HPV and head/neck/throat cancer

The 'debate' over the HPV vaccine has thus far has been a tug-of-war with radical religion/conservative politicians/nutbar anti-vaxers on one side, and the lives of women on the other side.

The HPV vaccine has been A Female Issue.

Turns out the people opposing the HPV vaccine were damning male children, as well.

Though I wrote about how HPV can cause head/neck/throat cancers in both genders before, there is more and more evidence coming to light that everyone, male and female, will benefit from the HPV vaccine series:

Local Inflammation and Human Papillomavirus Status of Head and Neck Cancers

This group in Buffalo, New York looked at 124 squamous cell carcinomas of the mouth, oropharynx, and larynx, collected between 1997 and 2007 (the first HPV vaccine on the market in the US, Gardasil, wasnt available until mid-2006).

Of the 124 samples, 50 tumors were positive for HPV-16.  Thats at least 40.3% of oral squamous cell carcinomas whos root cause was HPV.

I say 'at least' because the methods utilized in this study were very specific-- Though 19 variants of HPV are associated with cancers, they only looked for the variant HPV-16 (which is included in both Gardasil and Cervarix).  Other HPV variants could have been causing some of the HPV-16-negative lesions.

The vast majority of the HPV+ tumors were located in the oropharynx (65.3%), with a handful in the oral cavity (29%) and larynx (20.5%).

But this paper was not just about the connection between HPV and head/neck/throat cancers.  They also noted that like pelvic inflammation in women is correlated with increased risk of HPV cancer, inflammation in the mouth lead to an increased risk of getting an HPV induced tumor.  Periodontitis (advanced gingivitis) lead to a 2.6x increase in risk.

Parents-- Make sure you nag your kids to brush their teeth every night.  And get them the HPV vaccine series.  Your actions now will save them pain and suffering later.

More like this

The HPV vaccine has been A Female Issue.

No, It's always been a Merck and CDC issue. There was no "epidemic" of cervical cancer before the vaccine. This vaccine was always about profit profit profit.

India has more cervical cancer than the U.S but....

"A study published today in the Journal of the Royal Society of Medicine by Allyson Pollock, a public-health researcher at Queen Mary, University of London, and her colleagues, says that there is not enough evidence that cervical cancer affects enough women in India to warrant a vaccine."

By augustine (not verified) on 16 Jul 2012 #permalink

Did you notice where Abbie wrote epidemic? I didn't either, so why did you put in quotes?

Now, given that it's not an epidemic, what the reasons for/against?

Here's some data to chew on for perspective.

Question 1: What is the lifetime risk of a woman acquiring cervical cancer?

"Based on rates from 2007-2009 [in the US], 0.68% of women born today will be diagnosed with cancer of the cervix uteri at some time during their lifetime. This number can also be expressed as 1 in 147 women will be diagnosed with cancer of the cervix uteri during their lifetime."
Source: (http://seer.cancer.gov/statfacts/html/cervix.html#risk)

So while 0.68% seems low, 1 in 147 actually seems quite high to me. I bet you know more than 147 women. You could look at in another way and say, "In a group of 100 women, there is a 50% that one of those women will get cervical cancer in her lifetime." Those odds seem appreciable to me. Low-ish, but appreciable. This does not factor into the equation the data Abbie posts about here; namely, head and neck cancers.

Question 2: What is the efficacy of the HPV vaccine?

Abbie can correct me if I'm wrong, and she's posted fairly extensively on this issue, but I will say that the numbers I've seen are something to the effect of 99+%? This doesn't really even factor in herd immunity, so that's certainly relevant. If you prevent HPV from infecting new people for long enough, it will fade out of the population.

Question 3: What would be the expected footprint?

Let's assume that only 70% of cervical cancers are due to the strains in the HPV vaccine (I've seen people throw this number around before, but as it's not germane to my own work I've never really followed up). I'll use that number to be conservative. Based on the SEER link above, nearly 1/3 of women diagnosed with cervical cancer will die from it. These number translate to roughly 1/500 (from 1/147) women diagnosed in their lifetime with cervical cancer, and thus 1/1500 likely to encounter a fatal case (assuming uniformity in how these statistics scale pre/post full-scale induction of vaccination.) EPI people might disagree with the numbers, but I think I haven't committed any grievous sin of calculation here.

So all of these numbers actually look pretty compelling, to me. And none of this incorporates positive health benefits to head and neck cancers.

And then, there's the link you posted.

