HPV – The Virus That Won’t Go Away

Should boys be given the HPV vaccine is a controversial subject that really hit a new height last week, where it was hotly debated at Westminster Hall, in the House of Commons. An extremely common virus in the population, HPV is known to cause over 95% of all cervical cancers. However, the number of cases of cervical cancer is set to fall dramatically over the next 40 years due to the introduction of the HPV vaccine that is currently offered to all schoolgirls between the ages of 12 and 14, before they become sexually active.

 

 

In recent years, overwhelming evidence has also directly linked the virus to an increase in the incidence of head and neck cancers – a malignancy that affects the tonsils, back of the tongue and surrounding soft palate regions in the mouth. With funding from Cancer Research Wales, Professor Mererid Evans, a consultant oncologist who specialises in head and neck cancer at Velindre Cancer Centre, and Dr Ned Powell from the HPV research laboratories based at Cardiff University, led a pivotal Welsh study that demonstrated the extent of the problem in Wales and across the UK.

 

Their findings showed the number of cases of HPV related head and neck cancers has trebled over the last 25 cases, with over half now caused by HPV. Importantly, these predominantly occur in males and at a younger age (30-60). As HPV can also cause penile and anal cancers, the total number of vaccine-preventable and HPV related cancers that occur in men exceeds 100 cases per year, in Wales alone. A figure that looks set to increase further in the years to come. It has quickly become a major public health concern that we can no longer ignore.

While it is acknowledged that HPV vaccination of girls will to some extent protect the male population, it is known that up to 1 in 7 of eligible girls are not vaccinated – with some parts of the UK reporting less than 50% uptake in the cohorts targeted for vaccination.  In other countries, such as Japan, Demark, and Ireland HPV vaccination uptake rate continues to drop. Further, this would not prevent HPV infection in males who have sex with unvaccinated older women, have sex with women from countries who don’t currently have a national HPV vaccination programme, and men who have sex with men.

HPV related H&N cancers strike men in their prime, causing great anguish to patients and their families for a number of reasons. Another arguments put forward by governments vaccination advisory committee for not vaccinating boys is based on cost-effectiveness. While their modelling takes into account the cost of NHS treatment, it does not consider the wider cost implications such as costs to employers, welfare benefits and other aspects of social care.

It is estimated that vaccination of boys would cost in the region of £20-£22M per year. When we compare this to the £58M annual cost of treating anogential warts caused by HPV, and the extra £21M and £7M for the highly specialised therapies needed to treat HPV-related H&N and anal cancers – then vaccinating boys makes perfect sense.  However, it is the unnecessary suffering that can be prevented all together that should matter most.

 

 

The HPV ACTION organisation has recognised the international effort being made across the world with up to 15 countries currently vaccinating boys or pledging to do so in the near future. All of which raises several important ethical questions – is it right to allow a subset of our population in the UK to develop cancer, knowing full well we have the means to prevent it in the first place? Also is it fair that only one sex receives protection against something that affects both and men and women alike?