Tuesday, November 1, 2011 | Categories: Dr. Brian's Blog
Last week, an advisory panel to the US Centers for Disease Control recommended that all 11 to 12 year olds - boys as well as girls - be routinely vaccinated against a family of HPV viruses that cause around 25,000 cases per year of cancer in the US and roughly 2500-3000 cases of various forms of cancer per year in Canada. Two years ago, the CDC advisory panel issued what it calls a "permissive recommendation" for boys, which made the vaccine recommended for boys though not routine.
The current move by the CDC advisory panel makes it a "routine recommendation" - the highest one conferred by the CDC. If the panel's recommendatino is approved by the CDC, it will mean that HPV vaccination will be added to the routine childhood immunization schedule for boys as it already is for girls.
What made the panel recommend HPV vaccine for boys at this point in time? Vaccinating boys will prevent them from spreading Human Papillomavirus or HPV to their sexual partners - female or male. Doing that will indirectly help prevent cervical cancer in women. That's important given the fact that coverage rates for the HPV vaccine in young women remain less than 100%, according to reports.
Another reason for vaccinating boys is to prevent cancers to which they too are susceptible. You may remember that actress Farrah Fawcett died in 2009 of anal cancer. That's just one of the cancers caused by HPV. Others include head and neck cancers which have increased in numbers dramatically in the last few years.
A study published last week in the New England Journal of Medicine found that men who got the HPV vaccine developed 75% fewer anal lesions that turn into cancer than men who received a placebo.
In my opinion, there are no serious drawbacks to boys getting the vaccine. The side effects to the vaccine are minimal - mainly headache, fever and a sore arm. You may remember that the vaccine became a political hot potato during US Republican presidential debates when Representative Michelle Bachmann from Minnesota suggested that HPV shots could be very dangerous and even cause mental retardation - which is nonsense.
An estimated forty million doses have been given in the US with virtually no serious side effects. The one argument against the vaccine that seems to resonate with some is that by protecting against HPV - which is a sexually transmitted disease - it may encourage teens to be more sexually active. I disagree. A vaccine against pregnancy - which is not as farfetched as it sounds - might have that effect but not one against HPV. Teens will experiment with sex whether there's a vaccine or not.
It may be tempting for some to assume that condoms are so effective at preventing the transmission of sexually transmitted diseases that a vaccine isn't necessary. However, in the case of HPV, condoms help reduce but do not eliminate the spread of the virus.
The cost of the vaccine is an issue. At $100-130 per shot times three shots for a total of between $300 and $390 dollars, making it one of the most expensive vaccines on the planet. But as a society, we have to balance the benefit against the cost. While it's true we're not talking a large number of preventable cancers, to me, the number is significant and it's on the rise. The HPV vaccine is one of the first in medical history that can help prevent cancer. Prevention has to be better and more cost effective than treating it once it develops.
I also think there's a fairness issue here. In March 2007, following a move by the federal government to provide $300 in financial support, most if not all provinces and territories initiated publicly funded HPV vaccination programs for young women. With the evidence efficacy mounting in men, I think it's only fair that the same vaccine be offered to young men as well.
The Centers for Disease Control will formally accept the advisory panel recommendation and make HPV a routine recommendation for young men. The National Advisory Committee on Immunization in Canada is currently reviewing the current recommendations in light of new evidence and the impending decision in the US. While there's no formal timetable to include boys and young men, I think it's highly likely we'll see that soon. Late last year, New Brunswick health officials said they were looking at expanding the HPV vaccination program to include young boys.
A little money from the Canadian federal government, and I think we're there.