If you had the power to eliminate several common cancers and prevent your children from developing them, you’d use it, wouldn’t you? We have that power today for cancers caused by the human papillomavirus (HPV), but we aren’t fully using our available resources, including vaccination for primary prevention and screening and treatment for precancerous changes in the cervix.
HPV causes six different kinds of cancer: cervical, oropharyngeal (throat), anal, penile, vaginal, and vulvar cancers. Shockingly, most of them are on the rise in the United States. Our best prevention tool — the HPV vaccine — hasn’t been fully utilized. As of 2017, the last year for which full data are available, only 53% of eligible girls and 44% of eligible boys in the United States received the HPV vaccine. Part of the reason is that not everyone has learned what the vaccine can do. Another part is that some parents misunderstand it. We have an educational challenge. Some would say the vaccine has an image problem.
The Food and Drug Administration first approved the HPV vaccine, Merck’s Gardasil, in 2006, and approved an expanded version, Gardasil 9, in 2014. The best time to be vaccinated is during early adolescence, before an individual has been exposed to these viruses. Because HPV can be transmitted through sexual and other intimate contact, some parents don’t want to talk to their children about the vaccine, fearing (incorrectly) that HPV vaccination equals permission to have sex and ignoring the fact that the HPV vaccine prevents cancer. As with other immunizations, the goal is to protect individuals before they might be exposed to human papillomaviruses.
We now have the ability to eliminate the different kinds of cancers caused by HPV. In the U.S., nearly 34,000 individuals develop HPV-related cancers every year. Approximately the same number of men are diagnosed annually with HPV-related throat cancer as women diagnosed with cervical cancer. The difference is that cervical cancer can be detected before it starts with regular screening tests, while throat cancer can’t be detected early this way. As we plan to tell members of Congress Thursday, that’s why vaccination to prevent the HPV infections that cause these cancers is so urgent.
Just this week, The Lancet published a combined analysis of HPV vaccination programs in 14 high-income countries. It showed substantial benefits of three-dose, girls-only HPV vaccination programs on rates of HPV infection and diagnosis of anogenital warts and earliest-stage cervical cancer. Programs with multi-cohort vaccination (to age 18, or even to age 26 in Australia) and high vaccination coverage led to a greater and faster direct impacts and herd benefits.
Eliminating six cancers from the U.S. and the world can happen in our lifetimes if we achieve high vaccine coverage and more widespread participation in cervical cancer screening and treatment programs. Cancer centers and health organizations across the country are issuing a call to action to achieve the objectives of Healthy People 2020:
- Complete vaccination of more than 80% of females and males ages 13 to 15 by 2020
- Screen 93% of eligible females for cervical cancer by 2020
- Provide prompt follow-up and treatment of females who screen positive for high-grade cervical precancerous lesions.
As of 2016, only 80% of eligible women were screened as recommended for cervical cancer. We have a lot of work to do to make sure we reach and sustain these vaccination and screening goals.
The combination of HPV vaccination to prevent infections that can cause cancer plus cervical cancer screening and treatment for women is the optimal route to reduce and eventually eliminate cervical cancer and other genital and throat cancers in both women and men. To achieve this goal, we must invest the necessary resources to implement these lifesaving strategies. Insufficient vaccination is a public health threat. Our nation’s health care providers, parents, and adolescents need to take advantage of our shot to eliminate HPV-related cancers.
Anna R Giuliano, Ph.D., is the founding director of the Center for Immunization and Infection Research in Cancer at the Moffitt Cancer Center and a member of the American Association for Cancer Research. She is a member of the Merck Advisory Board and her institution has received funding for research through a Merck Investigator initiated studies program. Gilbert S. Omenn, M.D., chairs the Health Policy Subcommittee of the American Association for Cancer Research and directs the University of Michigan’s Center of Computational Medicine and Bioinformatics. He is on the board of directors of Galectin Therapeutics and the scientific advisory board for Oncopia Therapeutics.