Why our boys need the HPV vaccine too
After being diagnosed with mouth cancer, Rachel Parsons tells Victoria Lambert why our sons need vaccinating against HPV too
Around the country, parents of girls aged about 12 have received letters from the Department of Health (DOH): it is time for their daughters to be vaccinated against the human papillomavirus (HPV), which can cause cervical cancer. Uptake will be high; according to the DOH, more than 85 per cent of parents choose to accept the HPV vaccine for their daughters, and most women aged 15 to 24 years in England have now been given the vaccine since its introduction in 2008.
Moreover, it seems to be affecting rates of infection: the DOH has already seen a significant decrease with the two main HPV types that can cause cancer. But what about our boys, some parents are asking – don’t they need to be vaccinated against HPV too? After all, 80 per cent of sexually active people will be infected by HPV during their lifetime, and the virus has not just been connected to cervical cancer and other genital cancers, but also head, neck and throat cancers. Research is being undertaken which could link it to cancers of the upper GI tract as well.
Is it enough to hope they will be protected by the herd immunity of British girls? And what of young gay men, who will be left completely unprotected? The question of extending the vaccination scheme to adolescent boys has been under review, but in July the Joint Committee for Vaccination and Immunisation (JCVI) announced its interim guidance, that “adding boys is highly unlikely to be cost effective in the UK”. Its final decision will be published later this year, but for parents, campaigners and doctors, it is disappointing.
Forty-six-year-old Rachel Parsons, who lives in Coventry with her husband Tim, 51, a fire officer, and their five children, is one of those parents. When her daughter Esnes, now 16, was invited to enter the vaccination programme three years ago, Rachel was relieved. In recovery from mouth cancer, she knew only too well the danger of HPV.
“I was diagnosed with cancer nine years ago,” she explains. “I’d suffered a painful ulcer in my right cheek for several months, and been fobbed off by my dentist. But as it became larger and more painful, I went back to the GP, and was referred to University Hospital Coventry in July 2008. I had a biopsy, and when the results came back I was told I had a tumour which needed removing urgently.”
When she asked a specialist nurse if she would survive, the nurse was unable to say yes. “That was my lowest point, when the tears came. My youngest son was barely a year old.” A nine-hour operation followed, which included an incision from right to left ear around the front of the neck to check Rachel’s lymph nodes for any sign of spread. A vein was removed from her left forearm and grafted into her mouth to replace the missing tissue, and skin had to be taken from her stomach to patch up the incision in her wrist. “It was awful,” she says. “Recovery was difficult. I was checked every month for recurrence, and the area of new skin inside my mouth kept getting infected.”
Rachel was grateful to learn that all the cancer had been removed and that chemotherapy and radiotherapy were not needed. As each year went by, the chances of recurrence diminished, but she admits the experience was so traumatic, she still has annual checks.
At the time, no one knew what had caused the cancer, but she has now been told that the HPV could have been to blame. It is likely Rachel was infected in her youth as, at 21, she needed treatment for pre-cancerous cells on her cervix. With this experience, Rachel was at a loss to understand why her sons couldn’t also be protected by the NHS. “Why should they be put at risk of going through what I have had to?”
Her worries are not news to Peter Baker, campaign director of campaign group HPV Action. “It’s a classic case of sex discrimination,” he says. “The argument is that boys are protected if enough girls are vaccinated. But while our vaccination programme is one of the best in the world, boys can still pick up the virus from the 15 per cent of girls not covered. Moreover, they may meet girls from other countries where there is no vaccination programme at all, or where take-up is not as good.”
In France, he says, only 25 per cent of girls are vaccinated, and rates in Ireland and Denmark have dropped substantially in recent years due to unfounded scare stories about safety.
Baker adds: “The other problem with focusing on girls is that it does nothing to protect men who have sex with men. There is a pilot programme for this group, but it is flawed. Gay men are only offered the HPV vaccination if they turn up at a genito-urinary medicine (GUM) clinic for something unrelated, and if they explicitly state they have sex with other men (which they may not want to do). Given that the average age of first attendance at a GUM clinic is 31, the vaccine is probably going to be too late as most would have been affected by then.
“We believe that there may also be grounds for a legal challenge because the decision to leave boys and men at risk breaches equality law.”
A survey carried out by HPV Action earlier this year found that 97 per cent of dentists and 94 per cent of GPS would have their own sons vaccinated against HPV. Dr Andrew Green, a member of the BMA’S General Practitioners Committee (GPC), has said: “It is ridiculous that people are still dying from these cancers when their life could have been saved by a simple injection.”
In Westminster, politicians from all sides have advocated the change. The Royal College of GPS pronounced it was “disappointed” at the interim judgment and called on the DOH to extend HPV immunisation to boys “as a matter of urgency”. And 11 countries, including Australia, Austria, Italy and Norway, are already vaccinating boys or will be doing so in the near future. The vaccine is available privately, including at Boots, but at £300-400 is not cheap.
A spokesman for Superdrug, which offers the vaccine to both sexes between the ages of nine and 27, says: “We are aware there’s a misconception that this vaccine is for girls only. Overwhelmingly, it is female patients requesting the vaccination.”
So could the JCVI rethink its stance? Dr Gillian Knight, head of biosciences at the University of Derby, who is researching the link between mouth cancer and HPV, thinks that as more evidence grows it will strengthen the case for the programme to be rolled out.
“Currently, more men than women are presenting with Hpv-related head and neck cancers. Emerging research within the HPV field appears to show that the tonsils seem to be especially susceptible to the virus. But we need more research on where else in the body may be affected by this virus.”
She adds: “When that information comes through, there will be a stronger case for the government to re-evaluate the vaccination programme as it will be clearer if it is useful in preventing Hpv-related cancers in the whole population.”
But the DOH is standing by its position. Mary Ramsay, head of immunisation at PHE, says: “Evidence from around the world suggests that the risk of HPV infection in males is dramatically reduced by achieving high uptake of the HPV vaccine among girls. While there are some additional benefits to vaccinating both males and females, the current models indicate that extending the programme to boys in the UK, where the uptake in adolescent girls is consistently high, would not represent a good use of NHS resources.”
Peter Baker disputes this costeffectiveness argument. “Vaccinating boys would cost £22million a year at most. That is dwarfed by the cost of treating Hpv-related cancers and warts. The cost of treating anogenital warts is an estimated £58.44million a year; the secondary care costs of treating Hpv-related oropharyngeal cancer are likely to exceed £21 million a year. Another £7million is spent on treating men with anal cancer.”
For Rachel Parsons, her sons’ safety is beyond price: all four have now been vaccinated against the virus. “I wouldn’t want anyone to go through what I had to. My children may get cancer somewhere else – but if I can protect them as much as I can, I will.”