Tuesday, August 18, 2015

HPV Is an Epidemic That We Can Prevent

By Lois M. Ramondetta, MD
Houston Gynecological Oncologist
Chair, TMA Committee on Cancer
Be Wise – Immunize Physician Advisory Panel

This article was first published in the Houston Chronicle on Aug. 17, 2015, and is reprinted here with permission from the author.

I have devoted my entire professional life to protecting the health of my patients. But when I see patients diagnosed with cervical cancer, especially in its later stages, it's heartbreaking. And far too often, it's a losing battle.

When it comes to other forms of cancer, we're all aware the risks can be reduced through simple lifestyle behaviors, such as quitting smoking, eating healthier and increased exercise. It's a no-brainer for a parent to apply sunscreen to their child to prevent skin cancer.

It should be equally as obvious to get our kids vaccinated against the human papillomavirus (HPV). Doing so can protect against seven types of cancer associated with the virus.

The time has come for Texas, and the rest of the country, to ramp up efforts to get our children vaccinated and protect the health of future generations. I don't want your children to become my patients.

HPV exposure is part of being human. Almost every sexually active person will acquire HPV as some point in their lives.

Each year in the U.S., HPV infection leads to 45,000 cancer cases and nearly 10,000 deaths.

Two virus strains – HPV 16 and 18 – are blamed for almost all cervical cancers, more than 90 percent of anal cancers and a large share of genital cancers. They may also cause cancers in the back of the throat, most commonly at the base of the tongue and in the tonsils, called oropharyngeal cancers.

More than 70 percent of oropharyngeal cancers are HPV related. These cancers disproportionately affect men, and will soon be more common than cervical cancer.

Late last year, the Food and Drug Administration (FDA) approved the latest vaccine, Gardasil 9. According to the FDA, the complete three-dose vaccine has the potential to prevent the vast majority of HPV-related cancers.

The problem is, very few of us are getting our kids vaccinated.

Just this week the Centers for Disease Control and Prevention (CDC) published the latest vaccination rates. Less than 40 percent of girls and slightly more than 20 percent of boys receive all three doses.

Communication is our major obstacle to increasing these rates. We need more open communication between pediatricians and family practitioners and the families they treat. Because HPV is a sexually transmitted infection, some doctors and parents avoid discussions as they can be an awkward subject to address.

However, that's not necessarily true.

A recent study from the CDC shows physicians overestimate parents' hesitancy about the vaccine and, as a result, become more hesitant themselves to broach the subject. Such reluctance results in missed opportunities to vaccinate kids at the recommended ages of 11 and 12.

Some parents fear saying "yes" to the vaccine may encourage their children to say "yes" to sex at an early age. However, many studies have shown that adolescent girls who are vaccinated are no more likely to show signs of sexual activity than those who aren't vaccinated, including a 2012 study in the journal Pediatrics and a 2015 study in JAMA Internal Medicine.

MD Anderson clinicians and researchers are launching increased efforts to combat HPV-related cancers. We want to increase HPV vaccination rates in Texas and across the nation, improve early screening, and rapidly develop new and better therapies.

We have a vaccine and if we use it, we believe the cancer cases linked to HPV could almost be entirely eliminated. HPV-linked cancers could become as rare as smallpox or diphtheria.

If we want to make a significant impact, we need to face facts: HPV is an epidemic – one that in many cases is preventable.

Dr. Ramondetta is a professor of Gynecologic Oncology & Reproductive Medicine at the University of Texas M.D. Anderson Cancer Center and chief of the Division of Gynecologic Oncology for Lyndon B. Johnson General Hospital.

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