Each year in Ontario, about 250 people die of HPV-related cancers, and another 1000 will be diagnosed. HPV stands for Human Papilloma Virus, and most of us know it as the cause of warts.
There are more than a hundred versions, or strains, of the virus and some are more deadly than others, causing cancers of the genital tract, the mouth and throat, and the anus. The good news is that, starting in September, Ontario will be turning up the heat on HPV by introducing more ways to prevent it in the first place.
Setting aside the common wart that is acquired skin to skin, HPV is primarily spread through sexual activity, and close to 70% of us will become infected in our lifetime. The majority of us will clear the virus but in some individuals, the virus will persist and then damage the cells in such a way that they become cancerous. Before we had a vaccine to prevent HPV cancer, we had to rely on early detection like pap tests in women to find the cancer while there was still hope for cure. Once a vaccine became available, we began protecting women by immunizing girls in Grade 8, before they become infected. The vaccine, Gardasil™, protects against four strains of HPV, two of which cause cancer and two which commonly cause warts. Soon we should see a huge cohort of women who will no longer suffer from HPV-related cancers of the cervix. Unfortunately, there aren’t any other early warning tests for the various kinds of cancers that this virus can cause. But, starting this September, Ontario will offer the vaccine to both boys and girls in Grade 7. This is something that many of us, including our Board of Health, have been advocating for a number of years and we are busy planning for school-based immunization clinics that will start this fall.
In addition to offering this cancer prevention to children in school, public health will also be offering the HPV vaccine to any male under the age of 27 years who has sex with men, or who identifies as gay, bisexual or transgendered. For men who have sex with men, the rate of HPV-related cancers, such as anal cancer, is about 35 times higher than in heterosexual men. It is even higher in men who are HIV positive. For this reason, free vaccine will be available to all health care providers wishing to immunize their high risk patients as well as at our Routine Immunization or Sexual Health clinics at Peterborough Public Health.
Since 2007, Ontario has had publicly-funded HPV vaccine available to Grade 8 girls. Last year, there were new recommendations to reduce the doses for girls aged 9 to 14 years from three to two, based on research that showed younger recipients could mount an immune response with fewer doses. Here in Peterborough, 60% of Grade 8 girls received their HPV vaccine last year. Clearly we need to do better.
More than 170 million doses of Gardasil have now been administered globally and no serious side effects have been associated with the vaccine. A new vaccine that protects against nine strains of HPV has been approved in Canada and it will boost levels of protection even higher. With the new vaccine, about 90% of all cervical cancers may be preventable, up from 70% with the current quadrivalent (four-strain) vaccine. The only down side is that new vaccine may have a little more “ouch” to it, with slightly more redness, pain and swelling at the site, as it has more immune-stimulating components to it. It is not available yet as part of our publicly funded vaccines, but this may change as economic evaluations have proven it to be more cost-effective than the vaccine we are currently using.
It is thrilling to be living in an era where we can prevent cancer with immunizations. Starting next month, many more people in Peterborough can take advantage of free HPV vaccine to protect them from life threatening cancers. This is a good news story.
By Dr. Rosana Salvaterra, Medical Officer of Health, Peterborough Public Health
