In a June story published in the British daily newspaper The Guardian, actor Michael Douglas made some surprising comments about the cause of his throat cancer. Specifically, he said his type of throat cancer was caused by contracting the human papillomavirus (HPV) through oral sex. The story immediately went viral, and online reports ranged from immature to immature-yet-somewhat-informative. Eventually, some of the media focus shifted to the important public health issue his comments raised: the link between HPV and cancer.
HPV is the most common sexually transmitted infection in the country. In 2008, an estimated 14.1 million new HPV infections occurred — half in 15-24 year olds. About 75 percent of the reproductive-age population has been or will be infected with one or more types of HPV at one point or another. The majority of these infections will go away without causing health problems, but some cause serious harm and even death. HPV infection is linked to about 28,000 incidences of cancer each year in the U.S., including cancers of the mouth, throat, anus and vulva. HPV is responsible for virtually all cervical cancers in the U.S., which killed about 4,210 women in 2010. Worldwide, the problem of HPV related cancers is even worse. In 2008, globally, there were over half a million new cases and 274,000 deaths due to cervical cancer. More than 85 percent of cervical cancer deaths occur in developing nations.
The tragedy of these numbers is amplified by the availability of vaccines that can prevent the majority of cervical cancers in females. With proper vaccination, around three-quarters of cancer caused by HPV are preventable, according to the CDC, translating to a staggering 198,100 saved lives each year. Currently, two HPV vaccines are licensed by the FDA and recommended by both the CDC and the WHO: Gardasil for the prevention of cervical, anal, vulvar and vaginal cancer; and Cervarix for the prevention of cervical cancer and precancerous cervical lesions caused by HPV infection. Both are intended to be administered in three doses to females prior to the onset of sexual activity, typically from 10-14 years of age, though recent studies have shown that even one or two doses provide some protection. Gardasil is also licensed and recommended for use in males.
Unfortunately, rates of vaccination for HPV are not nearly as high as they should be. In the U.S., only 35 percent of the recommended population of females, and only 1 percent of males, are fully vaccinated — in spite of the Vaccines for Children Program providing some HPV vaccines at no cost to children. While other developed nations’ vaccination rates eclipse that of the U.S., the overall global rate of HPV vaccination is so low the WHO doesn’t include it among immunization rates it tracks. To combat this, record low prices for HPV vaccines in the poorest countries were recently announced.
Low vaccination rates can’t be blamed on adverse effects either. The vaccines have not been linked to any serious side effects and researchers have found no link between vaccination and increased sexual activity.
According to Dr. Harold Varmus, Director of the National Cancer Institute, research emphasizes HPV infection as a preventable cause of a number of cancers, and vaccination rates need to improve. “[T]he investments we have made in HPV research . . . will have the expected payoffs only if vaccination rates for girls and boys improve markedly,” said Dr. Varmus.
Since 2006, 41 states and the District of Columbia have introduced legislation to require the HPV vaccine, and to fund or educate the public about the vaccine. Only two jurisdictions have been successful in requiring the vaccine for school admittance, however. Virginia passed a school vaccine requirement for entrance into the sixth grade and the District of Columbia passed a similar requirement for girls over the age of 13, both in 2007. Also in 2007, Texas’ governor issued an executive order mandating the HPV vaccine for girls entering the sixth grade, but state legislators overrode the order. In California, legislation requiring certain health care plans to cover HPV vaccination was passed by the Senate and Assembly, but vetoed by the Governor, in 2008 and 2009. State lawmakers continue to debate and propose HPV-related legislation.
According to the American Cancer society, oral cancers could overtake cervical cancers as the leading cause of HPV-related tumors in the next decade. There is no conclusive evidence yet on whether the HPV vaccines are effective on oral cancers, at least in part because clinical studies would require 30 or 40 years to track any impact on oral cancer rates. But animal studies suggest that the HPV vaccine could be effective with oral cancer as well.
What is proven is that the HPV vaccine is extremely effective against cervical cancer, and is not used optimally. Cervical cancer is the second most common cancer among females worldwide, and it is in large part preventable. Hopefully, Michael Douglas’ viral snafu has given the public health community an opportunity to deliver meaningful information about HPV-related cancer and its devastating, but preventable, impact on women worldwide.
Prepared by Brett Baulsir, Fellow at the Legal Resource Center for Maryland Public Health Law and Policy. Brett is a 2013 graduate of the University of Maryland Carey School of Law and practiced for the Network’s Eastern Region through the Public Health Law Clinic.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this post do not represent those of the Robert Wood Johnson Foundation.