By Leah Smith, epidemiologist, Canadian Cancer Society
Mouth and throat cancers caused by human papillomavirus (HPV) are rising in Canada, especially among men, according to the new Canadian Cancer Statistics 2016 report. In 2016, nearly 4,400 Canadians will be diagnosed with a cancer caused by HPV and as many as 1,200 Canadians will die from an HPV cancer. The incidence of HPV mouth and throat cancers increased a dramatic 56 per cent in males and 17 per cent in females between 1992 and 2012. HPV mouth and throat cancers now represent more than one third of all HPV cancers in Canada.
HPV vaccination protects against the most common types of HPV that cause cancer. In the moment it takes to vaccinate your child, you are helping to protect them from cancer in the future. The Canadian Cancer Society is urging Canadians to get their children vaccinated against HPV -- a safe and effective way to prevent the cancer-causing infection.
Despite many studies showing that the vaccine is safe and effective, a number of myths persist about HPV. Here are the top 10.
Myth 1: HPV is only a threat to females.
Truth: HPV is a very common infection. It affects 75 per cent of Canadians at some point in their lives. Both men and women get HPV infections and the cancers caused by HPV. In Canada more than one in three HPV cancers occurs in males.
Myth 2: HPV infections aren't all that serious so vaccination isn't important.
Truth: Most people with an HPV infection never develop symptoms or health problems, and most HPV infections go away by themselves within two years. But that doesn't mean HPV is not serious. HPV can persist and lead to cancer.
HPV causes at least six different types of cancer. Treatment for these cancers can be painful and disfiguring. In 2016, it is estimated that almost 4,400 Canadians will be diagnosed with an HPV cancer and as many as 1,200 will die from an HPV cancer. We think that's serious.
Myth 3: My child doesn't need the vaccine yet because they aren't having sex.
Truth: HPV vaccination is about prevention, so it's important to get your child vaccinated before they're at risk of infection. The vaccines are most effective at a young age for two reasons: (1) children are less likely to have already been exposed to HPV and (2) HPV vaccination produces a better immune response in children than in adults. School-based HPV vaccination programs help make sure your child gets vaccinated at the right time (and for free!).
Myth 4: The vaccine hasn't been well tested and causes severe side effects.
Truth: HPV vaccination has been studied for over 20 years in more than 1 million people around the world. The evidence consistently shows that vaccination is safe and effective, and that any potential risks are far outweighed by the benefits.
The most common side effects are soreness, swelling and redness at the injection site, as well as light-headedness, dizziness, nausea, headache or fever. Because fainting after vaccination is more common in younger people, it is particularly important to observe each vaccinated person for 15 minutes after vaccine administration to avoid injury in the event of fainting and falling.
Myth 5: Giving the vaccine to children encourages them to have sex.
Truth: Studies consistently have consistently shown that HPV vaccination does not affect sexual practices and risk-taking behaviour. This includes a study of over 260,000 girls in Ontario.
Myth 6: The HPV vaccine can cause an HPV infection or cancer.
Truth: The HPV vaccine cannot cause HPV infection or cancer. It is not a live vaccine. It is made from an inactive protein from the virus and therefore cannot cause an HPV infection. On the other hand, not receiving the HPV vaccine at the recommended ages does leave people vulnerable to HPV and the cancers caused by HPV.
Myth 7: If I get the HPV vaccine, I don't need to go for cervical cancer screening (Pap tests).
Truth: Even if you get vaccinated against HPV, it is still possible to become infected with one of the types of HPV that current vaccines do not protect against. Therefore all women should continue to get screened for cervical cancer according to their local guidelines.
Myth 8: Only children can get the HPV vaccine.
Truth: HPV vaccines are approved for girls and women aged 9 to 45 and in boys and men aged nine to 26, but vaccination may be appropriate beyond those ages as well.
Publicly funded (free) HPV vaccination programs are only available through school-based programs or, in certain provinces, for high-risk individuals. Others may pay for it if they want it. Many private health insurance programs offer coverage for HPV vaccination.
Every individual has different circumstances. If you're not eligible for publicly funded HPV vaccination, talk to you doctor to see if it's right for you.
Myth 9: The HPV vaccine is not as effective as other vaccines.
Truth: HPV vaccines provide almost 100 per cent protection from the HPV types it targets if doses are received at the correct intervals and if it's given before you have an infection with these types.
Research is ongoing to determine how long the protection lasts and whether a booster shot will be needed in the future. Protection is expected to be long lasting.
Myth 10: Only people with multiple sex partners and who have unprotected sex are at risk of getting HPV.
Truth: Using condoms consistently and properly can decrease the chance of getting HPV or passing it on to your partner, but condoms do not eliminate the risk of HPV infection. Similarly, limiting the number of sexual partners helps reduce the risk of HPV but does not eliminate it completely.
Remember, most Canadians will have an HPV infection at some point during their life. HPV vaccination is an important tool that can help prevent these infections from ever occurring, but it should be seen as part of a broader prevention strategy that includes safer sex and, for women, cervical cancer screening.
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Pap tests are the commonly accepted screening to prevent cervical cancer. A doctor scrapes a cell culture from a woman's cervix and then examines the cells for signs of abnormality. But just because a few of those cells appear abnormal, requiring further screening, doesn't necessarily mean that you've got a cancer-causing strain of HPV -- that's only one potential cause. "The difference could be due to local irritation, a non-HPV infection, a low-risk HPV type, or even a mistake in the preparation of the cell sample," writes the American Sexual Health Association.
HPV is passed via skin contact, rather than bodily fluid. For that reason, condoms can lower the risk of the disease, but they are not a sufficiently preventive measure, as they are for viruses like HIV and bacteria like gonorrhea.
While the HPV-cancer connection most often relates to cervical health, a 2011 Journal of Clinical Oncology study found what doctors have long observed: There has been a surge in HPV-associated oral cancers. In fact, between 1988 and 2004, HPV-associated oropharyngeal cancers rose 225 percent. Oral sex is the primary culprit, making cancer screening of the mouth and esophagus another important test while visiting the doctor.
The HPV vaccine protects against four strains of the virus that are most often associated with cancer and genital warts, but that doesn't mean it prevents cancer entirely. One concern within the medical community is that the vaccination will provide a false sense of security and prevent innoculated men and women from receiving regular cancer screening. "Clearer information is needed concerning the incomplete protection offered by the vaccine, and that cervical screening will still be required," wrote a group of British public health researchers in the Journal of Medical Screening.
About 90 percent of HPV infections are resolved by the body's immune system.
Some strains of HPV ("low risk" types 6, 11, 42, 43 and 44) cause benign growths known as genital warts and other strains (types 16, 18, 31 and 45) cause cancer of the cervix, vulva, vagina, penis, anus, or an area called the oropharynx, which includes the back of the throat, the base of the tongue and the tonsils. But that doesn't mean that one leads to the other -- genital warts, which affect about one percent of the sexually active U.S. adult population -- do not lead to cancer.
The first HPV-preventive vaccine on the market, Gardasil, was approved by the FDA for use in girls in 2006 and in boys three years later. What's more, there are two FDA-approved vaccines for girls and women: Gardasil and Cervarix; while only Gardasil is available to boys and men. Still, HPV vaccination is the responsibility of all. Both the Centers for Disease Control and Prevention and the American Academy of Pediatrics both recommend the vaccine for boys for two primary reasons. First, inoculated boys will not be vectors for the disease, which can contribute to herd immunity and prevent dangerous infection in women. But more, the incidence of HPV-associated cancers that affect men is also growing, including anal and penile cancer and cancers of the mouth and throat.
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