An Ounce of Prevention (OK, a Shot) is Worth a Pound of Cure

On the heels of advances in vaccines that prevent human papillomavirus (HPV) infection—infection with high-risk types of HPV is the culprit of most cases of cervical cancer—the American College of Obstetricians and Gynecologists (ACOG) recently revised and updated its recommendations for vaccines to prevent cervical cancer.
      
A globally esteemed cancer center in Houston, TX, is already on it.
      
HPV vaccines are almost 100 percent effective in preventing HPV infection from the vaccine-related HPV subtypes in children before exposure and at ages under 14 - where “immune memory” seems to be more robust, according to Lois Ramondetta, MD, professor, Department of Gynecologic Oncology and Reproductive Medicine, at The University of Texas MD Anderson Cancer Center. However, vaccination rates in the United States are staggeringly low.
 
      
In an attempt to raise awareness of the vital importance of vaccinating at-risk youngsters, MD Anderson, along with the nearly 70 other National Cancer Institute (NCI)-designated cancer centers, has just sounded a clarion call recommending the vaccination to prevent some cancers from ever developing – making it the first time the NCI-designated cancer centers have joined forces in this way.
      
“We believe strongly in the use of the HPV vaccines especially for boys and girls under the age of 13,” Ramondetta says. “Not only could 4,000 deaths a year from cervical cancer be prevented, but 27,000 diagnoses and 9,700 total deaths from HPV-related cancers may be prevented in both men and women.” HPV-related cancers include cervical, oropharyngeal, anal, penile, vulvar, and vaginal cancer.      
      
Despite the success of HPV vaccines in preventing cancer, less than 40 percent of girls, and a little more than 21 percent of boys have been given the recommended three doses. Among the hindrances in improving this record is a dearth of powerful recommendations from physicians, and a lack of support from parents on whom it does not seem to register that the vaccine protects against several types of cancer, Ramondetta notes. In an attempt to improve response, MD Anderson recently hosted a summit attended by experts from the NCI, the Centers for Disease Control and Prevention, the American Cancer Society and many of the NCI-designated cancer centers to brainstorm ways to move past these obstacles.
      
It should also be noted that the stereotypical case of young women alone being infected by HPV may need to be overhauled. “Soon men may be the most effected by HPV as we see rapidly rising rates of tonsil and laryngeal cancers at MD Anderson,” Ramondetta says.
      
While the physicians at MD Anderson think globally, their thoughts also reside close to home. “We believe that it is not only our job to prevent cancer in our patients and the community at large, but importantly our own cancer community. We currently have over 20,000 employees,” Ramondetta says. To that end, in 2015 MD Anderson surveyed its employees. Surprisingly, they found that “we were not doing better than the population at large in terms of vaccinating our children,” Ramondetta says. “This year we are developing a HPV immunization clinic that will be held on Saturdays, specifically for the children of our employees in order to make vaccination more convenient.”
      
Ramondetta laments that she and her colleagues still see advanced cervical cancer patients, and now oropharyngeal cancers patients, all too often. “This is more tragic than any other cancer, in that we feel it could have been prevented had we started vaccinating well in 2006,” she says. “Being exposed to HPV is just part of being human.”
       
A link to a practice algorithm tailored for MD Anderson (and its particulars) and incorporating a multidisciplinary approach is found here.

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