“Experts Debate Giving HPV Vaccine to Boys
FRIDAY, May 18 (HealthDay News)
“Amid the controversy around mandated vaccination of young girls against the human papillomavirus (HPV), some experts are beginning to wonder whether the shot should also be given to boys.
While males cannot get HPV-linked cervical cancer, they make up half of the equation when it comes to spreading the sexually transmitted virus. And a new study released last week shows that the virus is also a leading cause of throat cancer, which affects both sexes.
“This is a viral infectious process, and the majority of the time it is passed through heterosexual contact. And I think it’s important to consider boys as equal players in that process,” said Dr. Michael Bookman, director of medical gynecologic oncology at Fox Chase Cancer Center in Philadelphia.
“Boys are not as prone to [HPV-linked] cancer as girls, but they are obviously involved in the transmission, and there is some risk of cancer in boys, as well,” he added.
No one is debating the effectiveness of the vaccine, called Gardasil. The shot is targeted against the four strains (out of 15) of HPV that are thought to trigger 70 percent of cervical cancers.
Since its approval for use in girls and women between the ages of 9 and 26 by the U.S. Food and Drug Administration last June, several states have moved to mandate Gardasil’s inclusion into routine school vaccination programs. That’s because vaccinating before the onset of sexual activity is most effective in preventing HPV infection.
Those efforts have met with strong opposition, however. Some conservative groups worry the vaccine will encourage sex among young people, while other critics view the mandates as an intrusion on parental rights. Most state measures do give parents the right to opt out of the program, however.
So far, those debates have centered on young girls. But, in more rare instances, boys and men can fall prey to HPV as well. Reporting last week in the New England Journal of Medicine, a team of researchers at Johns Hopkins University confirmed that infection with HPV via oral sex is by far the leading cause of throat cancer, which strikes 11,000 American men and women each year. HPV is also a major cause of anal cancer and genital warts, both of which affect either sex.
The threat of throat cancer is especially troubling, Bookman said, because doctors traditionally only look for these malignancies in long-time smokers and drinkers. “Head and neck exams are more associated with smoking and alcohol and less associated with HPV, although that’s changing,” he said.
And while girls and women typically see a gynecologist for their Pap smear to look for cervical cancer, “how many boys and men are going to go to a doctor and ask them to look at their throat? It’s just not that common,” Bookman said.
Debbie Saslow is director of breast and gynecological cancers at the American Cancer Society. She agreed that HPV also poses a threat to males, but she’s not yet convinced that Gardasil would help protect them.
“We have been considering vaccination for boys since day one, but the problem is that there is just no data yet — everything is holding until we get data that the vaccine actually works in boys,” she said.
Gardasil’s maker, Merck & Co., is largely responsible for pulling that data together. However, according to Bookman, “they took a more conservative stance when they approached the FDA for licensure, registration and vaccine recommendations — their safety data base was stronger for girls than boys.”
Saslow also is doubtful whether Gardasil — which costs $360 per three-shot regimen — would prove to be cost-effective if provided to boys as well, at least in terms of preventing the biggest threat, cervical cancer.
“It may be cost-effective to vaccinate boys if not that many girls get vaccinated,” she said. “But if most of the female population ends up getting vaccinated, then vaccinating boys won’t add very much.”
But what about the vaccine’s cost-effectiveness in preventing anal and throat cancers, plus genital warts, among boys? Saslow said that since Gardasil has not yet been proven to be effective in boys, or to be effective against cancers outside the cervix, those points remain up in the air. “We still have all these questions that we need to look at,” she said.
Another expert, Dr. Robert Frenck, a professor of pediatrics at Cincinnati Children’s Hospital, was equally noncommittal. Frenck, who sits on the American Academy of Pediatrics’ committee on infectious diseases, said his group is “in the process of developing the recommendations for HPV vaccine use.” He said the AAP recommendations would focus only on the vaccine’s “currently [FDA] licensed usage,” which is exclusively for females.
Still, Bookman believes that, should Gardasil prove effective in boys, widening its use to both sexes “is the correct way to try and do things.”
“What about everything

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A recent study among soldiers shows that the HPV virus is just as prevalent in men as in women. HPV or human papilloma is considered the primary cause of cervical cancer and the virus is transmitted sexually.

The study is the first to look at the risk of new HPV viral infections and chronic HPV virus in men. And it shows that the virus is equally prevalent in men as in women.

-We know much less about the spread of HPV virus in men than in women, but with this study, we can see how the HPV virus in men behave over time – and if they for example have a greater risk of developing new types of virus, if they once have been infected, says Professor Susanne Krüger Kjaer from the Danish Cancer Society, one of the researchers behind the study.

Risk of several types of viruses
374 male soldiers between 18 and 29 years participated in the survey, which have included cell samples from the penis for HPV study, questionnaires on lifestyle and Chlamydia tests. Researchers investigated both new HPV virus and chronic HPV virus in men. By the study’s start were 33 percent of the soldier HPV-positive. After six months the soldiers were tested again, and here was a further 14 percent tested HPV positive.

-The study shows that those who already had HPV-positive from the start, had a much greater risk of developing several types of HPV virus. And while we see that the number of sexual partners is essential for the men without incurring HPV infection: The more sexual partners, the higher the risk of HPV transmission “says Susanne Krüger Kjaer.

The researchers also showed that just as in women, the risk for chronic HPV infection increased if they had a so-called high-risk HPV type, and if they were smoking.

Serious consequences for women
HPV infection transmitted through sexual contact and is probably the most common sexually transmitted infection. A Danish study shows that up to 20-30 percent young Danish women are infected. It is also reported that as much as 50-80 percent of all sexually active people in their lifetime will have been infected with HPV at some point.

In men, HPV can give genital warts, but it is extremely rare that it develops into cancer (eg. Penile cancer). In contrast, the infection often have severe consequences for women, because – in addition to genital warts – can have severe cell changes on the cervix and cervical cancer, “says Susanne Krüger Kjaer.

In most women the virus disappears again by itself after 6-12 months. But in some cases developing infection to become chronic, and in those cases there is a risk for the development of cell changes on the cervix, which at worst can become cervical cancer. Among women with cervical cancer, the HPV virus is detected in 99 percent of the cancer cells.

HPV virus is usually without any symptoms and yet there is no effective treatment for it. What is being treated, the cell, which can cause infection. Unfortunately, condoms do not protect 100 percent against the virus.

The world’s first cancer vaccine
Researchers in the Cancer Society and the pharmaceutical company MSD currently work to test a vaccine to prevent chronic HPV infection. Study carried out in collaboration with researchers in other Nordic countries and in South and North America, covers a total of 12,000 women who received either active vaccine or placebo. The vaccine has been proved to be successful, and it is the first cancer vaccine in the world.

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