so I thought this vaccine is for women only.” But HPV is a sexually transmitted infection. Both men and women can have it, and the vaccine works for both sexes. One reason for the misunderstanding is that the HPV vaccine is often advertised as <a href="https://doi.org/10.1188/17.CJON.E239-E247">“cervical cancer vaccine.”</a> This occurs in the U.S. as well as in South Korea. </p>
<p>Some of the AAPI women told us their <a href="https://doi.org/10.1188/17.CJON.E239-E247">doctor did not recommend</a> the vaccine because Asian women are less prone to cervical cancer. This is not true; doctors saying this are not familiar with how the data might mask differences in AAPI subgroups. <a href="https://doi.org/10.1007/s10900-019-00634-9">Other women said</a> they were confused by medical terminology or the way the U.S. health care system worked – hardly a singular experience, no matter what your nationality or ethnicity. </p>
<p>Another problem is the sheer number of the subgroups of AAPI women. There are about 50, and among them, hundreds of languages and dialects, and with little or no accurate population-based data outlining their vaccination rates. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/318132/original/file-20200302-18283-1lnjf0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318132/original/file-20200302-18283-1lnjf0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318132/original/file-20200302-18283-1lnjf0v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318132/original/file-20200302-18283-1lnjf0v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318132/original/file-20200302-18283-1lnjf0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318132/original/file-20200302-18283-1lnjf0v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318132/original/file-20200302-18283-1lnjf0v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A human papillomavirus infection. HPV is the most common sexually transmitted infection globally.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/human-papillomavirus-infection-virus-hpv-is-the-royalty-free-image/1060642876?adppopup=true">Getty Images / Naeblys</a></span>
</figcaption>
</figure>
<h2>Storytelling made a difference</h2>
<p>We discovered in our study that narrative storytelling – that is, mothers and their children sharing their experiences and having conversations about HPV vaccination – can increase HPV vaccination rates. </p>
<p>From that, we’ve developed what we call a <a href="https://doi.org/10.1093/her/cyz022">storytelling intervention</a> for young Korean American women using a “peer-paired” approach. Because the storytellers are about the same age as the participants, a meaningful conversation is more likely to occur. The women are less shy about sharing their personal experiences, feelings and fears. </p>
<p>In our study, three pairs of young Korean women told their stories about the HPV vaccination experience. They also discussed their cultural attitudes toward vaccines. <a href="https://doi.org/10.2196/14111">We also produced</a> an educational video that addressed common misconceptions about HPV, along with a research manual and a web-based interface where participants could watch storytelling video interviews.</p>
<p>A comparison group received basic written information about HPV, but it was non-narrative. In other words, dry facts and no storytelling.</p>
<p><a href="https://doi.org/10.1177/1090198119894589">Our findings are conclusive</a>: The storytelling intervention group was twice as likely to schedule an appointment for the HPV vaccine than the comparison group. Simple storytelling – human-centered, interactive, culture-specific and group-tailored – led to positive health outcomes. </p>
<p>We are now expanding our research to include both men and women and other underserved or understudied populations. Our storytelling intervention strategy, which leverages today’s technologies, can now be replicated to reach diverse groups and promote health, and prevent cancers and other diseases. </p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/132512/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Minjin Kim previously received funding from the American Cancer Society. </span></em></p>Researchers have found a way to encourage cervical cancer screenings and vaccinations in Korean American women. Might their findings also work in other underrepresented populations?Minjin Kim, Postdoctoral Research Associate, UMass Chan Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1242982019-09-27T16:33:03Z2019-09-27T16:33:03ZWhy it makes medical – and mathematical – sense to finally vaccinate boys against the HPV virus<figure><img src="https://images.theconversation.com/files/294518/original/file-20190927-185403-1pvjg7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/human-papillomavirus-infection-virus-hpv-most-1214814547?src=KS_rpQ3IFnNFbiN8lP5OZQ-1-0">Shutterstock/Naeblys</a></span></figcaption></figure><p>From September 2019, boys aged 12 and 13 in the UK are <a href="https://www.gponline.com/hpv-vaccination-programme-will-expand-cover-boys-september/article/1590326">being offered free vaccination</a> against the Human Papillomavirus (HPV) for the first time. HPV causes cervical cancer, and girls and young women have been receiving the vaccine for over ten years. So why is it being rolled out for boys too? And why only now?</p>
<p>One reason for giving the vaccine to boys is that the <a href="https://academic.oup.com/jnci/article/87/11/796/1141620">vast majority</a> of cases of cervical cancer-causing HPV infections are transmitted through sexual intercourse. Men can carry the virus without symptoms and pass it on to their sexual partners. </p>
<p>In fact, HPV is the most frequently sexually transmitted disease <a href="https://www.sciencedirect.com/science/article/abs/pii/S129795891000007X?via%3Dihub">in the world</a>, and over 60% of all cervical cancers are caused by two HPV strains. Cervical cancer itself is the <a href="https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/">fourth most common cancer in women</a>, with around <a href="https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/">half a million new cases</a> and <a href="https://www.who.int/en/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer">over quarter of a million deaths</a> reported worldwide each year. </p>
<p>Unsurprisingly, given this high prevalence, when the first vaccines against HPV were <a href="https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/gardasil-vaccine-safety">approved in the US in 2006</a>, there was great hope surrounding their potential. Mathematical modelling <a href="https://www.sciencedirect.com/science/article/pii/S0264410X09008949?via%3Dihub">studies carried out</a> around that time indicated that the most cost effective strategy would be to immunise adolescent girls between the ages of 12 and 13 – the likely <a href="https://www.bmj.com/content/337/bmj.a769">future sufferers of cervical cancer</a>.</p>
<p>But, as I uncover in my new book <a href="https://amzn.to/2MkmdcM">The Maths of Life and Death</a> (along with many other surprising occasions where maths has played a crucial, but sometimes unseen, role) the mathematical models didn’t capture the whole picture. Most of the analyses did not include an important feature of HPV in their assumptions: that the strains of HPV guarded against by the vaccine can also cause a range of non-cervical diseases in <a href="https://www.nature.com/articles/6603501">both women and men</a>.</p>
<p>In July of 2018, a new mathematical <a href="https://doi.org/10.1016/J.EPIDEM.2017.06.004">study</a> led to <a href="https://www.gov.uk/government/publications/jcvi-statement-extending-the-hpv-vaccination-programme-conclusions">a recommendation</a> that all boys in the UK be given the HPV vaccination at the same age as girls.</p>
<p>This is in part because as well as causing cervical cancer, <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.23758">HPV types 16 and 18 contribute</a> to 50% of penile cancers, 80% of anal cancers, 20% of mouth, and 30% of throat cancers. In both <a href="https://doi.org/10.1002/cncr.23758">the US</a> and <a href="https://hpvcentre.net/statistics/reports/GBR_FS.pdf">the UK</a>, the majority of cancers caused by HPV are <a href="https://doi.org/10.1136/BMJ.B4928">not cervical</a>.</p>
<p>This fact came to the fore when the actor Michael Douglas was asked, during his recovery from throat cancer, if he regretted his lifetime of smoking and drinking. The actor candidly replied that he had no regrets about this, because his cancer had been caused by HPV, which he <a href="https://www.theguardian.com/film/2013/jun/02/michael-douglas-oral-sex-cancer">contracted through oral sex</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/294522/original/file-20190927-185407-4shss6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/294522/original/file-20190927-185407-4shss6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=503&fit=crop&dpr=1 600w, https://images.theconversation.com/files/294522/original/file-20190927-185407-4shss6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=503&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/294522/original/file-20190927-185407-4shss6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=503&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/294522/original/file-20190927-185407-4shss6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=632&fit=crop&dpr=1 754w, https://images.theconversation.com/files/294522/original/file-20190927-185407-4shss6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=632&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/294522/original/file-20190927-185407-4shss6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=632&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">Michael Douglas spoke candidly about HPV.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/new-york-ny-usa-may-8-636190979?src=pHRu-sX1lpvq7XptoJz8Ew-1-49">Shutterstock/lev radin</a></span>
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<p>Warts and verrucas are also caused by different types of HPV, and <a href="https://www.independent.co.uk/news/science/hpv-vaccination-study-cervical-cancer-treatment-health-a8862946.html">80% of people</a> in the UK will be infected with one strain of HPV at some point during their lives. </p>
<p>So cervical cancer is an important part of the HPV picture, but it is not, by any means, the whole story. It seemed that the link to other cancers and diseases had been underestimated.</p>
<h2>The rest of the picture</h2>
<p>The public, perhaps aware only of HPV’s role in cervical cancer, seemed to accept the decision to only vaccinate females. Why would we waste money vaccinating boys if they don’t suffer from the headline HPV cancer?</p>
<p>On top of this, mathematical models into the <a href="https://www.bmj.com/content/337/bmj.a769">impact of HPV vaccination suggested</a> that by vaccinating a sufficiently high proportion of females, the prevalence of HPV-related diseases in males would also decline.</p>
