One More Round on HPV

On previous blog posts, I advocated for mandatory HPV immunization in girls, but not necessarily in boys.  Well, I've changed my mind.  The vaccine should also be mandatory in boys.


A recent study confirmed what most epidemiologists have suspected for a while -- HPV is fueling the stratospheric, 225% rise in oropharyngeal cancers, involving such structures as the tongue and tonsils.  In the past, most of these cancers have been associated with tobacco and alcohol.  Rates of oral sex have been increasing, as many regard it as being safer than intercourse*, so the combination of that behavior and decreasing smoking rates means that 70% of oropharyngeal cancers are now due to HPV infection.  ("Human papillomavirus and rising oropharyngeal cancer incidence in the United States.")  HPV-positive oropharyngeal cancers can be seen in patients as young as 35 or 40.  While they tend to have a better prognosis than those who have tobacco-related cancer, standard treatment includes a toxic brew of radiation, chemotherapy and/or major surgery, including glossectomy (tongue removal).  There is no such thing as an oral Pap smear, so oropharyngeal cancer is often diagnosed late.  Probably one of the most famous patients is celebrated chef Grant Achatz of the restaurant Alinea, who was diagnosed with advanced tongue cancer in 2007.

This tongue dish from Alinea came from a duck, not the chef.

Fortunately for him and his fans, Achatz managed to avoid a glossectomy, and with aggressive therapy, he is now in remission.  Unfortunately, if current trends continue, projections show that the number of HPV-related oropharyngeal cancers will exceed the number of cervical cancers by 2020, and over half will be in men.


Of course, current trends don't have to continue, not if we make HPV vaccination mandatory in all preteens.  Although oropharyngeal cancer has not been a studied endpoint in any of the vaccine trials, one can make an educated guess about the expected efficacy.  HPV causes 70% of oropharyngeal cancers, 90 to 95% of which are due to HPV-16.  The HPV vaccines protect against HPV-16 with 90 to 98% efficacy in an unexposed population.  Using the most conservative numbers, the HPV vaccines should prevent 57% of orophayngeal cancers if given early. 

So do your family a favor.  Vaccinate your kid, and save a tongue.

*It's not an urban legend.  Oral sex is safer than other kinds of sex in terms of HIV infection.  One episode of receptive oral sex with an HIV+ partner carries a 0.06% risk of infection, compared to 0.1-0.2% for receptive vaginal and 0.3-3% for receptive anal.  And oral sex is widely believed to have a lower rate of pregnancy.