HPV vaccine (Gardasil) - not just for girls

Preventing cancer.

Anyone with a teenage daughter will be familiar with a relatively new vaccination provided in year 8 at school, which is designed to protect against cancer of the cervix. In the UK this is the second most common cancer to affect women under the age of 35, with around 3000 cases per year (8 cases per day) being diagnosed. Unfortunately death rates are high - around 970 women died from cervical cancer in 2011 in the UK.

The jab, GARDASIL, represents a truly dramatic improvement in healthcare. Just consider what this vaccination gives us – a proven and effective vaccination against a form of cancer. We often hear about the search for a cure for cancer, and here we have one step better – true prevention. No wonder it has become a routine childhood vaccination across developed countries all over the world.

But what about the boys?

Clearly boys and men are not at risk of cancer of the cervix, but there are very real benefits to boys being vaccinated too. For now however, the national immunisation program provided by the NHS only covers girls. In time, as in Australia, it will very likely be extended to males, but the wait means there is a population of boys missing out.

In order to understand how boys might benefit from the vaccination, it helps to understand what it vaccine does. Gardasil essentially protects individuals from a virus, namely human papilloma virus, or HPV.  We have long known that HPV is causative in over 70% of cervical cancer, but it is also known to cause vaginal and vulval cancers too. The majority of the adult population have been exposed to this virus through sexual contact as it is very common, and this is why we have cervical screening tests – to detect any cancer change in the general female population. Like many cancers, exposure to one of the causes does not mean you WILL develop cancer, but if you have not been exposed, you are very UNLIKELY to.

The Gardasil vaccine protects against the virus, and this explains why it is given before children mature and become sexually active.

The good news is that in boys there is also a benefit to be had. HPV is an established cause of anal cancer and genital warts (80% and 70% of cases respectively). Where a male has been protected by the vaccination, the risk of these illnesses dramatically falls. These are distressing, uncomfortable and unpleasant diagnoses to have, and it is fantastic that they are now preventable in a large number of cases.

What do the authorities say?

There is a lot of information available online regarding Gardasil and other HPV vaccinations. Much of this can be found on their website, but for truly impartial advice the Centres for Disease Control and Prevention is a resource that cannot be beaten. This is a US based public health institution which focuses on health protection and safety. You will have heard the name in the news many times as they are an authority typically providing international guidance on disease outbreaks globally. The CDC recommends 

“routine vaccination with GARDASIL for boys and girls ages 11 or 12. The CDC also recommends vaccination for young women ages 13 through 26 and young men ages 13 through 21 who have not already been vaccinated.”

Cancer research UK has a very informative page on HPV and vaccination, including advice of the benefits to boys, but recognising the cost of vaccinating all boys would be high, which may be a reason it is not yet available through the NHS.

Further benefits on the horizon – throat cancer

HPV is in fact a group of viruses, with over 150 different types. The vaccine targets those which we know can cause genital cancer and genital warts. An area of increasing interest surrounds cancers of the head and neck.  These cancers are increasing, especially in the male population with 3 or 4 men for every woman affected. Some centres suggest the ratio is much higher, with 6 or 7 times as many men than women affected. Research has shown that again, HPV is a primary cause. Estimates vary on the exact proportion for which HPV infection is the cause, however it may be as high as 70%. Alcohol and smoking are the prime causes where HPV infection is not detected. The total number of HPV related throat cancers has increased 4-5 fold in the past 10 years, and it is believed that HPV infection is the most likely reason for this increase.

Fortuitously, Gardasil vaccination targets HPV 6, 11, 16 and 18 and it is HPV 16 which causes the majority of infection related throat cancers.

As this was not the initial aim of the vaccination, research on benefit in terms of preventing throat cancer is only now starting to emerge. It has, however, been proven that the vaccine does prevent the infection, and it is expected that in time studies will reveal a reduction in throat cancers in this group. It is males who will benefit most as they are at far greater risk here.

Prevention not treatment

In both boys and girls it is important to realise the vaccination cannot provide treatment once the illness has occurred – it is a preventative and needs to be provided in childhood or early teenage years.

I routinely advise that HPV vaccination provides a fantastic advantage to both girls and boys, and recommend it to my suitable patients. For me, it is one of the highlights of healthcare development in recent years.

Gardasil is given as 3 injections over 6 months or 2 injections if given between the ages of 11-14. If you would like to arrange vaccination for your child, or want to discuss this or any other vaccination further, please feel free to come and see us for an appointment.

With best wishes

Dr James Hunt