<p>But imagine the outrage if a vaccination for human immunodeficiency virus (HIV) was given only to women for free, in the hope that men would be protected through women’s immunity.</p>
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Read more:
<a href="https://theconversation.com/parents-want-the-hpv-vaccine-for-their-sons-new-research-86594">Parents want the HPV vaccine for their sons – new research</a>
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<p>Perhaps the first point that critics would make (aside from the issues of partial vaccination coverage and vaccine inefficiency) would be about the protection of gay men – why should they be left defenceless against one of the most deadly viruses of our time, just because they don’t have sex with women? </p>
<p>Exactly the same argument holds true in the case of HPV. Early mathematical studies had ignored the impact of same sex couplings on the dynamics of HPV spread.</p>
<p>Models that include homosexual relationships suggest a <a href="https://doi.org/10.1073/pnas.0707332105">higher rate of sexual disease transmission</a> than those which consider only heterosexual relationships. And the prevalence prevalence of HPV in men who have sex with men is <a href="https://doi.org/10.1371/journal.pone.0139524">significantly higher</a> than in the general population. </p>
<p>When models were recalibrated to take into account homosexual relationships, protection afforded against non-cervical cancers, and new information on the length of protection that the HPV vaccination provides, it was found that vaccinating boys as well as girls became a more cost-effective option.</p>
<p>Now that the vaccination is finally here, available to boys as well as girls – in a move which will reduce the rates of many kinds of cancer as well as other HPV-related diseases. </p>
<p>This is good news for all of us. And on a personal note I am delighted that my son, as well as my daughter, will now be afforded equal protection against catching and spreading the virus that killed their grandmother. In the case of cervical cancer, as with many of the other cases I have <a href="https://amzn.to/2MkmdcM">investigated</a>, maths really can be a matter of life and death.</p><img src="https://counter.theconversation.com/content/124298/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christian Yates does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Everyone will benefit from wider HPV vaccinations.Christian Yates, Senior Lecturer in Mathematical Biology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1136102019-04-03T23:03:08Z2019-04-03T23:03:08ZCervical pre-cancer rates down 88% in decade since HPV vaccinations began – first findings<figure><img src="https://images.theconversation.com/files/267352/original/file-20190403-177178-bcnu48.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cervical cancer is third-biggest killer among young women. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bottle-vaccine-human-papillomavirus-hpv-disposable-467256860">Pittawut</a></span></figcaption></figure><p>Cervical cancer is the <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/age#heading-Two">third most common</a> cancer among women in the UK under the age of 35 after breast and skin cancer. In the <a href="https://www.ncbi.nlm.nih.gov/pubmed/25410654">majority of cases</a>, the cancer only develops if the patient is infected with human papillomavirus (HPV) types 16 or 18. This virus is mainly transmitted between people having vaginal, anal or oral sex. At some point in their lives, four in five people <a href="https://www.jostrust.org.uk/about-cervical-cancer/hpv/how-do-people-get-HPV">will be</a> infected by HPV strains – as many as 14 can cause cancer in total. According to recent studies, other cancers heavily linked to HPV infections include <a href="https://www.ncbi.nlm.nih.gov/pubmed/30590469">head-and-neck</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=HPV+vulval+pollock">vulvo-vaginal</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/25797230">anal</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/267355/original/file-20190403-177190-131469j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/267355/original/file-20190403-177190-131469j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/267355/original/file-20190403-177190-131469j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=697&fit=crop&dpr=1 600w, https://images.theconversation.com/files/267355/original/file-20190403-177190-131469j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=697&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/267355/original/file-20190403-177190-131469j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=697&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/267355/original/file-20190403-177190-131469j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=876&fit=crop&dpr=1 754w, https://images.theconversation.com/files/267355/original/file-20190403-177190-131469j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=876&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/267355/original/file-20190403-177190-131469j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=876&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">Green = gynaecological diseases.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cervical-cancer-vaccine-174165935">Africa Studio</a></span>
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<p>In an effort to reduce rates of cervical cancer, a number of countries launched immunisation programmes in the late 2000s, starting with Australia in 2006. The UK and its devolved governments launched a school immunisation programme in 2008 to vaccinate all girls aged 12-13. To speed up the time lag associated with achieving the benefits of vaccination, they also kicked off a three-year catch-up programme for girls aged up to 18 years. </p>
<p>A decade on, we are finally able to publish the <a href="http://press.psprings.co.uk/bmj/april/HPV.pdf">first results</a>. The data <a href="http://press.psprings.co.uk/bmj/april/HPVedit.pdf">relates to</a> Scotland, since it was cervically screening women from the age of 20 until 2016 – before falling into line with the minimum age of 25 used in the rest of the UK. This meant that Scotland obtained screening data for the 2008-09 cohort before the change in screening age. Scotland also has very detailed information about take-up rates, which have been very high: running to approximately 90% in Scotland for the routinely vaccinated girls and 65% for the older girls vaccinated as part of the catch-up programme. </p>
<p>For the first time, we can now confirm that the vaccination programme has begun to profoundly alter the prevalence of HPV 16 and 18 among Scottish women – and presumably elsewhere as well. </p>
<h2>The study</h2>
<p>My team performed an eight-year study of the women eligible for the Scottish national vaccination and cervical screening programmes. We looked at their vaccination status, year of birth, indicators of deprivation and whether they lived in urban or rural areas. Using complex statistical modelling, we were able to calculate the effect of vaccination on cervical pre-cancer. Though not all pre-cancer becomes cancer, all cancer requires pre-cancer. Cervical pre-cancer occurs quicker than cancer and therefore this focus has allowed us to see the impact of the vaccine earlier. </p>
<p>Among women born in 1995-96 – the first group to go through the regular vaccination programme in 2008/09 – there has been an 88% reduction in rates of cervical pre-cancer. This is a fall in incidence from 1.44% to 0.17%. </p>
<p>Not only that, women born in these years who had <em>not</em> received the vaccine were also less likely to develop cervical pre-cancer. This was because the high vaccine uptake meant that HPV incidence was much lower in their age group, thanks to a phenomenon known as “<a href="http://vk.ovg.ox.ac.uk/herd-immunity">herd protection</a>”. This is particularly good news, since this group is also less likely to attend cervical screenings.</p>
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<a href="https://images.theconversation.com/files/267353/original/file-20190403-177178-rtn3s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/267353/original/file-20190403-177178-rtn3s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/267353/original/file-20190403-177178-rtn3s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/267353/original/file-20190403-177178-rtn3s4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/267353/original/file-20190403-177178-rtn3s4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/267353/original/file-20190403-177178-rtn3s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/267353/original/file-20190403-177178-rtn3s4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/267353/original/file-20190403-177178-rtn3s4.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"></a>
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<span class="caption">UK vaccination programme is over a decade old.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cervical-cancer-vaccine-174165935">Image Point Fr</a></span>
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<p>The findings clearly show that the routine HPV vaccination programme for girls aged 12 to 13 has been a resounding success. This is consistent with the fact that we have <a href="https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(17)30468-1.pdf">also seen</a> a big fall in high-risk HPV infection in Scotland in recent years. The obvious conclusion is that we are going to see far fewer cases of cervical cancer in years to come. </p>
<p>From September, the UK is going to extend the vaccination programme to boys – becoming one of <a href="http://www.hpvaction.org/gender-neutral-vaccination.html">numerous countries</a> to do so. This is in response to the fact that rates of head and neck cancer <a href="https://www.menshealth.com/health/a19542008/head-and-neck-cancers-are-on-the-rise-and-younger-men-are-at-risk/">are rising</a> in men: approximately 60% of head and neck cancer is associated with HPV16 infection, and should therefore be mostly preventable through vaccination. This programme should also mean that high-risk HPV infections among the population should be eliminated more quickly, which should have knock-on benefits for rates of HPV-driven cancers.</p>
<p>Meanwhile, in parts of Canada, HPV vaccinations are now being offered to uninfected women as part of the cervical screening process. This may protect older women from developing cervical cancer. This process may be adopted internationally, including the UK. When we look at the picture as a whole, eliminating the HPV virus, and making huge inroads into the various cancers that it helps develop, is now becoming a realistic possibility.</p><img src="https://counter.theconversation.com/content/113610/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kevin Pollock is a board trustee for Jo's Cervical Cancer Trust.</span></em></p>Why it is now realistic to talk about eliminating cervical cancer altogether.Kevin Pollock, Senior Research Fellow, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag: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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Read more:
