If you overlook the plain ignorance of junk medicine pushers on the internet, it’s clear that there’s only a few things that you can do to lower your risk of cancer. Quitting tobacco is probably the biggest one. But right up there is the fact that the HPV vaccine lowers cancer risk – and as a consequence, lowers health care costs generally.
Despite it’s clear benefit to human health, the HPV cancer preventing vaccine, also known as Gardasil, is under utilized in the USA. There seems to be a lot of reasons why HPV vaccine uptake is low, but the evidence is clear that it is safe, it reduces cancer risk, and it lowers the costs of healthcare.
So, let’s take a look at some of the data.
HPV and the vaccine
Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the USA. There are more than 40 HPV sub-types that can infect the genital areas of males and females. Additionally, some HPV types can also infect the mouth and throat. HPV is generally transmitted from personal contact during vaginal, anal or oral sex.
A new, more powerful, version of the HPV vaccine – which received approval from the US Food and Drug Administration in December 2014 – protects teens and young adults from 9 subtypes of HPV, thus it lowers the risks of more types of cancer.
As some background, HPV infections are closely linked to many types of cancers in men and women. According to current medical research, below are some of the cancers caused by various HPV types:
- Cervical, vulvar, vaginal, and anal cancers can be caused by HPV types 16, 18, 31, 33, 45, 52, and 58.
- Genital warts are caused by HPV types 6 and 11. Although genital warts are generally benign (though unsightly), there is a small chance they develop into cancers.
- Various precancerous lesions of the cervix, vulva, vagina, and anus can be caused by HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58
- Oropharyngeal and penile cancers are caused by subtypes 16 and 18.
HPV is believed to cause nearly 5% of all new cancers across the world, making it almost as dangerous with regards to cancer as tobacco. According to the CDC, roughly 79 million Americans are infected with HPV–approximately 14 million Americans contract HPV every year. Most individuals don’t even know they have the infection until the onset of cancer. About 27,000 HPV-related cancers are diagnosed in the USA every year.
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HPV vaccine lowers cancer risk
A new study published recently in the Proceedings of the National Academy of Science, one of the most prestigious scientific bodies in the world, concluded that the HPV vaccine is grossly underutilized in the USA. The study estimated that only about 30% of girls and about 10% of boys get the required three dose regimen of the cancer preventing vaccine.
The low rate of vaccination of boys is particularly troubling because they are also at risk of some very serious cancers – penile cancer should make every man stop in their tracks. More importantly, men can transmit the virus to unsuspecting women (and vice versa to be fair). Being HPV free can stop these cancers quickly by creating herd immunity against the disease.
It’s really simple math. This vaccine prevents infection from more strains of the virus, and thus, it’s going to do a better job of preventing the disease and subsequent related cancers. There are so few things that can be done to prevent cancers, it’s quite incomprehensible why this vaccine isn’t being used more. The researchers from Yale and the University of Waterloo in Ontario, Canada, developed a model to determine the potential cancer prevention and economic benefits of the new vaccine, Gardasil 9.
The researchers predicted that switching to Gardasil 9 could decrease cervical cancer incidence by 73%, compared to the older versions of HPV vaccine (the bivalent, Cervarix, and quadrivalent Gardasil), which could lower cancer rates by 63% (which is still pretty good).The researchers also predicted that Gardasil 9 could reduce cancer mortality rates by 49%, whereas the older versions of the vaccine could lower mortality by 43%. To be fair, Gardasil 9 is more expensive per dose – around US$390-500 for the full three-dose regimen. However, most insurance plans cover the cost of the vaccine in the USA. And the Vaccines for Children program provides the vaccines for free for just about any child in the USA whose family cannot afford it. Despite the higher cost, the researchers anticipated that more widespread use would actually lower costs.
Why is the HPV vaccine underutilized?
This study brought up some points that may lead to underutilization of the cancer preventing vaccines:
- Many states have not included Gardasil in the mandatory schedule of vaccinations for school-aged children. There may be many reasons for this, including political ones.
- Many people think that protecting children from a sexually transmitted disease leads to promiscuity. This is simply not true based on substantial research evidence. In fact, this idea may lead some more conservative states to reject the vaccine in their state’s schedule.
- Many people believe that their children are not sexually promiscuous (I don’t know why parents hold on to that myth), so are not at risk from HPV. Even if that were true, maybe their child’s perfect spouse isn’t so perfect. Or they may be sexually assaulted by someone with the infection (yeah, we don’t want to think about that, but it happens a lot more than we want).
- People don’t realize that the vaccine can be given to children as young 10-11 years old, way before they become sexually active. They can go out in life protected from the disease, and become part of the herd immunity that blocks its transmission from one to another person.
- Many pediatricians and family physicians do not strongly recommend the vaccine.
- Many people believe that HPV isn’t serious. Yes, approximately 90% of HPV infections are asymptomatic and resolve spontaneously within a couple of years. Unfortunately, persistent infection with some HPV types can lead to other illnesses — including cancer. The CDC reports that roughly 33,200 HPV-associated cancers occur every year, with 20,600 of those occurring among women.
- Which leads to the lack of understanding that the vaccine prevents more than just the virus, but also the subsequent cancers. We should all want our sons and daughters to be protected from cancer.
- Finally, the myths about Gardasil are abundant. Factually, the evidence, including several massive epidemiological studies, have confirmed that Gardasil is extremely safe, probably one of the safest vaccines ever developed. If you want to read about the studies, look here, here, and here. There are so many more studies, I couldn’t begin to describe them all. But I do try.
The author’s summary is the TL;DR version of this conversation:
[infobox icon=”quote-left”]We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.[/infobox]
Get yourself vaccinated against the cancer causing HPV disease, if you’re a young adult. Or get your children and grandchildren vaccinated against the disease. Let’s kick cancer’s ass, and the HPV vaccine is one of the best ways to start.
- Durham DP, Ndeffo-Mbah ML, Skrip LA, Jones FK, Bauch CT, Galvani AP. National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States. Proc Natl Acad Sci U S A. 2016 Apr 18. pii: 201515528. [Epub ahead of print] PubMed PMID: 27091978.