Wednesday 24 January 2018

'Men are also at risk' - a doctor on why boys should also get the HPV vaccine

The HPV vaccine has been a contentious issue in recent years. But Dr Madeleine Ni Dhalaigh tells our reporter she believes that not just girls but also boys should be vaccinated against this group of viruses

Dr Madeleine Ni Dhalaigh. Photo: David Conachy
Dr Madeleine Ni Dhalaigh. Photo: David Conachy

Joy Orpen

Madeleine Ni Dhalaigh, who practises medicine in Co Roscommon, has five children, ranging in age from three to 15 years. That she has more than the national average of 1.4 offspring is hardly surprising, given that she comes from a family of seven, while her husband Michael comes from a brood of eight. "We always wanted a large family," she says.

Another thread running through the two families is medicine. Apart from the fact that Michael is also a doctor, Madeleine's parents were too. "My mother came from India in the 1950s to study medicine at the Royal College of Surgeons in Ireland (RCSI)," she explains.

"She then met my dad [Joe Daly] who was at UCD. Both of them became socially aware, progressive doctors. My grandfather and older brother also got degrees in medicine."

Nowadays, Madeleine, Michael, his mother, sister-in-law and uncle all share the same medical practice in Castlerea. But the families comprise other professions too. "That dilutes it a bit," says Madeleine with a chuckle.

As far as trends are concerned, she says psychological problems and addictions, are challenging areas facing family practices. "More and more young people are presenting with mental-health issues, and it's becoming increasingly difficult to find supports for them," she says.

"Alcohol had long been a problem. But now, even small towns in Ireland have poly-drug abuse. There is also an increase in people asking for z-drugs [sleeping pills] and tranquilisers on a regular basis."

On a more positive note, she says it is gratifying when she detects the early onset of a particular illness. "Being able to diagnose rheumatoid arthritis or diabetes at an early stage can lessen the impact considerably," she says.

And what about prevention altogether? One area that Madeleine is particularly passionate about concerns the human papillomavirus (HPV), which is the name given to a group of viruses. It's responsible for almost all cervical cancers, as well as a number of other conditions in men as well as women. She believes it could be virtually eradicated, given proper and widespread vaccination.

According to a spokeswoman for the HPV Vaccination Alliance (HPVVA), HPV is so common, nearly all sexually active men and women will get at least one type of it at some point in their lives.

Even though HPV is the most common sexually transmitted infection, most people are unaware they have HPV, and may unknowingly pass it on to partners. If an infection persists, it can cause serious health problems including cancers of the cervix, vagina, and vulva; cancers of the penis, the anus and the throat, including the tongue and tonsils (oropharynx), in both sexes.

The spokeswoman says about 420 people will be diagnosed with cancers caused by HPV in Ireland this year. The vast majority of them, some 300, will involve cervical cancer. About 90 patients, will die from this insidious disease, while many others will need intensive treatment, such as surgery, radiotherapy and/or chemotherapy.

Unfortunately, treatment for cervical cancer invariably results in infertility, which can cause additional anguish. A further 6,500 women will need treatment to remove pre-cancerous growths in the cervix caused by HPV.

However, Madeleine believes much of the heartache and pain associated with HPV could be prevented if young people were vaccinated against the virus.

She is also particularly sensitive to the threats all cancers pose, given her own, very real, personal experiences. In April of this year, Michael's brother and his wife lost Conor Henry, their beloved three-year-old son, to leukaemia. At the time, Madeleine was still in mourning following the recent deaths of her father and father-in-law from other forms of cancer. "And in 2010, my brother Luke, who was only 42 years old, passed away from pancreatic cancer," she says. "So my passion for cancer prevention has definitely been spurred on by these losses."

She adds that she is particularly concerned about cervical cancer, as it is the second most common cause of death due to cancer in women aged 25 to 39 years.

"When a young woman presents with what appears to be symptoms of the disease, my heart sinks," Madeleine says. "I immediately think of all the consequences she may be facing. She may need life-changing surgery which could include a hysterectomy, the clearance of lymph nodes and the removal of her ovaries. She may also need radiotherapy or chemotherapy, which may go on for months. It's a devastating illness, because it affects fertility and her ability to make choices."

She is also acutely aware of other conditions caused by HPV. "For example, while type 16 and type 18 cause 70pc of all cervical cancers, type six and type 11 cause genital warts, which are very common and spread easily.

"What most people don't realise is that our young men are also at risk from HPV. So, HIQA (the Health Information and Quality Authority) is looking into vaccinations for them as well. The statistics coming from countries like Australia are excellent. Having given nine million doses, they have seen a 90pc reduction in genital warts in men and women and a 77pc reduction in conditions associated with type 16 and type 18."

However, in spite of all this, the level of HPV vaccinations in Ireland has dropped severely since it was introduced, in 2010, for girls in their first year of secondary school.

"In just two years, it has fallen from 87pc to 50pc," says the HPVVA spokeswoman. "This is largely due to misinformation on social media. This [decrease in HPV vaccinations] will result in a minimum of 40 deaths; 100 women needing life-changing treatment, while 1,000 more will need invasive therapy.

"In coming together, the HPVVA is unequivocal that the vaccine is safe and saves lives. The World Health Organisation [WHO] and the European Medicines Agency [EMA] have concluded that the HPV injection is safe and has no link to any serious illnesses."

Donal Buggy of the Irish Cancer Society says, "It's only natural that parents are fearful when they hear claims about a vaccine. It's terrible that young girls get sick, but to link their illness to a life-saving vaccine when all the research shows no link, is dangerous and threatens lives."

Among the other 30 signatories to the HPVVA's 'contract' are the Children's Rights Alliance and the National Women's Council. And Madeleine is fully behind them.

"My older daughters are already vaccinated without incident. And I'll be vaccinating my son and my other two daughters when their time comes. HPV vaccination really is an opportunity to do something positive to keep our children safer as adults," she says.

For more information, see HPV.ie, which contains information accredited by the WHO

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