<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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Read more:
<a href="https://theconversation.com/new-study-shows-hpv-vaccine-is-working-to-reduce-rates-of-genital-warts-75129">New study shows HPV vaccine is working to reduce rates of genital warts</a>
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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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Read more:
<a href="https://theconversation.com/never-had-a-pap-smear-now-theres-a-diy-option-for-you-70706">Never had a Pap smear? Now there's a DIY option for you</a>
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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/872192017-11-10T10:47:13Z2017-11-10T10:47:13ZHPV jab and better tests mean women will need only three cervical screens from 2021<figure><img src="https://images.theconversation.com/files/194154/original/file-20171110-29374-kl6kw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The HPV jab given from 2008 with new testing procedures from 2019 could mean women need fewer tests over a lifetime.</span> <span class="attribution"><span class="source">Image Point Fr/Shutterstock</span></span></figcaption></figure><p>The human papillomavirus or HPV is an incredibly common sexually transmitted infection: more than <a href="https://www.ncbi.nlm.nih.gov/pubmed/25299412">85% of women will be infected during their lifetimes</a> and, according to the US Center for Disease Control: “<a href="https://www.cdc.gov/std/hpv/stdfact-hpv.htm">HPV is so common that nearly all sexually active people get it at some point in their lives</a>”. While the vast majority of infections clear on their own, a small proportion progress to cause <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet">cervical and other cancers</a>. </p>
<p>The risk of cervical cancer has been shown to be much higher for women with HPV, with the risk varying by type of HPV virus. HPV types 16 and 18 bring the highest risk, responsible for around 70% of cervical cancers between them. Compared to a woman without an HPV infection, women infected with HPV16/18 are <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa021641#t=articleTop">more than 300 times more likely to have cervical cancer</a>. The fact is that if there were no HPV, there would be almost no cervical cancer. Which means tackling HPV infection is of vital importance.</p>
<p>It’s this understanding of the carcinogenic effects of HPV that has led health authorities in the UK to offer <a href="https://www.gov.uk/government/news/hpv-vaccine-to-change-in-september-2012">HPV vaccination to girls aged 12</a> at school, free of charge, since 2008. The current vaccine, Gardasil, protects against four strains of HPV: types 16 and 18 that cause around 70% of all cervical cancers, and types 6 and 11 that cause around 90% of genital warts. Gardasil has been proven to have <a href="http://www.tandfonline.com/doi/abs/10.4161/hv.29532">96% efficacy against HPV infection</a> when followed up after nine years.</p>
<p>We built a microsimulation model of the natural history of cervical cancer in a cohort of girls from age 12 to 80, and considered a variety of vaccination and screening combinations in order to analyse the effects of the HPV vaccine and cervical screening on women. Our <a href="http://onlinelibrary.wiley.com/doi/10.1002/ijc.31094/full">study</a>, published in the International Journal of Cancer, found that the combined effects of vaccination and improved screening measures would mean that women require far fewer cervical cancer screenings – a relief for women, and an enormous cost saving for the NHS and taxpayer.</p>
<h2>Better checks with less fuss</h2>
<p>The current cervical screening, or smear test, first looks for abnormal cells. If these are detected, the sample is then tested for the presence of HPV. However the <a href="https://phescreening.blog.gov.uk/2017/06/14/what-gps-need-to-know-about-the-introduction-of-primary-hpv-testing-in-cervical-screening/">screening programme is due to change in 2019</a> to the more efficient approach of first testing samples for HPV, following a <a href="https://legacyscreening.phe.org.uk/policydb_download.php?doc=560">pilot study</a> which began in England in 2013. Our modelling suggests that seven screens over a lifetime will provide the same protection for women who have not been vaccinated against HPV as the 12 screens recommended under the current programme. </p>
<p>For young women who have been vaccinated against HPV and who are therefore at much lower risk of cervical cancer, our model suggested that the number of lifetime screens would fall from 12 to three. Women vaccinated aged 12 in 2008 are now 21, and would start being screened in 2021 under the current screening programme – which invites women for their first screen aged 25. So this forthcoming change in 2019 presents a great opportunity for health authorities to draw up adjusted guidelines for the lower number of screens required by vaccinated women to account for the lower risk they face. </p>
<p>In 2015 a new vaccine, Gardasil-9, which protects against 9 types of HPV and prevents around 90% of cervical cancers, was approved for use in Europe. If this vaccine replaces the current vaccine, women will only require two screens during their lives.</p>
<p>The <a href="https://www.nature.com/articles/srep02362">cost of cervical cancer screening in England in 2013 was around £175m</a>. The switch to the new testing regime would mean not only less women getting cervical cancer, but also substantial cost savings. We’d need more results from the pilot to get an accurate estimate, but it’s likely that savings would be in the region of £40-80 million each year – money that can be reinvested into other services. In any case, as cervical screening isn’t a fun experience, anything that reduces the number of times women need it is good news.</p><img src="https://counter.theconversation.com/content/87219/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca Landy receives funding from Cancer Research UK.</span></em></p>Smear tests are no fun for women, and the HPV vaccine and better screening will offer better protection from cancer and fewer trips to the women.Rebecca Landy, Cancer Screening Statistician, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/803582017-09-26T14:00:27Z2017-09-26T14:00:27ZHow the anal cancer epidemic in gay and bi HIV-positive men can be prevented<figure><img src="https://images.theconversation.com/files/187418/original/file-20170925-17379-lr0fcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Singers from the New York City Gay Men's Choir sing Dec. 1, 2015 at the Apollo Theater in New York for World AIDS Day. A new health foe has emerged among gay and bisexual men. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Ending-AIDS-Cuomo/5f660927b45f4a46812220dcd0a3d67b/1/0">AP Photo/Seth Wenig</a></span></figcaption></figure><p><a href="https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-msm-508.pdf">Almost 620,000</a> gay and bisexual men in the United States were living with HIV in 2014, and 100,000 of these men were not even aware of their infection. These men are <a href="http://www.thebodypro.com/content/68540/anal-cancer-rates-higher-in-people-with-hiv-than-i.html">100 times</a> more likely to have anal cancer than HIV-negative men who exclusively have sex with women. Yet, no national screening guidelines exist for anal cancer prevention in any population. </p>
<p>Anal cancer is predominantly caused by chronic or persistent <a href="https://www.analcancerfoundation.org/about-hpv/hpv-cancer/">human papillomavirus (HPV)</a> infection. HPV infection can lead to the development of anal precancer which, if remains undetected or not adequately treated, may lead to anal cancer. Likewise, HPV infection is also responsible for causing cervical, vaginal, vulvar, oropharyngeal, penile and rectal cancers. </p>
<p>The objective of screening is to identify and treat these precancers to prevent occurrence of anal cancer. However, one of the reasons for the lack of screening guidelines is that anal precancer treatment has not yet been shown to prevent invasive cancer. Our study, published today in the journal <a href="http://onlinelibrary.wiley.com/doi/10.1002/cncr.31035/full">Cancer</a>, attempts to find a possible solution to prevent anal cancer in HIV-positive gay and bisexual men, using the best available data. We found that age-specific anal precancer management, including post-treatment HPV vaccination, can potentially lead to an 80 percent decrease in lifetime risk of anal cancer and anal cancer mortality among gay and bisexual men. </p>
<h2>Anal cancer: the next big crisis</h2>
<p>Some in the medical community have identified anal cancer as the next big <a href="http://www.lavendermagazine.com/our-lives/the-next-gay-plague-anal-cancer/">crisis</a> among HIV-infected gay and bisexual men. Initiation of anti-retroviral therapy in the 1990s greatly reduced the AIDS-related death rate and improved survival. However, this improvement in survival led to an <a href="http://ascopubs.org/doi/abs/10.1200/JCO.2012.44.5486?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">increase</a> in the lifetime risk of developing anal cancer, especially among HIV-positive gay and bisexual men.</p>
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<p>Anal cancer is typically preceded by persistent HPV infection that often leads to precancer. HPV is common among U.S. men; about <a href="https://academic.oup.com/cid/article/doi/10.1093/cid/cix159/2999730/Prevalence-and-Risk-of-Penile-Human-Papillomavirus">one out of two</a> men in the general population has HPV infection. HPV typically clears naturally; however, under certain circumstances, it might persist longer and might progress to anal precancer. If it remains undetected, untreated or inadequately treated, this precancer can progress to anal cancer. </p>
<p>The <a href="https://www.cancer.org/cancer/anal-cancer/about/what-is-key-statistics.html">American Cancer Society</a> estimates there will be 8,200 new anal cancer cases in 2017. In the absence of national screening recommendations, more than 50 percent of these individuals will be diagnosed at stage III or IV, when five-year survival is less than 40 percent. This creates a major public health concern. </p>
<p>We do not yet know how best to manage anal precancer (also known as high-grade squamous intraepithelial lesions) so that anal cancer could be prevented. A national randomized clinical trial study – Anal Cancer HSIL Outcomes Research (<a href="https://anchorstudy.org/">ANCHOR</a>) – is currently determining optimal anal precancer management by comparing treatment and active monitoring. </p>
<p>The question then arises: How do we start managing our patients using the best available evidence? Likewise, it is imperative that these individuals have as much information as possible about anal cancer prevention.</p>
<h2>How our study brings insight</h2>