In India, say Pollock’s team, cancer surveillance, registration and monitoring are so poor that it would be impossible to tell whether the vaccine reduced cervical-cancer rates. In addition, they say, incidence rates for cervical cancer are low compared to the rest of the world, and have fallen from around 43 cases per 100,000 in 1982–83 to around 22 per 100,000 in 2004–05.

While it's higher than in the US, it's not so high that the socioeconomic issues associated with surveillance even make effective screen studies possible. But why do it at all? Is India particularly vulnerable to NGOs? Maybe so, but then there's this nugget (from the same link you provided, btw).

The idea that NGOs are alone in pushing HPV or that poor cancer monitoring is a justification for not rolling out a vaccine seems hard to swallow though. For one thing, cervical cancer is the number one cancer affecting women in India, and kills 73,000 women each year; this number is set to rise to 115,000 in 2025.

Cancer rates may be poorly counted in India, but all developing countries suffer from a lack of robust data on disease burden, so it’s difficult to see how this justifies holding back a proven vaccine that the government will not be paying for (the vaccine is sold over the counter).

For the World Health Organization, which strongly backs the rollout of the vaccines in India, the evidence suggests that cancer rates are set to rise. Inaction is not really an option.

Seems to me like this isn’t a CDC issue (this is India, not the US), and it’s not really even a Merck issue. This is a human health and welfare issue.

ugh, evidently the CITE tag doesn't work for scienceblogs. Damn. I wish I could edit that for quote marks in the second half. I spent so long on that reply =(

Did you notice where Abbie wrote epidemic? I didn’t either, so why did you put in quotes?

That's generally the MO scare tactic of a vaccine. It's how you sell them. You say the word epidemic. Geesh, don't you read CDC/corporatocracy press releases? This is how the propaganda works.

By augustine (not verified) on 16 Jul 2012 #permalink

@ Jason, could you tell us how long the HPV vaccine works? If my daughter gets the vaccine at twelve but the 3 series vaccine wears off at 24 and then she contracts the virus is the vaccien all for naught. Don't you think it would be a waste of resources and unnecessary exposure to risk?

By augustine (not verified) on 16 Jul 2012 #permalink

@ Augustine
1. Get a booster shot at 20.
2. What risks are you worried about specifically?
3. There may be a varying risk for cervical cancer depending on age of contracting the virus.

By Kelly M Bray (not verified) on 16 Jul 2012 #permalink

The HPV vaccine is already under consideration for use on boys in Sweden.

By Birger Johansson (not verified) on 16 Jul 2012 #permalink

You wrote, "Of the 124 samples, 50 tumors were positive for HPV-16. Thats at least 40.3% of oral squamous cell carcinomas whos root cause was HPV."

How does this compare with the incidence of HPV-16 in the general population? This comparison is critical: If the general rate of HPV-16 is 40%, then there's no correlation with this cancer; If it were higher, then there would actually be a negative correlation.

By Caveat M. Tor (not verified) on 17 Jul 2012 #permalink

Why do you think the vaccine will wear off at 24?

What do you guys think about articles like the one below? I'm really annoyed by people who claim to be above ad hominem attacks using ad hominem as their go to argument about people who have concerns about vaccines, for whatever the reason. It's never about legitimate arguments, it's always about people being 'anti science' or 'anti vax' nutjobs. The same goes for concerns about GM crops, concerns re: the bird flu research, etc- 1. never refer to the argument, 2. always dismiss the person as being 'anti science'. The thing is, that argument makes the enormous assumptions that 'science' is always a positive endeavor and that just because someone is a 'scientist' that they should be above reproach -


John - many of the people who post on blogs (like this one) crying out against vaccines get short shrift because their opinions/blog posts often display uncritical reasoning - appealing to arguments that their child isn't sexually active, so doesn't need a vaccine against a sexually-transmitted pathogen; they appeal to anecdote, ignoring/finding reasons to discredit large-scale, well-conducted studies which show a vaccine is safe (or otherwise); and there seems to be a universal assumption that scientists are evil :/

I like to think I am *not* an evil scientist, and I don't know any scientists who have an agenda to find (or not find) particular results - I sit through a lot of talks and lab meetings where people say "And we found completely the opposite of what theory/previous research suggests, and now we want to find out more..." But if you put your research out there, and it touches an emotive subject, you can expect to be called every name under the sun. Some anonymous forum user called my fellow authors and I "evil pseudo-scientists in the pay of big pharma" because our results weren't what they wanted to see.

