Uk-wide vaccination of 12-13 year old girls against the Human Papillomavirus (HPV) began in 2008 and has achieved coverage of over 85% of this target population. As a result, prevalence of HPV 16 and 18, the particularly dangerous forms of the virus, has fallen significantly and we can look forward to a substantial reduction in HPV related cervical cancers. HPV can be considered a necessary but not sufficient cause of cervical cancer.
What has this got to with boys? Quite a lot, in fact. As Michael Douglas has very publicly stated (bravo Michael), HPV plays a role in oropharyngeal cancer too (tonsils, throat, base of tongue, soft palate) including his throat/tongue cancer. Whilst the incidence of most cancers in this area of the body, mouth, nose, gum etc has been stable, for oropharyngeal cancer it doubled in England between 2000 and 2010 alone. Throat cancers - let's call them that for simplicity - had been declining for a while, in line with the decline of their main cause, namely alcohol and tobacco consumption. But in the last couple of decades there has been a dramatic increase of HPV positive (meaning the virus is present) throat cancers in developed countries, to as much as 80% of all throat cancers in some countries. It typically affects men. In fact, in England for example, the typical HPV-positive throat cancer patient is a middle aged, non-smoking white man of higher socioeconomic status with a history of multiple sexual partners. But don't be fooled: this history can go back a long time. In both cervical and oropharyngeal disease, persistent HPV infection may precede diagnosis by several decades.
One of the leading Head and Neck oncologists in the UK recently led an appeal to the Welsh Government (she is based in Cardiff) to vaccinate boys as well as girls against HPV. Three quarters of those affected by HPV related throat cancers are men, and HPV is responsible for about 5% of cancers globally. You can see the news article here: http://www.bbc.co.uk/news/uk-wales-33203666
Unlike with cervical cancer, screening for HPV related throat cancer is very difficult, because of the nature of the tissue and the absence of a premalignant stage. In the USA, it is predicted that the number of HPV-positive throat cancers will surpass the number of cervical cancers by 2020.
How is the virus transmitted? In its guidance on lowering your cancer risk, the Macmillan website, after all the essential and well-known points about healthy lifestyle, makes a coy and vague reference to safer sex. Most people, I think, would associate this with using a condom. But if we are to protect our young against risks, we have to be both better informed and more explicit. HPV seems to be sexually transmitted but, unlike HIV for example, condoms do not necessarily provide full protection. There is also reason to be believe that oral sex may entail higher risk of HPV transmission.
Before we succumb to moral panic and paranoia, it is worth remembering that most of us will be infected with HPV at some point. In the vast majority of cases, our immune systems will just see off the virus. It is when our immune systems somehow fail to do so that cancer can start. But when considering whether or not to vaccinate boys, it is important to note that the ability of women to see off the virus in their cervix, where it is very common (in the UK 1 in 3 women in their early twenties carry a current cervical infection), seems to be much higher than the ability of men to see off the virus in their tonsils.
The one good piece of news in all this doom and gloom is that HPV-positive throat cancers respond significantly better to treatment than HPV-negative ones. Knowing this, I remember hoping fervently that mine was positive, and the sense of relief when it was.
But the fact that HPV-positive cancers may respond better to treatment is certainly not any kind of response to a situation where a particular kind of cancer is increasing rapidly and where a vaccine already exists which could hugely reduce the risk to boys. I fully support the call to the Welsh Government to vaccine boys in Wales, but I won't be waiting for the Government's response. I shall put my hand in my pocket and stump up the £500 odd to have my early teenage son vaccinated privately. I would not want anyone to go through what I am going through now, least of all him. If you have a young teenage boy yourself, you may wish to think about it too.
Sorry it was all so dry and technical, but I think it's important! Thanks if you got this far
This blog is based heavily on a paper prepared by Ned G Powell and Mererid Evans, Human Papillomavirus - associated head and neck cancer: oncogenic mechanisms, epidemiology and clinical behaviour, for the Mini Symposium : Human Papillomavirus in Head and Neck Cancers, published by Elsevier Ltd 2015