<p>Using a mathematical model, we simulated the life course of 100,000 hypothetical HIV-positive men who have sex with men (MSM) who were 27 years or older and were diagnosed with high-grade squamous intraepithelial lesions. In our model, we compared four different management strategies: (1) individuals were not provided any form of treatment, which is the current practice; (2) individuals were actively monitored (followed biannually) and those who developed early cancer were treated; (3) individuals were immediately treated using surgery (current most popular strategy among clinicians who treat precancer); and (4) individuals in addition to surgical treatment received HPV vaccination (potential strategy). </p>
<p>We followed these hypothetical patients over their lifetime in our computer model to estimate harms and benefits of the management strategies. We tracked the number of individuals who developed anal cancer and then estimated their risk of death from anal cancer. We then estimated above outcomes by patient age. For each strategy, we estimated age-specific lifetime outcomes considering cost, quality of life and life expectancy. </p>
<p>We found that HIV-infected gay and bisexual men who are 38 years or older should be treated using surgical treatment of ablation (either infrared coagulation or electrocautery), and that HPV vaccination should be administered at the time of surgery. This strategy is cost-effective and has the potential to decrease the lifetime risk of anal cancer by up to 80 percent in those men. </p>
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<p>The model also found that because younger men are more likely to be cured of their precancer without intervention, patients younger than 29 should not be treated and those between 29 and 38 years old should be actively monitored (watch-and-wait approach) in order to prevent treatment-related inconvenience and morbidity that might affect their quality of life. </p>
<h2>How the HPV vaccine could help</h2>
<p>Currently,<a href="https://www.cdc.gov/hpv/parents/vaccine.html"> HPV vaccination</a> is not recommended for administration among individuals 27 years or older. However, <a href="http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2613366">multiple observational studies</a> have shown, and our <a href="https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/civ628">findings</a> have confirmed, that a practice of vaccinating individuals who have already been diagnosed with precancer may decrease the risk of the precancer coming back after treatment. </p>
<p>Given that the HPV vaccine has minimal side effects, we believe that <a href="http://www.sciencedirect.com/science/article/pii/S0264410X17310733">clinicians can consider adopting this practice</a>. Such practice may have many advantages, such as decreasing the number of treatments a patient needs for precancer recurrence thus decreasing the adverse outcomes of surgical treatment (possibility of scarring, <a href="http://www.listentoyourgut.com/symptoms/33/anal-stenosis-and-strictures.html">anal stenosis</a> and incontinence). In the long run, post-treatment HPV vaccination also has the potential to decrease the lifetime risk of anal cancer, save health care costs for treating patients for recurrence and cancer, and improve their life expectancy and quality of life.</p><img src="https://counter.theconversation.com/content/80358/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ashish A. Deshmukh was supported by the Janice Davis Gordon Memorial Postdoctoral Fellowship and the Thomas H. and Mayme P. Scott Fellowship in Cancer Research. He also receives funding from National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Elizabeth Chiao receives funding from National Institutes of Health</span></em></p><p class="fine-print"><em><span>Jagpreet Chhatwal consults to Merck and Gilead on unrelated topics. He has received research funding from the National Institutes of Health, National Science Foundation, and American Cancer Society.</span></em></p><p class="fine-print"><em><span>Scott B. Cantor receives funding from National Institutes of Health.</span></em></p>A new study shows that anal cancer, caused by the virus HPV, can be successfully fought in HIV-positive men by timely treatment and HPV vaccination of lesions that may ultimately lead to cancer.Ashish A. Deshmukh, Assistant Professor, University of FloridaElizabeth Chiao, Associate professor, Baylor College of Medicine Jagpreet Chhatwal, Assistant Professor, Harvard UniversityScott B. Cantor, Professor, The University of Texas MD Anderson Cancer CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/751292017-03-28T19:04:08Z2017-03-28T19:04:08ZNew study shows HPV vaccine is working to reduce rates of genital warts<figure><img src="https://images.theconversation.com/files/162806/original/image-20170328-21243-1sznyex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For young women, receiving the cervical cancer vaccine has also meant a massive drop in genital warts, which are caused by the same virus. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/nhse/8135428744/">NHS Employers/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The human papillomavirus (HPV) vaccine was introduced in Australia in 2007 and New Zealand in 2008 to prevent cervical cancer. It was free for women up to age 26 in Australia and to all women under 20 in New Zealand. This is because 99.7% of cervical cancers are associated with the sexually transmissible infection.</p>
<p>There is mounting evidence the HPV vaccination program is preventing cervical disease. This includes both precancerous lesions and cervical cancer. Although it takes 10 to 20 years from HPV infection until cervical cancer develops, the <a href="https://www.mja.com.au/journal/2016/204/5/hpv-vaccine-impact-australian-women-ready-hpv-based-screening-program">data are already showing</a> a 17% decline in precancerous lesions in women aged 25 to 29.</p>
<p>But the human papillomavirus is also responsible for causing genital warts. Despite a range of questions about the vaccine’s efficacy in this area, a <a href="http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2017/vol-130-no-1452-24-march-2017/7191">recent New Zealand study</a> has shown a large reduction in genital warts. </p>
<p>In women in the age group offered vaccination, 25% had genital warts diagnosed when attending a sexual health clinic in 2007 (before the vaccine was introduced). In 2013, the rate had dropped to less than 5%.</p>
<p>Although HPV vaccination for males was not added to the New Zealand National Immunisation Schedule until 2017, genital warts in males attending sexual health clinics dropped from 22% in 2007 to less than 5% in 2013.</p>
<p>So how is this possible? It can be attributed to something called “<a href="https://theconversation.com/explainer-what-is-herd-immunity-52377">herd immunity</a>”. HPV is a sexually transmitted virus, so if women are vaccinated and can’t be infected with certain HPV types, then their sexual partners won’t be exposed. While genital warts are unpleasant, they are not deadly, unlike cervical cancer.</p>
<h2>Genital warts in Australia</h2>
<p>A 2013 <a href="http://www.bmj.com/content/346/bmj.f2032">Australian study</a> also showed the impact of the vaccine program on genital warts only a few years after its introduction. The prevalence of genital warts in women under 21 dropped by 92% between 2007 and 2011. </p>
<p>Even though boys were not part of the HPV vaccine program until 2013, by 2011 genital warts had fallen by 81% in males under 21.</p>
<p>This study showed a few other interesting features of the effects of HPV vaccination on genital warts. While a reduction was observed for both females and males in the under 21, and 21 to 30 years age groups, no change was seen in the over 30s – an age group not eligible for the HPV vaccination program. </p>
<p>There was also no difference in genital wart rates in men who have sex with men. This should change with the 2013 introduction of vaccination in males in Australia.</p>
<p>Unfortunately, Aboriginal and Torres Strait Islander women are <a href="http://www.cancervic.org.au/about/media-releases/2015-media-releases/may-2015/risk-cervical-cancer-alltime-low-australian-women.html">still twice as likely</a> as non-Indigenous women to be diagnosed with cervical cancer, and four times more likely to die of the disease.</p>
<p>It is <a href="http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0150473">well established</a> Indigenous women are more likely to suffer from HPV-related cervical disease. This is despite the fact young Indigenous women are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182900/">not more likely</a> than their non-Indigenous counterparts to have a HPV infection. </p>
<p>A <a href="https://www.mja.com.au/journal/2017/206/5/human-papillomavirus-vaccination-and-genital-warts-young-indigenous-australians">recent study</a> looked at the effect of HPV vaccination on genital warts in Aboriginal and Torres Strait Islander and other Australian populations. It found a fall in the rate of genital warts in both Indigenous men and women under 30, but not in men and women over 30, or in men who have sex with men.</p>
<p>The Gardasil vaccine, commonly used in the Australian program, protects against four HPV types: 6, 11, 16 and 18. HPV6 and 11 cause genital warts, while HPV16 and 18 are associated with 70% of cervical cancers. Emerging evidence suggests the drop in cervical disease is following the same pattern as observed for genital warts.</p>
<p>These latest data from New Zealand contribute to an already large body of evidence that demonstrates that introducing a population-based HPV vaccination program greatly reduces HPV-related disease, and genital warts in particular. This is in direct contrast to trends for other sexually transmitted infections such as chlamydia, which have <a href="http://www.healthstats.nsw.gov.au/Indicator/com_chlamnot">steadily increased</a> over the past few years.</p><img src="https://counter.theconversation.com/content/75129/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dave Hawkes works for the Victorian Cytology Service which currently operates the National HPV Vaccination Program Register. </span></em></p>A new study has found rates of genital warts have decreased significantly since the HPV vaccine was introduced.Dave Hawkes, Honorary Fellow at Department of Pharmacology and Therapeutics, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/718712017-02-03T02:07:05Z2017-02-03T02:07:05ZWe have a vaccine for six cancers; why are less than half of kids getting it?<p>Early in our careers, few of us imagined a vaccine could one day prevent cancer. Now there is a vaccine that keeps the risk of developing six Human Papillomavirus (HPV)-related cancers at bay, but adoption of it has been slow and surprising low. </p>
