5 Common But Embarrassing Symptoms You Should Definitely Talk to Your Doctor About

HPV-related Cancers Increasing Among Women

Cervical cancer is increasing among women in the the United States. A new study shows less women are getting screened as rates go up in rural areas. OBGYN Physician Dr. Kimberly Callegari from Kaiser Permanente Los Angeles discusses what you can do to protect yourself.

HPV Knows No Gender: Why A Women-only Approach Falls Short

Conversations about the human papillomavirus or HPV, have become increasingly common in the past few years. However, the discussion is often times limited to cervical cancer, with recommendations focused on vaccinating girls and women against HPV as prevention. HPV however, can also cause cancer in men and there is a lack of dialogue and knowledge regarding the benefit of vaccinating boys and men. HPV-related infections can lead to penile, anal, or oropharyngeal cancer in men. Hence, it is equally important to vaccinate men against HPV.

HPV and men

There are over 200 different strains or types of HPV. Of them, 40 strains can infect the genital area including the skin of the vulva, vagina, cervix, penis, scrotum and anus. It is one of the most common sexually transmitted infections (STIs) and is spread through skin-to-skin contact. Those who are sexually active yet unvaccinated may contract HPV even without knowing it. In most cases, the immune system can get rid of the infection within a year.

Approximately 15 strains are consider high risk due to their association and propensity to cause cancer. In women, these strains infect a type of cell in the cervix, called squamous cells, which can lead to changes resulting in cervical cancer. In men, HPV infections are responsible for almost 50 per cent of all cases of penile cancer, 10 per cent of cancers of the larynx, between 33 per cent and 72 per cent of cases of oropharyngeal cancer, and 85 per cent of cases of anal cancer. The incidence of HPV-related cancers have been increasing among men over the past few decades and vaccination may help to curb the rise in cases. Sexual behaviour, such as having more lifetime partners and engaging in men who have sex with men (MSM) practices, is linked to an increased risk of HPV.

Importance of HPV vaccine for males

While there has been a significant push towards vaccinating women against HPV, the same urgency is absent when it comes to men. As per global figures, about 4 per cent of men receive the vaccine. There are several reasons why men must receive it. The immune response in men to HPV is generally poor and does not provide adequate protection, resulting in high prevalence, frequent reinfections and high rates of transmission. Men are disproportionately affected by HPV related oropharyngeal cancers by a 2 to 1 ratio. Moreover, it can affect sperm health and quality leading to difficulty with fertility.

Several barriers to enhancing vaccine uptake exist. The most common is the lack of awareness or reluctance to be vaccinated due to embarrassment, fear of side effects and perceived low susceptibility to the virus. Furthermore, there is a significant amount of misinformation, especially the notion that HPV affects only females. Also, cultural or community-based norms impact uptake.

Hence, it is necessary to formulate strategies that prioritize vaccinating men and women against the HPV virus. Vaccination can prevent 90% of the HPV-related cancers. Ideally, the process must begin in children between 11 and 12 years of age prior to HPV exposure. Furthermore, early vaccination can potentially provide herd immunity which may reduce the rate of infection at a larger scale. Stakeholders must enhance efforts to create awareness about the virus and prevention strategies to improve vaccine acceptance.

According to the WHO, HPV vaccination is one of the most effective ways to reduce the global cancer burden. While several countries have made vaccinating girls and women mandatory, it is necessary to adopt the same approach towards boys and men. Dispelling myths, providing education, and encouraging individuals can enhance vaccine uptake among men and boys. Vaccination against HPV is not just an individual decision but a collective responsibility of the community.

The author is MD, Head and Neck Medical Oncologist, Memorial Sloan Kettering Cancer Center, New York, US. Views expressed in the above piece are personal and solely those of the author. They do not necessarily reflect Firstpost's views.

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The HPV Vaccine Could Eliminate 6 Types Of Cancer. Why Don't More People Get It?

In 2017, Leighann Lenti began experiencing bleeding between periods, cramping and vaginal discharge. At the time, she was in her late 30s and thought these changes were simply part of perimenopause.

A year later, her Pap smear returned with abnormal results. At first, doctors thought she had cervical dysplasia, or pre-cancerous cell changes. Often, these cells can be removed and stopped from turning into cancer through a procedure called a cervical cone biopsy. But after the biopsy, Lenti received the pathology results and learned some surprising news.

"The doctor called and was like, 'Leighann, I'm so sorry, but it's cervical cancer,'" the now 45-year-old from Austin, Texas, tells TODAY.Com. "I did not expect this."

Lenti, then 38, met with a gynecologic oncologist to learn her treatment options. She had Stage 1 cancer, and doctors performed another cervical cone biopsy in the hope of removing it all. But the tests revealed the cancer had spread farther than they realized.

"They did not get clean margins, so I ended up having a full hysterectomy, including removal of my fallopian tubes, my uterus, my cervix and the upper top part of my vagina because there were some pre-cancerous cells there, as well," Lenti explains.

