Gill Stannard

Sunday, January 28, 2007

Do boys need immunising against cervical cancer?

The recent recommendation to vaccinate boys, as well as girls, with the ‘cervical cancer jab’ may not be as strange or opportunistic as it first appears.

With the new Human Papilloma Virus (HPV) Vaccine on the market the media is orchestrating a collective sigh of relief amongst women – the end to cervical cancer is here! But the vaccine, for all it’s merits, is a bit like shutting the stable door once the horse has bolted and distracts us to the real cause of the disease.

Lets go back to basics. HPV is considered the primary cause of cervical cancer but there is more to this than meets the eye. How do women actually contract this virus? Just as mosquitoes are the vectors in the transmission of malaria, in HPV it is men or more specifically their semen. Insecticides might ultimately wipe out malaria but the same solution of vector control cannot be as easily applied to cervical cancer.

Understanding that cervical cancer is most often the outcome of an STD may be difficult for some women to swallow. For monogamous women with only one partner for life it is even harder. However if that single partner had ever had sex (presumably unprotected but research has not looked into this issue) with any other woman before or after the commencement of their relationship, she is unwittingly at risk. The reality is the amount of sexual partners a woman, or her partner, has had significantly increases the risk of HPV and cervical cancer.

Considering HPV, however asymptomatic, is more common than cervical cancer – it is helpful to understand the cofactors that may trigger the virus causing deadly cellular changes.

In men the evidence of penile HPV is strongly associated with an earlier age of becoming sexually active and increases with the amount of sexual partners. The circumcision argument also raises its head, with uncircumcised men being 3 times more likely to harbour HPV.

The incidence of HPV in women is also increased with the younger age at first sexual intercourse and the number of partners. Cofactors that may trigger cancer include being exposed to other STDs such as Chlamydia, having more than 5 children, taking oral contraceptives and smoking. Passive smoking has also been investigated as a trigger. A deficiency in Vitamin E, lycopene (in fruits such as tomatoes) and possibly Vitamins C and B12 are also showing up as likely cofactors.

Without touching on the health controversies concerning the risks and efficacy of vaccinations – the aetiology of cervical cancer should make us consider broader issues around the prevention of this disease. This could be viewed as a female reproductive cancer caused primarily by the male of the species. Acknowledging this means we need to make men understand their responsibility in the transmission and development of cervical cancer.

We need to teach boys, as well as girls, about the importance of using condoms. The “pill” however much it has been viewed as a panacea for the prevention of unwanted pregnancies is an entirely inappropriate method in the light of the spread of HPV and ultimately cervical, penile, tonsillar and anal cancer (though the first is most common, HPV is logically connected with other sexually transmitted cancers). While researchers largely focus on oral contraceptives being solely a hormonal trigger for cervical cancer, there are other factors that may also be a cause such as the disincentive to use barrier methods and nutritional deficiencies that are more predominant in women taking ‘the pill’.

Prohibition is rarely a workable solution to disease prevention. The controversy around the HPV immunisation and ‘promiscuity’ is short sighted. It is safer to assume that all humans, regardless of age, are essentially sexual beings. Making boys/girls/men/women aware of the causes of cervical cancer, rather than just focusing on a jab which has not been in development long enough to gather adequate post market surveillance (how effective is it, how long does it work for, are there any side effects or genetic ramifications?) plays a role in the long term eradication of this common cancer.

Lastly, it’s not time to stop pap smears just yet but perhaps penile HPV screening and treatment could be an equally effective preventative measure.

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