<p>Although it’s been available for more than a decade, as of 2014 only <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6429a3.htm">40 percent of girls</a> had received the full three doses of the vaccine, while only <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6429a3.htm">22 percent</a> of boys had received all three. That is far lower than the <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6429a3.htm">87 percent vaccination rates for the Tdap vaccine</a>, which prevents tetanus, diptheria and acellular pertussis. Rates of uptake are low in all population groups.</p>
<p>Some of the reasons include misinformation about the vaccine and why it’s administered to children. Because it is transmitted sexually in almost all cases, many parents assume their children do not need it until they are sexually active. Some believe that giving it will encourage early sexual behavior. Three separate doses on three separate doctor visits place a burden to many working parents. And, of course, there are those few who believe that vaccines are not good for children.</p>
<p>Now, however, with the approval of a <a href="https://www.cdc.gov/media/releases/2016/p1020-hpv-shots.html">two-dose regimen</a> for children under age 15, we have an opportunity to revisit the conversation with providers and parents and reinvigorate efforts to expand HPV vaccination. If successful, we may save tens of thousands of Americans from cancer every year.</p>
<h2>A common virus with an uncommon risk</h2>
<p>Oncologists and cancer control researchers, including my colleagues at <a href="http://cancer.osu.edu/">The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute</a>, regard HPV as the leading cause of many cervical, anal, vaginal, vulvar, penile and oropharynx cancers, or head and neck cancers. In fact, studies are now revealing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912410/">how HPV damages the genes in our cells</a> and triggers the mutations of cancer.</p>
<p>The U.S. Centers for Disease Control and Prevention (CDC) tracks HPV infections and trends, and the numbers are daunting: 79 million Americans are currently carriers for at least one type of HPV, and about <a href="https://www.cdc.gov/hpv/parents/questions-answers.html">14 million</a> become newly infected each year. Most infections are benign, and nine of 10 fade within two years. Several strains have been directly linked to cancers, however, inflicting <a href="https://www.cdc.gov/cancer/hpv/statistics/index.htm">more than 30,000</a> Americans annually.</p>
<p>HPV is almost universally transmitted through sexual activity, but it can also be <a href="https://www.cdc.gov/std/hpv/stdfact-hpvandoropharyngealcancer.htm">transmitted through kissing</a>. For the vaccine to be most effective, immunity must develop well before exposure, which is why it’s important that young people get the vaccine. </p>
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<img alt="" src="https://images.theconversation.com/files/155253/original/image-20170201-29915-1hy2jbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/155253/original/image-20170201-29915-1hy2jbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/155253/original/image-20170201-29915-1hy2jbz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/155253/original/image-20170201-29915-1hy2jbz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/155253/original/image-20170201-29915-1hy2jbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/155253/original/image-20170201-29915-1hy2jbz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/155253/original/image-20170201-29915-1hy2jbz.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="attribution"><span class="source">From www.shuterstock.com</span></span>
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<p>The full schedule should be completed at an early age, well before engaging in these risky behaviors. Clinical trials have shown that when administered correctly, the HPV vaccine provides close to 100 percent protection against cervical precancers and genital warts, and over the last decade there has been a <a href="https://www.cdc.gov/hpv/parents/questions-answers.html">64 percent reduction</a> in the HPV infections the vaccine targets.</p>
<p>The first HPV vaccine, <a href="http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM094042">Gardasil</a>, launched with U.S. Food and Drug Administration (FDA) approval in the summer of 2006. Almost immediately it became embroiled in dangerously incorrect assumptions – even more prevalent at that time – about vaccines, and a persistent political debate that confuses the recommended HPV vaccination age (as young as nine) with when young people become sexually active (much later). </p>
<p>Despite those challenges, the publicity surrounding the vaccine helped health care providers raise awareness, and vaccination rates have grown.</p>
<p>The current formulation, Gardasil 9, requires three doses over six months for young people aged 15 to 26. However, the CDC recently recommended Gardasil 9 as being <a href="https://www.cdc.gov/media/releases/2016/p1020-hpv-shots.html">equally effective in two doses</a> for adolescents nine to 14 years old, with the dosages separated by as much as a year. As parents consider HPV vaccine options, the two-dose approach will likely prove more convenient and easier to provide.</p>
<h2>Two doses, many lives</h2>
<p>Recently, the U.S. National Cancer Institute (NCI)-designated Cancer Centers – 69 world-leading research and treatment facilities distributed across the country – called on Americans to universally <a href="https://cancer.osu.edu/%7E/media/files/shared/press-releases/cancer/2017/hpvconsensusstatement-jan2017.pdf?la=enhttps://cancer.osu.edu/%7E/media/files/shared/press-releases/cancer/2017/hpvconsensusstatement-jan2017.pdf?la=en">endorse the vaccines</a> and follow the CDC’s new two-dose recommendation when appropriate.</p>
<p>The new two-dose push is critical. Any cancer is bad, but many of the cancers caused by HPV are particularly difficult. Head and neck cancers are disfiguring and can cause tremendous problems with swallowing and with speaking. In turn, those problems can render patients unable to eat and can dramatically affect a person’s desire to socialize.</p>
<p>After more than a decade of use, it is clear that HPV vaccines are safe and effective. Providers must talk to parents and patients about the vaccine, understand concerns, and respond with clear information and strong recommendations. Parents and guardians, too, should talk to their health care provider to learn more about the HPV vaccine and its benefits. </p>
<p>There are HPV resources for both patients and physicians, such as a <a href="https://www.cdc.gov/std/hpv/hpv-factsheet-march-2014.pdf">CDC fact sheet for patients</a> and a <a href="https://www.cdc.gov/hpv/hcp/index.html">series of resources for clinicians</a>, but the most impact will come from one-on-one conversations. In trusted communication with patients, providers can emphasize the <a href="https://www.cdc.gov/hpv/parents/vaccinesafety.html">HPV vaccine’s universal safety</a> – in both clinical trials and widespread global use – and explain why the vaccination must come well before a child is sexually active, not as an adult. Ultimately, as with MMR or the flu shot, this is about a virus, not about sex.</p>
<p>All parents and guardians should have their sons and daughters complete a two-dose 9-valent HPV vaccine series before age 13, or complete a catch-up vaccine series as soon as possible in older children, including three doses in those older than 15. The ideal time is when a child is receiving other childhood vaccines at age 11-12. If this bundling had been done, the HPV vaccination rate would be over 90 percent in this country.</p>
<p>Young men and young women up to age 26 who were not vaccinated as preteens or teens need to complete a three-dose vaccine series to protect themselves against HPV.</p>
<p>As a cancer control researcher, and as a parent of three boys, I have closely followed the arrival of HPV vaccines. There is no room for equivocation – these vaccines exist, they work and if they can prevent my children from developing cancer later in life, I had them vaccinated. During the last century, vaccines helped bring many diseases under control, and eradicated smallpox. There is a vaccine that may help eradicate several cancers in this century – but only if we act.</p><img src="https://counter.theconversation.com/content/71871/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Electra D. Paskett has received funding from the National Cancer Institute and Merck.</span></em></p>A vaccine to prevent cancer was long a dream for those who treat the disease. But fewer than half of all girls and even fewer boys have been vaccinated. Cancer specialists hope this will soon change.Electra D. Paskett, Professor of Cancer Research, College of Medicine, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/678662016-11-01T23:32:46Z2016-11-01T23:32:46ZWomen’s cancers: curable for the rich, often a death sentence for the poor<p>Every minute, a woman dies of breast cancer. Every two minutes, a woman dies of cervical cancer. Perhaps you know <a href="http://gco.iarc.fr/today/fact-sheets-cancers?cancer=29&type=0&sex=0">these statistics</a>, and perhaps these cancers have directly affected you, or someone you love. </p>
<p>Each year 2.7 million women will be diagnosed with cancers of the breast, cervix, endometrium, or ovaries, and more than a million of them will die from these cancers. </p>
<p>Did you know that most of those women live in developing countries? </p>
<p>A woman diagnosed with breast cancer in most high-income countries is <a href="http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/survival#heading-Zero3">very likely to survive</a>. The opposite is true for the hundreds of thousands of women facing the same diagnosis in poor countries. Survival should not be a fluke of geography. </p>
<p>A woman’s agency – that is, her ability to seek and receive an accurate diagnosis and care early in the course of disease – can be the difference between life and death. Pervasive myths regarding cancer as a death sentence, and the stigma that accompanies a diagnosis of breast or gynaecological cancer only make these barriers harder to overcome. </p>
<h2>Rich and poor</h2>
<p>In the case of cervical cancer, 85% of women diagnosed, and 87% of those who die are from poorer countries. Cervical cancer is almost entirely preventable via <a href="http://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html">HPV vaccination for girls</a> and cervical screening, with treatment of pre-cancererous growths. None of this requires an oncologist or high-level cancer centre. </p>
<p>These cost-effective interventions can save millions of lives, if made affordable. Many low-income countries are <a href="http://www.gavi.org/support/apply/countries-eligible-for-support/">eligible for lower-cost HPV vaccines</a> through <a href="http://www.gavi.org/library/news/press-releases/2013/hpv-price-announcement/">Gavi, the Vaccine Alliance</a>, but many women with a high risk of death from cervical cancer live in <a href="http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/abstract">countries deemed too wealthy</a> for this special access, while other countries risk losing the vaccine upon “graduation”. In other words, developing countries can effectively be disadvantaged by virtue of their economic success. </p>
