KISS OF DEATH
Sexually transmitted or even passed from mouth to mouth, the HPV virus is the cause of our fastest-growing killer cancer. The NHS immunises girls against it but NOT boys. Why? Because it’s cheaper to treat infected males than to protect them. Which is why
THE NHS is refusing to give teenage boys an inexpensive vaccine that grants long-term protection against Britain’s fastest-growing form of cancer – on the grounds that it is cheaper to treat deadly tumours later in life.
The jab grants immunity to the human papillomavirus (HPV), and has been provided free to all girls aged 12 to 13 since 2008 because HPV causes cervical cancer.
But it is now known it also causes ‘oropharyngeal’ cancer of the tongue, mouth and throat, whose incidence is rocketing, as well as tumours of the genitals and anus.
Vaccinating boys would cost an additional £22 million a year – against a total NHS UK budget of £148billion. But according to Treasury rules, vaccinating boys is not thought ‘cost-effective’, even though HPV cancer patients face months of expensive, agonising treatment.
HPV is spread through genital and oral sex, but can also be transmitted by saliva exchanged by kissing. Studies show some people who contract it are virgins, while 80 per cent of all UK adults have been infected. Only a minority will develop cancer, often decades after they got the virus.
Professor Margaret Stanley, of Cambridge University’s pathology department, the incoming president of the International Papillomavirus Society, said: ‘You cannot protect against these cancers by only vaccinating half the population. Not to immunise boys is classic Treasury shorttermism. You may not spend so much now, but it will cost far more years later.’
She said that in other countries such as Canada, Australia, Italy and the US, boys were already being vaccinated. She added: ‘We are in the midst of an HPV pandemic.’
Prof Christopher Nutting, a mouth and throat cancer specialist at the Royal Marsden Hospital in London, said: ‘My patients are being struck down by a preventable cancer that will affect them for the rest of their lives. It’s unfair that women are protected but men are not. The vaccine will work. It is starting to make cervical cancer incredibly rare. Why wouldn’t we do the same for cancer of the throat?’
HPV oropharyngeal cancers already afflict four times as many men as women. The Mail on Sunday has learned that a decision on whether to recommend vaccination for boys by the NHS Joint Committee on Vaccination and Immunisation (JCVI) – the first step towards a boys’ immunisation programme – has been delayed indefinitely.
Having pondered the matter since 2013, last summer the JCVI issued an interim statement saying that immunising boys ‘does not meet the economic cost-effectiveness criteria for the introduction of a new vaccine’. The statement sets out a brutal logic: that the ‘net monetary benefit per vaccinated person’ was too low to justify vaccinating boys against a disease that might not strike until after many years. This triggered calls for a change of heart from Professor Harald zur Hausen, who won the Nobel Prize for discovering that HPV causes cancer. Top health organisations including the Royal Society for Public Health, the Royal College of Obstetricians and Gynaecologists and the British Dental Association are supporting a campaign, Jabs For The Boys, led by a group called HPV Action. Campaign co-ordinator Peter Baker said: ‘The decision is too important to be left to accountants.’
The JCVI is now investigating whether feeding new data into its computer models will permit a change of mind. A final decision had been expected next month, but the JCVI chairman, Andrew Pollard, Oxford University’s professor of paediatric infection, last night admitted it may not happen this year. It will take another two years after such a decision for boys’ vaccination to start.
Prof Pollard said: ‘There are clear benefits from vaccinating boys as well as girls. We’re all very aware this is an awful disease, not only for patients and their families, but for society.’ But the committee could only recommend this if it ‘represents a good use of NHS resources’ as defined by Treasury rules. The Mail on Sunday can reveal: In 2011, the last year for which figures are available, HPV caused 1,400 mouth, tongue and throat cancers in men and 450 in women,
Not to immunise boys is classic short-termism. It will cost far more later PROFESSOR MARGARET STANLEY
while head and neck tumours are men’s fourth most common type of cancer;
Projections show the incidence of these cancers is set to rise by a staggering 229 per cent by 2025 – more than any other type;
Seven hundred men develop HPV cancers of the anus and penis each year;
Wealthier families are already having their teenage boys vaccinated privately, paying £300 for a two-dose course – an enormous mark-up from the £17 each shot costs the NHS.
The prognosis for HPV oropharyngeal cancers is good with intensive treatment. Prof Nutting said more than 80 per cent will survive five years or longer from diagnosis. However, the physical and emotional tolls are immense.
Prof Stanley said: ‘The treatment is so frightening that many survivors can’t talk about it. You may be unable to work again, and you will certainly be off work a long time. And many of these patients are people who should have a terrific amount of life, who have children, who are at their peak.’
