The Mouth Cancer Foundation, while welcoming the government’s introduction of a human papilloma virus (HPV) immunisation programme for girls aged 12 - 13 years of age against cervical cancer, is concerned that boys are not being vaccinated.
This decision follows the advice of the Joint Committee on Vaccination and Immunisation (JCVI) which, based on a detailed review of evidence surrounding HPV vaccination, did not consider it to be cost-effective in preventing cervical cancer.
But according to an article recently published in the British Journal of Cancer, researchers from Finland using mathematical models of human papillomavirus (HPV) type 16 virus infection to determine the optimal age to vaccinate individuals as well as different approaches to introducing the vaccine into the general population concluded that:
- Vaccination generates the greatest long-term benefit when administered prior to the first sexual contact.
- Vaccination of males as well as females has a greater impact when administered at an early age.
The MCF is concerned that the JCVI may not have given due consideration to the vaccine's cost-effectiveness in preventing anal and throat cancers, plus genital warts, among boys.
Recent mounting evidence is confirming that infection with HPV via oral sex is by far the leading cause of throat cancer. This threat of throat cancer is especially troubling because doctors traditionally only look for these malignancies in long-time smokers and drinkers. And while girls and women typically see a gynecologist for their Pap smear to look for cervical cancer, not many boys and men are going to go to a doctor and ask them to look at their throat.
Historically, at least 25% of those diagnosed with mouth cancers are non-smokers. The other 75% of those diagnosed have used tobacco in some form during their lifetimes. But today the research into the relationship of HPV and mouth cancers gives us clues as to the origin of cancer in those 25% of diagnosed individuals who did not smoke, and also into changing behaviors both in tobacco use and sexual practices. The age standardised incidence of oral cancer in British males stayed at around 7 per 100,000 males between 1975 and 1989, but since then, the rate has steadily increased to reach 9.8 per 100,000 in 2004, an increase of 40% since 1989. While female oral cancer rates have remained significantly lower than male rates, their incidence trends have been similar with an average increase of 2.5% each year since 1989.
Given the decline of tobacco use over the last ten years, (the historic primary cause of the disease) and the increasing rate of incidence of oral cancers, particularly those of the posterior mouth, it is likely that the ‘75% – 25%’ statement which has been made by everyone is no longer an accurate representation of the situation. There have been large increases in the incidence of oral cancer diagnosed in men in their 40s and 50s whose rates have doubled from 3.6 to 8.8 per 100,000 for men aged 40-49 and from 11.5 to 24.9 for men aged 50-59. These rising trends of oral cancer in young and middle-aged men, particularly of cancer of the tongue, have also been reported in other European countries and the USA. This increase in a cancer that is often difficult to treat and sometimes debilitating and disfiguring, is alarming.
In general it appears that HPV positive tumors occur most frequently in a younger group of individuals than tobacco related malignancies. They also occur more in white males, and in non smokers. The rising incidence and mortality rates in young and middle-aged adults is incontrovertible. There has been debate over the causes of this increase but in recent years, there has been mounting epidemiologic and experimental evidence of a role for human papillomavirus (HPV) as the etiologic agent of a subset of head and neck cancers. The association is strongest for oropharyngeal cancers, especially those of the tonsil. The HPV group is the fastest growing segment of the oral cancer population.
The Oral Cancer Foundation (our sister organisation in the U.S.) strongly believe that in a younger population of non smoking mouth cancer patients, that HPV will present itself as the dominant causative factor. We both believe that since the historic definition of those who need to be screened is now changed by this newly defined HPV etiology, and no longer valid, it is NOT POSSIBLE to definitively know who is at risk for the development of the disease, and who is not. Simply stated, today ANYONE OLD ENOUGH TO HAVE ENGAGED IN SEXUAL BEHAVIOURS WHICH ARE CAPABLE OF TRANSFERING THIS VERY UBIQUITOUS VIRUS ARE AT RISK. For this reason we are concerned that boys are not being vaccinated.
It is hoped that the new cervical cancer vaccines approved for use in pre sexual individuals for the prevention of cervical cancer being developed and marketed by Merck and GlaxoSmithKline, will have a positive collateral impact in the world of head and neck / mouth cancers in the next couple of decades, as these young, vaccinated individuals do not develop HPV related malignancies in sites far removed from the cervix.
The Mouth Cancer Foundation is a strong supporter of the use of the vaccines, and encourages their use in young males as well as females in the U.K.
- French KM, Barnabas RV, Lehtinen M, et al. Strategies for the introduction of human papillomavirus vaccination: modeling the optimum age- and sex-specific pattern of vaccination in Finland. British Journal of Cancer. 2007;96:514-518.
- UK Oral Cancer incidence statistics:
- Sturgis EM, Cinciripini PM. Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus-associated cancers? Cancer. 2007;110:1429-35.
- The HPV Connection