She later learned HPV-18, a strain of human papillomavirus, caused her cervical cancer. She never received the HPV vaccine, Gardasil-9, and believes if she had, she would have never developed this cancer. When the vaccine was released, Lenti was too old. In her early 30s, she asked her doctor if she could have it and was rejected.

Leighann Lenti loves to travel and visited Finland recently. Courtesy Leighann Lenti

"I asked about the vaccine," Lenti says. "My doctor explicitly said, 'It is only indicated for up to a (certain) age' … I was seven or eight years older than that, so my doctor would not give it to me." Lenti has been cervical cancer-free since treatment and is now an outspoken advocate for the HPV vaccine among her friends. She also participates in the Breasties, a community for young people impacted by breast and gynecological cancers.

Since her diagnosis, Lenti has been vaccinated against HPV, as recent guidelines allow some people up to age 45 to qualify for it.

"One of the things I learned after my diagnosis was the HPV is not just an infection of the cervix or genitalia," she says. "It's being connected to head and neck cancers. It's being connected to anal cancers."

HPV — a common virus often transmitted through sex — can actually cause six different types of cancer: cervical, vaginal, vulvar, penile, anal and throat cancer. This means both men and women are at risk for HPV-related cancers.

The good news? The HPV vaccine, first released in 2006, is 97% effective at preventing these cancers and has minimal side effects, the research shows.

"For years, the public has wanted a vaccine against cancer," Electra Paskett, Ph.D., professor of epidemiology at The Ohio State University, tells TODAY.Com. "We now have a vaccine that could protect for up to six different types of cancer."

HPV and the cancers it causes

HPV, or the human papillomavirus, "is a really common virus," Dr. Linda Eckert, an OB-GYN and author of the book "Enough: Because We Can Stop Cervical Cancer," tells TODAY.Com. About 42 million people currently have a high-risk HPV infection, which can lead to led to conditions such as genital warts or cancer, according to the U.S. Centers for Disease Control and Prevention.

It's transmitted through skin-to-skin contact, according to Mayo Clinic. Most of the time, the body will fight off the virus before it causes symptoms, but if it does progress, the most common symptom is warts, usually on the genitals, hands or feet.

The American Cancer Society notes that there are more than 200 types of HPV. As as result, "about 80% of adults will have it at some point in their lives, but most of the time, it goes away on its own within two years," Eckert says.

Only 12 types of HPV are considered high risk and can lead to cancer.

"When you become infected with one of these 12 types and ... The body doesn't get rid of it on its own, that's what can lead to pre-cancer and cancer," Eckert explains.

But many people are unaware that HPV can cause cancers besides cervical cancer — including in men.

A recent survey commissioned by the The Ohio State University Comprehensive Cancer Center found "about half the people thought that HPV only caused cervical cancer," Paskett says.

"The responses show that people generally think it's only a problem that women need to worry about (and) that men can't get HPV or don't get HPV to the same degree that women do," Paskett, the Marion N. Rowley chair in cancer research at The Ohio State University, explains.

In fact, in recent years, more men have been dying of HPV-related cancers than women "because men get throat cancer at twice the rate that women do," Eckert says. "Throat cancer does not have a Pap smear equivalent to screen for it, so it's more commonly found at an advanced stage."

The taboo of HPV

Because HPV can be sexually transmitted, some people worry that vaccinating against it may encourage young people to practice unsafe sex. But experts say people need to shift their thinking.

"This is nothing about promiscuity," Paskett says. "This is a very prevalent virus, and we need to stop thinking of the HPV vaccines as something for sexually transmitted illness and start thinking about it as a cancer-preventing vaccine."

Also, HPV can be spread through any skin-to-skin contact.

"It can be transferred by fingers, just not as efficiently," Eckert says. "People don't realize how common it is."

When Shirley Pattan had her first Pap smear, it was abnormal. Several years later, she was diagnosed with cervical cancer in situ and underwent a cone biopsy to treat it.Courtesy Shirley Pattan

Shirely Pattan found out at 17 years old that she had HPV after her first Pap smear came back abnormal. She was stunned because she'd only had one sexual partner.

"I didn't really understand how I could have gotten HPV," the now 48-year-old from Florida tells TODAY.Com.

For the next few years, she underwent increased screening for pre-cancerous cells. Then in 2002, at 25 years old, she experienced irregular bleeding. Doctors had her undergo a variety of tests before she was eventually diagnosed with cervical cancer. She remembers feeling "emotional" and wondering, "Where did this come from?"

Pattan was also too old to get the HPV vaccine when it came out.

A cervical cone biopsy removed all her cancer with clean margins. She didn't need any follow up therapies, such as chemotherapy or radiation, because doctors caught her cancer early, at Stage 0.