<h2>Bridging the gap</h2>
<p>In a <a href="http://www.thelancet.com/series/womens-cancers">series in The Lancet medical journal</a>, we highlight the gross inequities in access to prevention, early detection, and treatment for these two common cancers. We review what type of interventions could close this divide, including HPV vaccination and screen-and-treat approaches for cervical cancer prevention. </p>
<p>For breast cancer, key interventions include improving a woman’s access to early diagnosis. Increased public awareness, timely access to diagnostic imaging and a biopsy for accurate diagnosis, and improved access to surgery can make a world of difference. </p>
<p>For the majority of women whose breast cancers are “hormone positive”, the addition of an estrogen-blocking drug such as tamoxifen (which is generic, inexpensive and widely available with low rates of serious toxicity) can greatly improve survival. </p>
<p>There are challenges in taking these interventions to scale, beyond issues of cost. For example, there continues to be <a href="http://www.hpv.org.nz/hpv-vaccine/hpv-vaccine-myth-vs-facts">widespread misinformation</a> regarding the safety as well as the effectiveness of the HPV vaccine, a problem we must urgently overcome to increase coverage globally. </p>
<p>There are pragmatic approaches that can be taken to meet these challenges. Task-sharing – for example, where a nurse receives additional training to perform a visual inspection of the cervix with acetic acid – can greatly improve access to this life-saving intervention, particularly where gynaecologists or other trained physicians are scarce. </p>
<p>Zambia has been <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122169">successful in this approach</a>, which also includes taking digital photographs of the cervix for quality assurance by a remote gynaecologist </p>
<p>Telemedicine can also help bridge the gap, for example when community health workers use smartphones to encourage women to attend the clinic if they have a suspicious breast lump. Nurses can also use smartphones for digital photos as well as data-tracking and follow-up communication between physician and patient.</p>
<h2>A question of funding</h2>
<p>There is stark lack of global funding for cancer, in spite of the fact that cancer <a href="http://www.who.int/gho/en/">kills more people</a>, in fact twice as many, than HIV/AIDS, malaria, and tuberculosis combined.</p>
<p>Breast and cervical cancer alone account for half a million more deaths – mostly of women in the prime of their lives – than the number of women who die from <a href="http://www.unfpa.org/maternal-health">complications of pregnancy or childbirth</a>.</p>
<p>Any time a woman dies in childbirth, it is a tragedy. But equally tragic is a woman who survives her pregnancy, only to succumb to breast cancer when her child is not yet five. But where is the cry for global investments? Where is the fund for women’s cancer in the developing world?</p>
<p>The case must also be made for leverage existing resources, for example by providing breast health education and cervical screening at reproductive health clinics. Women who are living with HIV are four to five times more likely to develop cervical cancer. This is why UNAIDS and the WHO <a href="http://www.unaids.org/en/resources/documents/2016/HPV-HIV-cervical-cancer">recommend</a> combining HIV services with cervical cancer education, screening and treatment, in settings where HIV prevalence is high.</p>
<p>That said, the total funding for all <a href="http://www.who.int/mediacentre/factsheets/fs355/en/">non-communicable diseases</a> is a mere fraction of what is required, and each day millions of families face catastrophic expenditures, which come from largely out-of-pocket sources. </p>
<p>A 2015 report from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539728/">eight ASEAN countries</a> found that one year after a cancer diagnosis, 48% experienced financial catastrophe, 29% of adults had died, and just 23% were alive with no financial catastrophe. </p>
<p>Investments must be made now, including direct international assistance for health, as well as increased expenditures from national governments. Countries moving towards universal health coverage must expand beyond traditional packages that focus exclusively on infectious diseases and mother-and-child health to incorporate services for breast and cervical cancer.</p>
<h2>The threat to development</h2>
<p>Women’s cancers are a major threat to development. It is imperative that we work together, across disciplines, and recognise the role of other partners, including in the UN system, academia, civil society, and the private sector in advocating for women’s health and rights. </p>
<p>Gender equality has its own goal in the United Nations’ <a href="http://www.un.org/sustainabledevelopment/development-agenda/">Sustainable Development Agenda for 2030</a>, and thus presents a critical opportunity for advocates and activists in the gender equality, sexual and reproductive health and rights, and cancer associations and communities to link forces with other women’s advocates to drive greater investment in fighting cancer. </p>
<p>The “life course” approach raised in the UN programme, <a href="http://www.everywomaneverychild.org/">Every Woman Every Child</a>, is essential to improve the health of women and girls. And caring for people throughout their life course also involves screening for, and treating, women’s cancers. </p>
<p>The good news about women’s cancers is that they are often preventable and treatable. Our greatest challenge now is to make sure that is the case for all women, not just those who are lucky enough to be born in the wealthiest parts of the world. </p>
<p><em>This article was co-authored by Rengaswamy Sankaranarayanan from the International Agency for Research on Cancer. He receives funding from the Bill and Melinda Gates Foundation; the US National Cancer Institute and the Association for International Cancer Research.</em></p><img src="https://counter.theconversation.com/content/67866/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ophira Ginsburg receives funding from Grand Challenges Canada.</span></em></p><p class="fine-print"><em><span>Lynette Denny has received funding from Glaxosmith Kilne, Merck and Roche</span></em></p><p class="fine-print"><em><span>Lesong Conteh and Richard Sullivan 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>Of women who die from cervical cancer, 87% live in poor countries.Ophira Ginsburg, Associate Professor, Women’s College Hospital and Research Institute, University of TorontoLesong Conteh, Senior Lecturer in Health Economics, Imperial College LondonLynette Denny, Chair and Professor of Obstetrics & Gynaecology, University of Cape TownRichard Sullivan, Director, Institute of Cancer Policy, King's College LondonLicensed 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>
<figure class="align-center ">
<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>
<blockquote>
<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>
</blockquote><img src="https://counter.theconversation.com/content/54077/count.gif" alt="The Conversation" width="1" height="1" />
<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>
<figcaption>
<span class="caption">The oropharynx is the middle part of the throat.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<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>
</figcaption>
</figure>
<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/583142016-06-06T10:00:48Z2016-06-06T10:00:48ZStories of vaccine-related harms are influential, even when people don’t believe them<p>In 2013 a boy who was given the HPV vaccine died almost two months later.</p>
<p>Two quick questions: First, does this worry you? And second, do you believe that the vaccine caused the boy’s death?</p>
<p>This is a real case reported in the Vaccine Adverse Event Reporting System (<a href="https://vaers.hhs.gov/index">VAERS</a>). VAERS is monitored by health experts at the Centers for Disease Control and Prevention and Food and Drug Administration to detect very rare or emergent harms that may be caused by vaccines. The vast majority of adverse events reported in VAERS <a href="https://vaers.hhs.gov/about/index#number_reports">are mild</a> (such as fever), but a few are serious, like death and permanent disabilities. Staff <a href="https://vaers.hhs.gov/about/faqs#reports_followed_up">follow up</a> on certain cases to better understand what happened. </p>
<p>A <a href="http://www.webmd.com/children/vaccines/news/20100505/more-parents-refuse-delay-childs-vaccination">growing number of parents</a> are refusing to vaccinate their children, and one reason <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113438/table/T1/">they often state</a> is that they do not trust that doctors and government agencies sufficiently research the potential harms of vaccines. Given that, we wanted to find out whether telling people about VAERS and the information it gathers could influence their beliefs about vaccine safety.</p>
<h2>Vaccine refusal and the importance of trust</h2>
<p>It’s important to stress that just because a case like the one mentioned above is reported to VAERS doesn’t mean that the vaccine caused the problem. That’s because VAERS is an open-access reporting system. </p>
<p>Health care providers <a href="https://vaers.hhs.gov/professionals/index">are required to report</a> certain adverse events, but they are not the only ones who can contribute to the database. Anyone can make a report in VAERS for any reason. Similarly, anyone can access VAERS reports and data. In fact, advocates both for and against vaccines refer to VAERS data as evidence of either the existence of harms or the rarity of harms. </p>
<p>This open-access feature makes VAERS a potentially rich source of information about possible vaccine-related harms. It also means, however, that the events reported in VAERS often turn out to have nothing to do with a vaccine.</p>
<p>Take for example, the boy who died less than two months after receiving the HPV vaccine. Here’s what the full VAERS report says: “Sudden death. He was perfectly healthy. The vaccination is the only thing I can think of that would have caused this. Everything else in his life was normal, the same.” </p>
<p>The fact that there were no reported problems for almost two months between the vaccine and the child’s death might make you, like us, skeptical that the vaccine was the cause. Yet, it is important that the death was reported so that it can be followed up.</p>
<p>Being transparent about risks is critical to building trust. In fact, that’s part of the reason that VAERS data is available to everyone. </p>
<h2>Does VAERS make people trust vaccine safety?</h2>
<p>It seems plausible that describing VAERS in depth could build trust. Doing so would demonstrate that every effort is being made to collect information about potential vaccine harms, and that even with such a comprehensive effort very few serious events are reported. Further, transparency would also show that these few serious events are not necessarily caused by the vaccine, and this information is available for anyone to view and evaluate. </p>
