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HPV (Human Papilloma Virus) is known to be related to cancers for a long time. However it was only recently that breakthrough has been made to introduce vaccines that can prevent HPV infection. The reason for this is that HPV infections are rarely, if ever, immediately ife-threatening.
Vaccination has always focused towards preventing causes of immediate death or disability.
The importance of HPV vaccination has not been recognised either by healthcare providers or recipients as most of the HPV infections are silent but at least 50 percent(1) of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80
percent of women will have acquired genital HPV infection, manifest or otherwise.
The study conducted by Professor Margaret Stanley has dealt with HPV as aetiology, primarily of cervical cancer. However, HPV is also known to have a role in the causation of colorectal cancers, bladder cancers and head and neck cancers. In a study(2) conducted by National Cancer
Institute, NIH, Bethesda, Maryland, it was seen that more than 50% of patients with colorectal cancers were positive for HPV DNA, where as the controls were negative for the same. This implies that even though HPV cannot be designated as the causative factor in colorectal cancers, it does increase the risk of development of these cancers. Further, more than one-third of patients who were positive had the HPV 16 subgroup.
Though the protection provided by the vaccine is not 100%, the study has still proved a 70% efficacy of the vaccine. Vaccines that are part of the British National Vaccination Schedule vary in their efficacy. For example, the influenza vaccine(1) is only 50%- 60% effective in preventing influenza-related hospitalization or pneumonia in adults > 65 years, but it is still strongly advocated since it decreases a substantial amount of morbidity and burden of disease in the general population.
Cancer Prevention is a very important part of healthcare provided by the NHS (National Health Service) in the United Kingdom (UK). There are organised, active cancer screening programmes(3) for the prevention of colon cancer, cervical cancer and breast cancer. HPV vaccination along with screening programmes can effectively be part of a multi-modal approach to cancer prevention and treatment if introduced as a part of the British National Vaccination Schedule in the UK.
There is the question of cost-effectiveness in introducing HPV vaccination in the British National Vaccination schedule as its role is less important in males than in females. However, there have been studies which show that HPV has a role in causation of male genital warts,
carcinoma in situ and invasive carcinoma of the penis(4). In addition, as the study by Professor Margaret Stanley suggests, vaccination of young boys would help in establishing herd immunity, thus helping to prevent
cervical cancer. Hence, though the significance of HPV vaccination is lesser in males due to the lower incidence of penile cancer, vaccination is still important in males in preventing penile cancer and cervical cancer.
Since, at present there is no effective treatment for HPV infection except for removal of warts and excision of tissue damaged by the virus where possible, in my opinion HPV infections is better dealt with before it infects the body, than after.
1. Centre for Disease Control and Prevention,Sexually Transmitted Diseases.
2. Clinical Cancer Research Vol. 11, 2862-2867, April 15, 2005
4. International Journal of Cancer, 2005 Sep 10;116(4):606-16.
M. Stanley has summarized and reviewed the importance of the recently available human papillomavirus (HPV) vaccine 1. In addition to this summary, I would like to stress the importance of the significant education initiatives that will be necessary to implement the success of the HPV vaccination. Yes, the vaccination may have the ability to reduce up to 70% of the HPV-associated cervical cancers...
M. Stanley has summarized and reviewed the importance of the recently available human papillomavirus (HPV) vaccine 1. In addition to this summary, I would like to stress the importance of the significant education initiatives that will be necessary to implement the success of the HPV vaccination. Yes, the vaccination may have the ability to reduce up to 70% of the HPV-associated cervical cancers we know today, however variability in socidemographic characteristics, confusion over the sexually transmissible nature of the disease and the education of health-
care workers and the media are crucial factors in making the genesis of this vaccination program successful. Along with the continuation of the gold standard PAP smear/test the new HPV vaccine shows considerable promise to help reduce and/or eradicate many cervical cancers 2. That said, HPV vaccination is also a double edged sword. The more complicated ethical reality of health care disparities and parental consent for childhood vaccination may detract from an effective vaccination program. Time will tell.
References:1 Stanley M. Prophylactic HPV Vaccines. Published online 26 Jan 2007; J. Clin. Pathol. doi:10.1136/jcp.2006.040568
2 Dekker AH. Fostering acceptance of human papillomavirus vaccines. J Am Osteopath Assoc. 2006 ;106(3 Suppl 1):S14-8.