Pattan felt embarrassed about having cervical cancer, something Lenti also experienced.

"I, for sure, went into a pretty dark shame spiral where I spent an unhealthy amount of time thinking about my past decisions in terms of sexual relationships and feeling a tremendous amount of guilt," Lenti says. "I can say with a surety ... That there is nothing that I did that caused me to get cancer. It is not my fault."

Both women wish they'd known more about their bodies prior to their diagnosis. When Pattan had her children vaccinated against HPV, she still didn't realize how many cancers it prevented.

"It was never really communicated to me," she says. "People are seeing it more of a sexually transmitted infected situation instead of a cancer prevention tool." 

Prior to her diagnosis with cervical cancer, Shirley Pattan wondered how she could even have HPV because she'd only had one partner. Courtesy Shirley Pattan The HPV vaccine and dropping cancer rates

The HPV vaccine, called Gardasil-9 — which has no live virus and is completely non-infectious — protects against the six types of HPV most likely to cause cancer, Eckert says. (These are strains 6, 11, 16, 18 31, 33, 45, 52 and 58.)

When the vaccine was first introduced, it was a three-dose series, but new data show two doses provide lasting protection when administered between ages 9 and 14. This age group "(makes) a better immune response," Eckert says, stressing that it should be given before being exposed to HPV to be most effective.

That said, it's recommended to receive the vaccine through age 26 and even up to 45 in some circumstances, usually in three doses at later ages. Both males and females should get the vaccine in the U.S., Eckert says.

As the HPV vaccine has become more widespread, cervical cancer rates have dropped, and several countries anticipate that they will eliminate cervical cancer altogether, thanks to high rates of HPV vaccination combined with Pap smears and HPV screening.

"Australia is going to be the first continent to eliminate cervical cancer," Eckert says. "Sweden is also on their way toward elimination. Ireland wants to eliminate it by 2040."

This would be the first time a cancer has been eliminated entirely, Eckert says. "It's just so remarkable that it's possible to eliminate a cancer."

Data from the United States also show positive cervical cancer trends: The American Cancer Society's 2023 cancer statistics found a 65% decrease in cervical cancer from 2012 to 2019.

A Feb. 27 Morbidity and Mortality Weekly Report (MMWR) from the CDC also showed a significant drop in the number of people with pre-cancerous cervical cancer changes.

"Among people aged 20 to 24 years who were screened for cervical cancer from 2008 to 2002, rates for all pre-cancerous lesions have decreased about 80%," Paskett says. "We decreased these by 80% because of the vaccine."

While research shows the impact the HPV vaccine is having on cervical cancer, Eckert stresses that the benefits could extend to more deadly cancers, too.

"Cervical cancer, globally, is by and large the biggest HPV cancer there is," she says. "But if you look in the United States, actually we have more people dying of throat cancer than we do cervical cancer, and HPV 16 causes almost 70% of throat cancers."

As of 2022, about 58.6% of 13 to 15-year-olds in the U.S. Had received the vaccine, according to the National Cancer Institute. The goal is 80% by 2030. But more recent data show HPV vaccination rates in the U.S. Have started to dip since the pandemic, and more outreach affected communities is needed, per the CDC.

Is the HPV vaccine safe?

Many critics of the vaccine question its safety, but there's no data-backed reason to do so, the experts stress.

"The safety data is actually quite compelling," Eckert says. "There's been 270 million doses given, and it's been very carefully looked at by many global agencies."

Since being diagnosed with cervical cancer, Leighann Lenti has been outspoken with loved ones about the benefits of the HPV vaccine.Courtesy Leighann Lenti

She says researchers in the United States, Europe, Australia and Japan have examined the safety of the vaccine "trying to see if there was any relationship between long-term side effects or harm in the vaccine, and it just hasn't been found."

Paskett agrees: "It is safe, and it is effective. ... It's safe because we see no more side effects (or) adverse effects than in the other childhood vaccines."

There is ongoing litigation against Merck, the maker of Gardasil, due to accusations that the company concealed the risks of the vaccine. The plaintiffs claim that Merck should've added warnings to the vaccine label because they allege the vaccine caused excessive increases in heart rate and premature ovarian failure. However, a federal judge recently ruled in favor of Merck, asserting that there wasn't enough evidence under federal law to add the warning, Reuters reported.

"Federal law requires more than speculative inferences prior to adding dire warnings to lifesaving vaccines that discourage their use," the judge wrote in the decision, according to Reuters. "That evidence is lacking here."

Most commonly, people complain of a sore arm or exhaustion after they receive the HPV vaccine.

"The risk-benefit ratio is pretty clear on this vaccine," Eckert says. "It's a safe vaccine, and the harms of catching HPV-associated diseases, especially if they turn into cancer, is really significant."

To learn more about the HPV vaccine, the American College of Obstetrics and Gynecology, the American Academy of Pediatrics and Cervivor all have additional information.

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