Tuesday 23 October 2018

Vaccinations for all would get rid of this killer forever

The latest research on HPV shows there is still much ignorance around the cancer-causing virus, writes Emily Hourican

CANCER: Treatment is painful and unpleasant — chemotherapy, radiation and usually surgery. Stock picture
CANCER: Treatment is painful and unpleasant — chemotherapy, radiation and usually surgery. Stock picture

Emily Hourican

No one thinks they will get cancer. Just as none of us think we will be hit by buses or struck by lightning. A certain amount of magical thinking is necessary to get through life. Without it, we would scarcely dare to leave our houses.

The kind of bravado that says 'It won't be me', even when statistics suggest it well might, is a good thing. But, once that magical thinking disrupts the sane precautions we should all take to stay well and safe, then it's gone too far.

Sometimes, advice around precautions is complicated and we can be forgiven our confusion. At other times, the advice is simple and straightforward, but we don't listen.

The health advice around Human Papilloma Virus (HPV), cancer and vaccinations is just such an example.

The most recent research, commissioned by MSD Ireland and carried out by Behaviour and Attitudes on a sample population of 1,000 adults in Ireland, and given as a print exclusive to the Sunday Independent, shows that the levels of ignorance around HPV infection - what it is, who has it, what it can do, how to protect against it - are quite surprisingly high.

Almost two-thirds of Irish adults, 65pc, don't know that HPV can cause cancers in men and women. The majority, 87pc, think they have never been exposed to HPV. A third, 38pc, do not believe HPV can be transmitted from person to person. Over half, 59pc, don't know there are vaccines to prevent against HPV infections, in the same way we now protect against smallpox, polio and other once-fatal diseases.

Today is the first International HPV Awareness Day. So let's get aware. The point about HPV is that the virus is highly contagious and highly prolific. Almost all Irish adults will contract it at some point in their lives. The only certain way to avoid it is complete sexual abstinence. HPV infection has no clinical symptoms, so you won't know you have it.

For most men and women, the virus does no harm and will clear up by itself. However, where it doesn't, it can cause cancer.

The current estimate is that almost 5pc of cancers worldwide are caused by the virus. When it comes to cervical cancer, HPV causes 99pc of cases. In Ireland, 335 women are diagnosed with HPV cancers each year, of which 290 are cancer of the cervix. Around 90 of those women die each year; cervical cancer is the second most common cause of death from cancer in women aged 25-39.

For those lucky enough to live, treatment is painful and unpleasant - chemotherapy, radiation and usually surgery, all carried out on the most delicate parts of the female body, those parts involved in having children, a happy sex life and a secure identity as a woman.

Those who do not live, because of the age profile, are very often the lynchpins of entire family and community networks - they have children, ageing parents, a web of family and friends who love and rely on them.

The second most significant cases of HPV cancer, and these largely affect men, are oropharyngeal, head and neck cancers. These increased by 225pc from 1998 to 2004 and are estimated to outnumber cervical cancers by 2020. In Ireland, 85 men a year are diagnosed with HPV cancer of the head and neck.

HPV head and neck cancer is the one I had, specifically cancer of the tongue base. I was diagnosed in 2015 and treated with daily doses of radiation and weekly intravenous drug drips for seven weeks. It was by far the most painful and unpleasant experience of my life, and the toll it took on those around me - my children, my husband, my mother and siblings - was far more than I ever wanted to put them through. Before that diagnosis, I had paid zero attention to any HPV cancer information because I was certain it wouldn't be me. Frankly, given my overall commitment to healthy living, I would have put good money on getting through life without ever hearing the words 'You have cancer'.

Getting cancer, for me, was a completely random, unexpected happening. That HPV virus probably lay dormant in my system for 20-odd years. Then one day, it got busy, and the result was a tumour. That's the way it happens.

We are lucky enough to have a vaccine to prevent infection in the first place. The HPV vaccine has been offered free to all girls in their first year of secondary school in this country since 2010, as it is in 84 other countries. Protecting from HPV infection means protecting from cancer. In all vaccinating countries, a steady decrease in both pre-cancers and cancers is now being seen.

In Ireland, the vaccine was at first enthusiastically received, with uptake of around 80pc. That dwindled significantly to below 50pc but is now up at around 62pc again because of excellent efforts made by healthcare professionals to circulate clear and accurate information.

The Government is moving towards vaccinating boys as well as girls. Twelve countries, including Australia, the UK and Canada, have universal vaccination, which means direct protection for boys and men, rather than forcing them to rely on the herd immunity provided by vaccinating girls which clearly only works as long as our boys and men remain within the herd.

That, it seems to me, is clearly wrong and inefficient.

A government health technology assessment (HTA) into introducing the vaccine to boys is under way, with results expected by the autumn.

For anyone who worries about the safety of the vaccine, James Paul O'Neill, Professor of Otolaryngology, Head and Neck Surgery at the Royal College of Surgeons, has a message: "The jury is not out on the safety of this vaccine. The jury is very much in. This vaccine is one of the most heavily-scrutinised vaccines of all time, and one of the safest.

"Believe in high-quality medical and scientific evidence - not social media anecdotes. It is essential we protect girls and boys and begin a vaccination programme immediately. We can beat cancer. Protect your children. Vaccinate them."

One thing about the HPV virus is that it only lives in humans. It cannot go off and incubate itself elsewhere.

This means that if we vaccinate fully against it, it would disappear from Ireland, just like smallpox and polio.

And if that happens, 420 people a year in Ireland, plus their families and friends, will be spared the misery of treatment for HPV-related cancer, and possibly death from it.

Sunday Independent

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