Dr. Wilson C. Mertens: A vaccine to prevent cancer is underutilized

For the Gazette
Tuesday, December 05, 2017

A large part of my clinical practice involves treatment of patients with head and neck cancer. The fastest growing type of head and neck cancer involves malignancies of the tonsils and related areas that are caused by a viral infection. The virus, known as the human papilloma virus or HPV, whose various types are responsible for the most common sexually transmitted infections in the country, is also the culprit behind most cases of female cervical cancer.

Treatment of head and neck cancers, which often appear as bulky tumors in the back of the throat and in lymph nodes in the neck, frequently requires extensive radiation therapy, commonly with the addition of chemotherapy at the same time. The treatment causes considerable discomfort and swallowing problems during delivery, which can take two months with prolonged recovery time.

While these cancers are often very curable, long-term side effects such as dry mouth, swallowing difficulty, and dental issues are frequent.

Head and neck cancer is something no one wants, but it is something every parent can help lower their child’s risk for, along with the risk in girls for cervical cancer, which can cause infertility, and anal cancers in both boys and girls.

Since 2006, an effective vaccine has been available that prevents infection by the HPV virus subtypes that are most frequently related to cancer. The vaccine, which is recommended by the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians, is generally given at the age of 11 or 12, in two shots six to 12 months apart. If the child is older than 14, the vaccine is administered in three shots. The vaccine is recommended for young women through age 26, and young men through age 21. 

To be effective, the vaccine should be given before exposure to the viruses, or in other words, before someone becomes sexually active. Studies are showing it to be effective in preventing infections in both men and women with some studies showing protection against the targeted HPV types to last years.

HPV infections are common in the country; the CDC estimates that 90 percent of sexually active men and 80 percent of sexually active women will be infected by at least one type of HPV during their lifetime. It is estimated that about half of these are a high-risk HPV type, most of which show no symptoms and eventually resolve, but some of which can persist and, if left untreated, progress to cervical, anal, oropharyngeal cancers and even penile cancers.

The CDC has a goal that by 2020 at least 80 percent of all eligible adolescents will be vaccinated, but we are far from that goal, even here in Massachusetts where, as the state’s Health and Human Services website notes, “routinely recommended pediatric vaccines, including HPV vaccine, are provided free of charge by the state.” According to 2016 statistics from the Massachusetts Department of Public Health, a full set of vaccinations for HPV were received by 53 percent of eligible females, and 35 percent of males. Most states have even lower rates.

The low rates of vaccination — only about 43 percent of teens nationwide have received all of their recommended dosages — is surprising and disturbing.

Early surveys revealed some parents regarded administering it as giving permission to young people to have sex, while later surveys indicate some parents believe there is no need if their child is not sexually active.

This indicates a lack of understanding about the vaccine, something survey respondents acknowledge along with reporting that their health-care provider did not recommend it, perhaps because of uncertainty surrounding how to explain that this type of cancer prevention is not tantamount to promoting sexual activity.

The recommendation is to give the vaccine at the same time children receive the meningococcal and Tdap vaccines, and for the health-care provider to explain it as a cancer prevention vaccine, which it is, no matter at what point it is administered.

Vaccinating children early will help avoid infections that may occur in adolescence, but also beyond. An infection, once it occurs, cannot be undone and persistent HPV infections can lead to cervical, penile and tonsillar cancers years or decades later.

Millions of doses of the HPV vaccine have been delivered worldwide, and follow-up data, including from the World Health Organization, consistently demonstrates its efficacy and safety.

Its benefits are real. As Electra Paskett, an Ohio State University epidemiologist, states: “If we said we have a vaccine for breast cancer, we’d be vaccinating day and night.” Exactly.

Dr. Wilson C. Mertens is vice president, medical director cancer services Baystate Regional Cancer Program based in Springfield. He is one several Baystate health professionals who address issues related to cancer in this space on a rotating basis each month.