<p>We decided to test this idea in <a href="http://www.sciencedirect.com/science/article/pii/S0264410X16300846">a recent internet survey</a>. We surveyed over 1,200 people, who were divided into three groups. </p>
<p>One group received the standard CDC Vaccine Information Statement for the HPV vaccine. We chose the HPV vaccine because this vaccine is <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6329a3.htm">particularly underutilized</a>. The second group was given detailed information about VAERS – what it is, what it is for and what it contains – as well as the number of serious adverse event reports received about HPV. To be specific, this group was told that there were seven deaths and 24 permanent disabilities reported for the HPV vaccine in 2013 out of a total of approximately 10 million vaccine doses given that year. A third group received all of that information and then also read the actual adverse event reports in detail. We hoped that reading these reports would show this group that not all of these deaths and permanent disabilities were caused by the vaccine. </p>
<p>We found that telling participants about VAERS, without having them read the actual reports, improved vaccine acceptance only very slightly. Even worse, when participants read the detailed reports, both vaccine acceptance and trust in the CDC’s conclusion that vaccines are safe declined significantly. </p>
<p>What we found next surprised us: The vast majority of our survey respondents, the same ones who were less accepting of vaccines and less trusting of the CDC, said that they believed the vaccine caused few or none of the reported deaths and disabilities. This means that the individual stories of perceived vaccine harms were highly influential, even when people didn’t believe they were true.</p>
<h2>We are influenced by information even when we don’t believe it</h2>
<p>Think back to your reaction to reading about the tragic death we described earlier. Our data suggest that just learning about this death may have caused you to feel more negatively toward the HPV vaccine, even if you believed that the vaccine did not cause the death. </p>
<p>While we can’t say that everyone reacted to the stories the same way or to the same degree, it seems clear that at least some people didn’t believe that the vaccine caused the reported harms, but they were nonetheless negatively influenced by those reports. </p>
<p>Systems like VAERS are essential for public health, providing an opportunity to learn about and investigate every possible case of potential harm caused by vaccines. But the power and emotion evoked by the stories of VAERS reports may influence us and undermine trust in vaccines, no matter what our rational mind might think.</p><img src="https://counter.theconversation.com/content/58314/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Scherer receives funding from the National Science Foundation, the Informed Medical Decisions Foundation, and the University of Missouri Research Council and Research Board.</span></em></p><p class="fine-print"><em><span>Brian Zikmund-Fisher receives funding from the Agency for Healthcare Research and Quality, the U.S. Veterans Administration, and the National Science Foundation. </span></em></p><p class="fine-print"><em><span>Victoria Shaffer receives funding from the Agency for Healthcare Research and Quality, the National Science Foundation, and the Informed Medical Decisions Foundation. </span></em></p><p class="fine-print"><em><span>Niraj Patel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Individual stories of perceived vaccine harms can undermine trust in vaccine safety, even if people don’t believe the vaccine was to blame.Laura Scherer, Assistant Professor, Psychology, University of Missouri-ColumbiaBrian J. Zikmund-Fisher, Associate Professor of Health Behavior and Health Education, University of MichiganNiraj Patel, Graduate Student, University of Missouri-ColumbiaVictoria Shaffer, Associate Professor of Psychology, University of Missouri-ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/417642015-05-14T20:01:35Z2015-05-14T20:01:35ZNew register shows importance of vaccination beyond childhood<figure><img src="https://images.theconversation.com/files/81666/original/image-20150514-28586-1tf2v9h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Given the increasing number of vaccines recommended for adolescents and adults in Australia, the newly announced initiatives are a very good idea.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/wellcomeimages/16580160449/">Wellcome Images/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Health was not one of the winners of <a href="http://www.budget.gov.au/">Tuesday night’s big-spending federal budget</a>, but one initiative tucked away in the budget papers is worthy of applause – the establishment of an adult immunisation register and the expansion of the childhood register to include adolescents. </p>
<p>The <a href="http://www.budget.gov.au/2015-16/content/bp2/html/bp2_expense-14.htm">budget papers</a> say immunisation data collection will be expanded to include school-based adolescent vaccinations and that an adult register will be established from September 1, 2016. </p>
<p>The move means that we will soon record all vaccinations delivered to adolescents and adults through the government-funded National Immunisation Program (NIP). The program covers the cost of vaccines, but not all the recommended shots are on the NIP.</p>
<h2>Existing register</h2>
<p>Australia already has an immunisation register for children. The <a href="http://www.humanservices.gov.au/customer/services/medicare/australian-childhood-immunisation-registe">Australian Childhood Immunisation Register (ACIR)</a> is the envy of many countries around the world. It was established in 1996 and, after a shaky start, now provides accurate data on the immunisation status of all registered children under seven years old. </p>
<p>The register also provides data for the regular reporting of immunisation coverage, with data available by state, regions within the states, Indigenous status and age group. This allows gaps in vaccine coverage to be highlighted and, in turn, for targeted interventions to improve uptake. The adult register could perform a similar role.</p>
<p>Recognising how well the ACIR has allowed monitoring of vaccine coverage for children, many clinicians and public health workers have long advocated having the same information available for adolescents and adults. </p>
<p>Adult vaccinations will be recorded, potentially for every Australian adult, and this information could well become part of the new opt-out e-health record.</p>
<h2>Getting the adult register going</h2>
<p>Before the ACIR was established, the call for its establishment was a recurring theme at the immunisation conferences sponsored by the <a href="http://www.phaa.net.au/">Public Health Association of Australia</a>. It’s been exactly the same with the adult immunisation register. </p>
<p>For at least ten years now, one of the resolutions at every immunisation conference has been the establishment of an adult immunisation register. But most of us supporting these resolutions did not think the idea had much traction in Canberra. So, the announcement has been something of a welcome surprise. </p>
<p>Still, it’s probably an idea whose time has come, given the increasing number of vaccines recommended for adolescents and adults in Australia. </p>
<p>The influenza and <a href="http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-pneumococcal">pneumococcal vaccinations</a> have been recommended for adults for a long time. Originally targeted at older people, <a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-influenza">influenza vaccines are now recommended much more widely</a> and are funded for people of any age with an existing illness, such as heart or lung disease, that may increase the risk of serious illness. </p>
<p>But data on uptake are sparse and there are unresolved questions about the impact of these vaccines. Knowing precise coverage may help resolve these problems.</p>
<p>A new vaccine against shingles (<em>Herpes zoster</em>) has recently been recommended for older people, as recognition of the burden this virus poses. It has been funded in the budget for adults between 71 to 79 years old, with an opportunity for a catch-up after November 2016.</p>
<h2>Vaccines for adolescents</h2>
<p>Adolescents and young adults are encouraged to receive the <a href="http://hpv.health.gov.au/">human papilloma virus (HPV) vaccine</a> to prevent specific strains of genital warts and reduce the risk of cervical cancer in women. <a href="https://theconversation.com/the-case-for-vaccinating-boys-as-well-as-girls-against-hpv-6">Australia has led the world</a> with the roll-out of this vaccine. Collecting data on the initiative will be critical to understand population coverage and identify coverage gaps.</p>
<p>Measles has been eliminated for Australia, which means there’s no strain of this virus circulating for more than a year. But because the virus is circulating elsewhere in the world, <a href="https://theconversation.com/measles-outbreaks-show-the-illness-is-down-but-not-yet-out-19149">it can be imported into the country</a>, often via young adult returning travellers. </p>
<p>The initiatives announced in the budget would allow monitoring of measles vaccine status in young adults, as the current childhood vaccination register allows monitoring in children. Along with other strategies related to measles control, this may well turn out to be important in maintaining Australia’s measles elimination status.</p>
<p>If unexpected disease outbreaks occur, as there have been for whooping cough (pertusis), immunisation registers will help us determine whether it’s due to low vaccine coverage. <a href="http://www.ncirs.edu.au/immunisation/fact-sheets/pertussis-fact-sheet.pdf">Given new recommendations for adult vaccination against whooping cough</a>, it will be just as important to know the proportion of adults who are vaccinated as it is to know how many children are.</p>
<p>It is hard to see a downside for these initiatives. But whether it will be enough of a sweetener to compensate for the cuts that have been flagged for the overall health budget remains to be seen.</p><img src="https://counter.theconversation.com/content/41764/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heath Kelly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tucked away in the budget papers is an intitiative worthy of applause – the establishment of an adult immunisation register and the expansion of the childhood register to include adolescents.Heath Kelly, Professor (Adjunct) in Infectious Diseases Epidemiology, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/369322015-02-09T15:36:29Z2015-02-09T15:36:29ZWhy boys should get the HPV vaccine too<figure><img src="https://images.theconversation.com/files/71305/original/image-20150206-28612-1cjhmf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not just about girls.</span> <span class="attribution"><span class="source">Teens by Shutterstock</span></span></figcaption></figure><p>Ask anyone about Human Papillomavirus, or HPV, and they will probably tell you that it is linked to cervical cancer. If they are a teenage girl living in the UK, they will know this as they will have been given a jab to “stop them getting cervical cancer”. Because of this, parents will probably view HPV as a problem for their daughters, not for their sons. But they’d be wrong. </p>