Unfortunately, most oropharyngeal tumours are diagnosed at a late stage. This means many patients need surgery, chemotherapy and radiotherapy – and suffer appalling side effects.
Like several patients who spoke to the MoS, Chris Curtis, 59, said the first symptom he noticed was a lump on the side of his neck. A successful businessman from Blackpool, he was told he had a tumour at the base of his tongue, and two secondaries on each side of his throat.
After chemo and radiotherapy and two operations to remove cancerous cells, he had to be fed through a tube into his stomach for three years: ‘Special mush to keep my calorie intake up, as well as all my morphine, all my meds.’
He added: ‘I couldn’t pay my mortgage, couldn’t pay bills. I was a bag of bones: I went from 22st to 10st. I didn’t go out. My family would eat in the dining room and I would be stuck being fed through my tube by machine. I planned suicide twice. All that stopped me was the thought of my kids.’
Seven years after diagnosis, Mr Curtis has no saliva glands and barely any sense of taste. ‘You’ve seen the cream-cracker challenge?’ he says. ‘I live with that every minute of every day. I look at a burger and chips and I see cardboard. If I eat a tomato, it feels like it’s exploding in my mouth – it’s intolerable.’
After his partial recovery, he founded and runs The Swallows, a charity that supports oropharyngeal cancer survivors. ‘Since this is the UK’s fastest-growing cancer, we’re getting busier and busier. And yet there is something out there that can stop this happening. We’ve got to use it.’
Female HPV oropharyngeal cancer patients may be rarer but their ordeals are no less gruelling. Nicola Holt, 56, a mother-of-two and the former director of an engineering recruitment firm, said she started feeling ill and coughing frequently in 2012, but it was not until 2014 that she was referred to the Royal Marsden and diagnosed. By then her cancer was advanced.
‘Telling my children was the hardest thing,’ she said.
After two courses of chemotherapy, she had to undergo radiotherapy five days a week for six weeks. She wore a close-fitting mask and was strapped to a table to render her immobile and so ensure that the radiation was directed accurately.
‘I was very sick from the chemo, bringing up blood and green bile and projectile-vomiting,’ she said. ‘The whole of my mouth was ulcerated and it burned every time I was sick. What scared me most was the thought of being sick inside that mask and choking.
‘For months the cancer takes over your life, and there is no respite. It tests you to breaking point.’
Prof Stanley pointed out that vaccinating boys would also increase protection for girls and women – because many girls are not vaccinated now, although it is available.
Indeed, the patchy coverage of vaccine for girls is one of the major criticisms made by experts of the JCVI’s current policy.
Underpinning the claim that vaccinating boys would not be costeffective is the notion that treating girls creates a ‘herd immunity’, so that heterosexual males are unlikely to catch the virus. But in practice, there are huge variations.
Dr Peter Greenhouse, a consultant in sexual health, said that in Swindon, for example, more than 90 per cent of girls get the vaccine. However, in West Sussex, the figure is 50 per cent – hugely increasing the chances of infection from a kiss or sexual encounter.
In large parts of London, the girls’ rate is only 70 per cent.
Professor Giampiero Favato, a health economist at Kingston University, led the study that persuaded the Italian government that vaccinating boys would be cost-effective.
He said: ‘Twenty years from now, we will laugh at this model. Its conclusions are wrong because treatment has changed and become much more expensive.’
He said it also failed to take account of the altered sexual behaviour of the ‘Tinder generation’, and the fact that many British males have relationships with women from countries where girls are not vaccinated. He added: ‘A boy will only be protected if he is with a vaccinated girl. A girl will be protected regardless of her choice. This is profoundly unequal. As for the indirect costs – the loss of earnings, tax paid, the sheer human suffering – this is a big black hole.’
Prof Pollard, of the JCVI, said the committee could only recommend vaccinating boys if it found this conformed with the ‘health technology assessment methodology’, which is derived from the Treasury’s ‘Green book’. That meant the wider social costs had to be disregarded: ‘Under the rules we are only looking at costeffectiveness from the health providers’ [ie NHS’s] perspective.’
Each possible vaccine had to be considered in the context of the NHS as a whole, he said. ‘We’ve seen the recent pressure on emergency departments and cancer therapies. Each new drug or vaccine has to be looked at under the same rules.’
The reason for the delay in reaching a decision was that ‘there is additional work to do: there are some areas where there is new information that has to be assessed’ – including the rising cost of treatment and the increase in HPV cancers.
Equality was also important, he said. ‘There is an equity issue, and when making a recommendation on giving HPV vaccination to boys we will ask the DoH to consider it.’
Treatment is so scary, many can’t talk about it