So it's hard, as a scientist who loves evidence, big data sets and conclusions drawn from the largest evidence base possible, so avoid ad hominem attacks in some cases. The individual who is anti-vaccination may have their comments most swiftly addressed by someone explaining to them that they don't know what they're talking about and that pulling their head out of their arse and losing their paranoia, while reading some science papers, might improve their understanding of the situation. But I think people on ERV generally try to explain the science rather than resorting to that tactic!

Yes, I see what you're saying, but with the shenanigans engaged in on a continuous basis by the pharmaceutical industry, combined with an almost complete lack of accountability and oversight by those in positions of power, who's to blame people for not believing results? From ghost writing articles to making up entire journals as marketing tools, how is the average person supposed to know the difference between legit research and results which have simply been bought and paid for? It's a lot easier to call people nut jobs rather than taking the time to really look at the entire situation and when shenanigans are allowed (or when those involved are not held accountable) in one aspect or category of research it taints all of the other fields as well.

Why do you think the vaccine will wear off at 24?

Because that's what vaccines do. They wane.Hence the call for boosters in vaccines. And when do you publically issue a call for booster? When the amount of cases in the vaccinated become undeniable.
What makes you think it won't?

By augustine (not verified) on 17 Jul 2012 #permalink

I've seen several pretty good arguments in support of vaccines.

I have yet, to see one single rational argument against--apart from "it's kinda expensive".

So's an iPad.

Yet nobody's advocating banning [i]them[/i]...

... meh.

By Bob Powers (not verified) on 18 Jul 2012 #permalink

Either you don't look or you're not a rational person yourself. That would pretty much explain it.

By augustine (not verified) on 18 Jul 2012 #permalink

I help study head and neck cancers and have been trying to talk it up. I do deplore the expense of the vax though. And the makers are trying to make money, no shock there.

About epidemics: Head and neck cancer rates are rising, despite decrease in smoking. HPV+ head and neck cancers explain the rise. Ya got your pretty rare anal and rectal cancers to boot. None of these are happy events.
Guys, get it together, be part of the solution. It helps you, and it helps the women, and other men.

On to the official advice:
Either get the vax or do not come in contact with anyone else's genitals. Get how harsh that is? Maybe you can worry about kissing other people on the mouth as well as the nether regions - the transmission needs more study.

Hey Augie - Has Orac scared you off?

Thought you would try trolling this blog for a while??

People dont bother even trying to enter into rational debate with augy - he is a well known and much ridiculed troll over at respectful insolence.

Well meaning and honest debate just turns into a trollfest with him.

That's funny, Shanee. I've NEVER recalled you ever saying anything on Disrepectul Indolence.
Would you care to add anything meaningful to the discussion here. It doesn't sound like it. It appears you only wish to carry on the ad hominem tone that the unscientific DI likes to carry. It's good for blog hits but it lacks any scientific credibility.

By augustine (not verified) on 28 Jul 2012 #permalink


I help study head and neck cancers and have been trying to talk it up. I do deplore the expense of the vax though.

My twenty-one year old son is getting the HPV series now. The health insurance from his job does not cover it, so we promised to pay for them.

It is a tiny amount compared to the costs his grandfather has had to pay over the years to deal with mouth cancers. Fortunately they were caught early, so it just involves removing bits every few years... for the last forty years. He became a very militant anti-smoker in the late 1960s.

Im there augie - not often. You might recall my discussion of how a chiropractor tore off all the intercostal arteries of one of my patients during an 'adjustment'

No augie it wasnt an ad hominem it was ridicule - which I suspect is why you ran away from Orac. It doesnt take long to peruse your posts on DI to get your measure - just advising honest people here not to waste their time with you.

Since this thread still seems to be currently active...
The HPV issue has recently reached newspaper headlines in my home country, with a doctor from the US informing an inquest (via video-link) that his super-secret nested-PCR process could detect fragments of recombinant HPV DNA within blood samples from a young woman who had died 6 months after a Gardasil injection. Therefore, Gardasil diddit.

This is of course Orac's beat rather than ERV's, and rest assured that he is on the case:

From the virology perspective, though, does anyone have any knowledge of the Dr Sin Hang Lee of CT -- the inventor of the proprietory trade-sekrit “short-target DNA sequencing PCR”, that can detect traces of a purported HPV-fragment contaminant, 6 months after it was diluted within the 3 or 4 litres of bloodstream? He also claims to sell the BEST EVER test for Chronic Lyme disease, and oh, a host of other products.

Any virology insights into the few details he has divulged about his tests (covered by Orac here) would also be useful.

By herr doktor bimler (not verified) on 11 Aug 2012 #permalink