<p>HPV is a virus that is passed from person to person through sexual contact. It is incredibly common, and almost everyone will have caught HPV <a href="http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/what-is-the-hpv-virus">at some point in their lives</a>. Most people are able to get rid of the virus themselves with no lasting harm, but for some the virus can lead to a number of different health problems. </p>
<p>HPV can cause genital warts, something both men and women suffer from. But it can also cause cancer. The most widely known <a href="http://www.sciencedirect.com/science/article/pii/S0264410X12017343">is cervical cancer</a> and that is why most people link HPV with women, but HPV can also cause cancer in the throat or the anus, and it doesn’t take a medical expert to work out that men have these body parts too. It can also lead to cancer of the penis, which is a very male issue. </p>
<p>Cancer is a frightening disease, and a comprehensive vaccination programme could stop <a href="http://www.ncbi.nlm.nih.gov/pubmed/16404738">5% of all cancers</a> in the world and potentially wiping out cancers caused by HPV in a generation. There are not many cancers we can say this about. But to do this, we have to start vaccinating boys. </p>
<h2>Getting to boys through girls</h2>
<p>Since 2008, 12 to 13-year-old girls in the UK have been able to get vaccinated against HPV for free, usually through a school vaccination programme. But the same opportunity has not been offered to teenage boys. This is despite the fact that they could develop HPV-related diseases, and the fact that the vaccine works in boys. For example, researchers in North America <a href="http://www.ncbi.nlm.nih.gov/pubmed/21288094">have shown</a> that the same vaccine that is given to girls, if given to boys, would reduce their chances of getting genital warts and some HPV cancers. </p>
<p>So why does the UK government not offer the vaccine to boys? This is already happening in Australia, the United States, two Canadian provinces and Austria. The UK argument is based around the assumption that as this is a sexually transmitted infection, vaccinating girls will mean that they don’t have the virus and it won’t be passed on to boys. </p>
<p>This argument stands up if every single girl gets vaccinated, and all boys only have sexual contact with vaccinated girls. This is unlikely to happen. And where does it leave the men who have sex with other men? It leaves them unprotected.</p>
<h2>Men who have sex with men</h2>
<p>It <a href="http://www.ncbi.nlm.nih.gov/pubmed/22413761">has been argued</a> that it is not cost-effective to vaccinate all boys and that we should just vaccinate men who have sex with men. Superficially this may seem like a suitable solution, but the practicalities of vaccinating men who have sex with men are complicated. </p>
<p>The vaccine offers most protection if it is given to the person before they have any sexual contact (so they have not been already exposed to HPV), that is why 12 to 13-year-old girls are vaccinated. It is totally inappropriate to ask 12 to 13-year-old boys if they are likely to have sex with another male when they are older, and if so, would they like an HPV jab?</p>
<p>The other solution is to vaccinate men who have sex with men at a sexual health clinic, but this would <a href="http://jid.oxfordjournals.org/content/early/2013/11/21/infdis.jit626.abstract">in all likelihood be too late</a>, as they will have probably already caught HPV at this stage. This is why all adolescents, both boys and girls should be offered the vaccine as they are in other parts of the world. We can, and should be protecting our adolescents in the UK in the same way.</p><img src="https://counter.theconversation.com/content/36932/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gillian Prue is affiliated with HPVAction.org</span></em></p>Ask anyone about Human Papillomavirus, or HPV, and they will probably tell you that it is linked to cervical cancer. If they are a teenage girl living in the UK, they will know this as they will have been…Gillian Prue, Lecturer, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/278542014-09-22T04:34:02Z2014-09-22T04:34:02ZHealth Check: can sex affect your risk of getting cancer?<figure><img src="https://images.theconversation.com/files/59643/original/tnsrvmcd-1411346790.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As with most matters health, how sex and cancer risk are linked is complicated and dependent on several factors.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/lucasfrasca/10036159755">Lucas Frasca/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>The <a href="http://www.nhs.uk/Livewell/Goodsex/Pages/ValentinesDay.aspx">sex act has many health benefits</a> from reducing stress and tension, to boosting your immune system. It may even affect your risk of developing certain cancers.</p>
<p>But as with most matters health, how sex and cancer risk are linked is complicated and dependent on several factors. Your age, gender, and how often you practice safe sex will all influence your potential cancer risk. </p>
<p>To date, the only clear literature linking sex and cancer is that concerning the human papillomavirus (HPV). There are over 200 strains of HPV, but some are more cancer-causing than others. The good news is that we <a href="https://theconversation.com/four-things-you-should-know-about-hpv-vaccinations-15178">now have a vaccine</a> against the most common cancer-causing strains of the virus.</p>
<p>Most commonly, HPV is linked to cervical cancer. But both men and women can increase their risk of developing cancer through sexual activities that pass on the virus. </p>
<h2>HPV infection</h2>
<p>A lot has been written about HPV and cervical cancer. So much, in fact, that most people don’t even realise men can also get HPV, and that they can get HPV-related cancers too. Indeed, men have largely been ignored in the <a href="http://www.tandfonline.com/doi/abs/10.1080/10810730.2011.585700">media and promotion of the HPV vaccine</a>.</p>
<p>Boys have been included in the Australian school-based HPV vaccination program <a href="http://hpv.health.gov.au/the-program/">since 2013</a>. But preliminary results of research with male adolescents and their parents suggest there’s low awareness and understanding about the vaccine. </p>
<p>Adolescent boys aren’t sure what the vaccine is for, nor why they need to get it; parents think their sons are not at risk of HPV-related cancers. But HPV can cause a range of cancers in both men and women, in sites other than the cervix. These include cancers of the anus and genitals, as well as cancers of the head, neck, and throat. </p>
<p>Indeed, HPV infections are now a proportionally significant cause of <a href="http://www.ncbi.nlm.nih.gov/pubmed/21816661">oropharyngeal (head, neck, and throat) cancer diagnoses</a>. And epidemiological modelling suggests that by 2020, HPV will cause <a href="http://www.ncbi.nlm.nih.gov/pubmed/21969503">more oropharyngeal cancers</a> than cervical cancers in the United States. </p>
<p>In 2013, news reports of Hollywood veteran (and self-confessed ladies’ man) Michael Douglas <a href="http://www.bostonglobe.com/lifestyle/health-wellness/2013/06/09/michael-douglas-blames-throat-cancer-oral-sex-what-are-risks/Akb38cr5CCvj2HUKXJ5SCP/story.html">identified HPV as the cause of his throat cancer</a>, creating public interest in the relationship between sexual activity and cancer risk. </p>
<p>Unfortunately, some interpretations of this news were incorrect, leading people to believe that oral sex could also “cure” cancer after Douglas <a href="http://www.ibtimes.com/michael-douglas-says-oral-sex-both-cause-cure-throat-cancer-not-quite-1288941">also made that claim</a>. In fact, the only “cure” in the case of HPV-related cancers is prevention. </p>
<h2>HPV vaccination</h2>
<p>Vaccination is the primary method of preventing HPV-related cancers. But as mentioned above, some parents still question why males need the vaccine if girls are receiving it through the school-based program. </p>
<p>The reason is twofold. </p>
<p>Among heterosexual couples, HPV is transmitted between males and females (either partner could be infected first and transmit it to the other). So, vaccinating women provides some benefits to men, but full protection of heterosexual men only occurs if most women receive the vaccine. </p>
<p>While the school-based program in Australia has reached quite <a href="http://www.hpvregister.org.au/research/coverage-data/vaccination-2012">high coverage of girls</a>, it isn’t high enough to fully protect all heterosexual boys. What’s more, men who are vaccinated will help protect future partners who are not vaccinated. </p>
<p>The second reason is that adolescent boys who do or will eventually identify as bisexual or homosexual are not protected. It’s unrealistic, impractical, and stigmatising to try to single out this population at the age of 12, when school children receive the HPV vaccine. </p>
<p>By vaccinating adolescent boys in a school-based program, we can protect the homosexual community from developing HPV-related cancers as well. And this is very important given the <a href="http://www.ncbi.nlm.nih.gov/pubmed/19342375?dopt=Abstract">higher prevalence of HPV infection and related disease </a> in this population. </p>
<p>HPV is a real risk for developing cancer in both men and women, and it is transmitted through sex. But, reducing this cancer risk is easily done through vaccination. After HPV vaccination, the only real cancer worries are those not directly related to sexual behaviours. </p>
<p>So get vaccinated against HPV, eat your veggies, exercise, and watch out for those other carcinogens in your life. But you won’t have to worry about contracting cancer from your sexual partners.</p><img src="https://counter.theconversation.com/content/27854/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible and the Scottish Universities Life Sciences Alliance for research into anticancer drugs. </span></em></p><p class="fine-print"><em><span>Hayden Fletcher and Spring Chenoa Cooper 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 sex act has many health benefits from reducing stress and tension, to boosting your immune system. It may even affect your risk of developing certain cancers. But as with most matters health, how sex…Spring Chenoa Cooper, Senior Lecturer, University of SydneyHayden Fletcher, PhD Candidate (Paediatrics and Child Health) , University of SydneyNial Wheate, Senior Lecturer in Pharmaceutical Chemistry, University of SydneyLicensed as Creative Commons – attribution, no derivatives.