Most of us think that the human papilloma virus (HPV), an easily sexually transmitted virus, causes only cervical cancer in women. What’s not talked about as much is that it leads to a variety of cancers in men, too, some of which are spiralling. According to a Memorial Sloan Kettering Cancer Centre newsletter of 2021, HPV led to a five-fold increase of head and neck cancers in young men in the US from 2001 to 2017, the data being formally released at the 2021 annual meeting of the American Society for Clinical Oncology. In fact, oncologists at Sloan Kettering found that cases of head and neck cancer were being reported by people infected with the virus many years ago. Which means there is a delay between infection and development of cancer in men and boys should be seen at risk too. Dr Sarika Gupta, Consultant, Gynaecologic Oncology and Robotic Gynaecology at Indraprastha Apollo Hospital, New Delhi, argues that while the HPV vaccine has been rolled out in the country and there is an awareness campaign to get all girls vaccinated, there is enough reason to vaccinate boys as well.
Modelling by the University of Warwick estimates that by 2058 in the UK, the HPV vaccine programme currently being used (vaccinating both girls and boys) could prevent up to 64,138 HPV related cervical cancers and 49,649 other HPV related cancers.
How does the HPV virus cause cancer in boys/men?
The virus doesn’t have a gender bias and without the vaccination, every sexually active person is a carrier with the risk of developing cancer at some point in his/her life. Most HPV infections may go away on their own. But some of these can cause certain types of cancer. If you look at the US data from the Centers for Disease Control and Prevention (CDC), between 2013 and 2017, there were approximately 25,000 cases of HPV-associated cancers in women and 19,000 in men. CDC data further shows that there are now more cases of head and neck cancers than cervical cancers in the US, 70 per cent of which are caused by the HPV virus. So, both boys and girls are being vaccinated in the US at the school level itself. The virus even causes oropharyngeal cancer at the back of the throat, including the base of the tongue and tonsils, in both men and women.
When should boys be given the vaccination?
The HPV vaccine can be recommended for both boys and girls as soon as they turn nine. It protects both equally. For boys, the ideal age category would be between nine and 15 as it gives maximum protection in the early years and elicits better antibody response. With this dose, boys are protected and cannot transfer from partner to partner. So, they cannot transmit the virus to girls and together they can build a herd immunity of sorts in the community. Of course, it is important at this point to immunise girls, considering India is carrying one of the highest burdens of cervical cancer after Africa, but we must not forget the boys and do a risk assessment too.
What should the dosage be for boys?
Between nine and15 years, only two doses are enough. But if you sign up later, you would need three doses.
Does the vaccine protect against all HPV viruses?
There are 15 strains of the virus and our home-grown vaccine can protect the young population against four strains, among them the two main aggressive ones. The imported vaccines take care of nine strains. It is the best way of preventing cancer and many countries are seeing a drop in cases post-vaccination.
Why is HPV a silent threat for boys?
HPV can cause several kinds of cancer. But only cervical cancer can be detected early with a screening test. In fact, women should not forget to get their pap smear screening done every year after they are 25. The other cancers caused by HPV may not be detected until they manifest rather late in the day. The HPV vaccine prevents such threats.
Which countries have introduced HPV vaccines for boys?
Many Western nations have, particularly the US and UK. Twenty-five percent of all global deaths due to cervical cancer occur in India, according to a report by the George Institute of Global Health. In African nations, it is 30 to 40 per cent. Which is why at this point in time, our girls need it more and supplies have to be prioritised. When we have enough, even boys can have it. The HPV vaccine, first introduced in the US in 2006, has proven so effective that WHO says it could, in combination with screening, eliminate cervical cancer worldwide by the end of the century.
Apart from the US and UK, Australia, Austria, Bermuda, Brazil, Canada, Croatia, Germany, Israel, Italy, Lichtenstein, New Zealand and Serbia have “gender neutral” immunisation programmes.