Search for tag: "hpv"

Interviewer: HPV virus vaccine, questions that are answered, that's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Deanna Kepka from Huntsman Cancer Institute. This interview, we want to get to some of the common misconceptions that people might have about the HPV vaccination. Maybe some common reasons why they don't have their children get it in time when they should. But first of all, let's start with why should somebody get the HPV vaccination. Why is it important?

Deanna: Why should you have your children get the HPV vaccine? It is because we have a cancer prevention vaccine. But it's not that it prevents seven different types of cancers, it also prevents a lot of pre-cancers and hundreds of thousands of cases of genital warts each year in the United States.

Interviewer: But a lot of children aren't getting it. First of all, what are the CDC recommendations for when a child should get the vaccines by?

Deanna: Children should get the vaccine at ages 11 and 12. They should be received when they're receiving their other immunizations at the same time, which is the Tdap vaccine and the meningococcal vaccine. If they get the vaccine at ages 13 and older, it's considered a late immunization, but they can still receive the HP vaccine all the way up until their young adulthood years.

Interviewer: Okay. But it's recommended to get it at those earlier ages.

Deanna: Eleven and 12 or younger.

Interviewer: And don't just assume that it's going to be something that your physician's going to offer, because a lot of them just make it optional or don't even mention it.

Deanna: Exactly. That's one of our biggest barriers is that it's not presented strongly by primary care providers.

Interviewer: And since it's a cancer preventing vaccine, it should be.

Deanna: As a parent, you need to ask for it.

Interviewer: All right. So let's talk about some of the common misconceptions. And I think one of the main ones is that they're afraid that they give their boys or girls that are 11 or 12 a vaccine that prevents not only cancer but a sexually transmitted disease that now, all of the sudden, their kids are going to become more sexually active.

Deanna: Yeah and that is just not true. It's just a myth. And it's been disproven by a lot of research that's been shown that even if you vaccinate kids at a younger age with the HP vaccine and then you take others and you don't vaccinate them and you randomize the groups, the kids that received the vaccines aren't any more likely to engage in sexual activity at an earlier age than the ones who did receive the vaccine.

Interviewer: All right. And for a lot of parents, it seems to be some sort of an ego thing almost, like my child's not going to do that. That seems to be a big barrier. They have a hard time getting past that.

Deanna: Well, I mean, we give our kids . . . we have no problems giving our kids the Hepatitis B vaccine as babies, do we? And that's a sexually transmitted infection. I'm thinking that when you're talking about a sexually transmitted infection, your child is age 11 and 12, parents start to get really, I don't know, cold feet, a little queasy because puberty is right around the corner or right there. And I think that sense of anxiety around that time in their child's life just makes them turn off and shut down instead of thinking about this vaccine as a cancer prevention vaccine.

Interviewer: You did a much better job of putting it than I did. Thank you. So another one of the misconceptions is a lot of people think it's a new vaccine, so there's not a lot of history out there of side effects. That's not true either.

Deanna: It's been around for more than 10 years. We have hundreds of thousands, hundreds and hundreds of thousands of doses have been given in the United States. And the CDC does an excellent job collecting adverse responses to vaccinations in our country, reports of adverse responses, and this vaccine doesn't have any higher rates of adverse reactions than any other immunizations that we give our children in our country.

Interviewer: And then there's another misconception that it's just a girl's vaccination.

Deanna: And again, that's not true. There are a number of cancers that only affect boys or men. There's HV related penile cancer. HPV-related oropharyngeal cancer affects both girls and boys or men and women, because it does affect people when they're in their older years, 50s and 60s, but it has a higher incidence in men. Meaning that more man than women have HP oropharyngeal cancer than women. So when you give your son the HP vaccine, you're not only protecting transmission to women, but you're also protecting your son from HP-related cancers, including anal cancer, penile cancer, oropharyngeal cancer, and genital warts.

Interviewer: And there's also a really good reason to get it at a young age. Tell me about how that actually helps develop stronger protection.

Deanna: Right. Studies have shown that your immune system is stronger at those younger ages, 11 and 12. You're more likely to develop a stronger immune response, and we have data to prove it. And that's why we have the recent CDC recommendations out now where if you get the vaccine under age 15, good news parents, you only need to get two doses now because two doses is strong enough. If you get it at ages 15 and older, you need three doses.

Interviewer: All right. And here in Utah, there is some additional challenges for the HP vaccine. Explain what those are.

Deanna: I know, it's so sad to me because we have . . . I work at Huntsman Cancer Institute, we have this cancer prevention vaccine, and this has been my passion for the last 10 years, and when the data came out, way about a year ago, we were state number 49 for girls.

Interviewer: Not in a good way.

Deanna: Not in a good way. We had one state doing a little bit worse than us, and that's Wyoming, our neighbor. So I'm working with them too. And this means that we have less than half of our girls getting this HPV vaccine in the state of Utah. So we've a lot of room for improvement here.

Interviewer: Any final thoughts or anything that I forgot to mention when it comes to misconceptions of people have about the HP vaccination and why they should get it?

Deanna: I think we all need to think about friends and family members that we know who have struggled with cancer, who've fought against cancer, people that have lived with cancer, battled cancer, died from cancer. If you ask any of them if they could've prevented their cancer with the vaccine at ages 11 and 12, they would've said yes and gotten that vaccine. So please do that for your child.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: May 1, 2018
originally published: June 13, 2017

Interviewer: Your doctor told you that you have a type of head and neck cancer that was caused by the HPV virus. Now what? We're going to talk about that next on The Scope.

Announcer: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: You've been told by your doctor that you have a type of cancer that was caused by the HPV virus and it's in your head and your neck. We're going to talk about an HPV head and neck cancer right now with Dr. Marcus Monroe. He's a head and neck cancer expert in the University of Utah Health Care. Let's just start with the basic. First of all, head neck cancer caused by HPV, tell me about it? What's happened?

Dr. Monroe: So HPV is Human Papilloma Virus and it actually causes a very specific subset of head to neck cancers. Cancers in the region of the head and neck that we call the oropharynx, which includes the tonsils and the base of the tongue so the part of the tongue that's behind what you can actually see in your mouth.

The important things for a patient that has been newly diagnosed are, one, to seek out a medical team that has experience in treating head and neck cancers. Probably more than any other cancer, the treatment of head and neck cancer's really a team sport. Typically treatments can include surgery, radiation, chemotherapy and so having physicians with expertise in radiation oncology, medical oncology as well as surgical oncology are very important. It's important to seek out a team that works well together.

In addition because the head and neck, you can think of the tonsils and the back part of your throat if you've ever had a sore throat just the pain and the difficulty of getting through that infection. Treatments in the area can be particularly rough and so it's really important not only to have the physicians but to have the entire support team. And so that includes dentists, swallowing and language therapists, nutritionists, physical therapists, and really a complete support group.

Interviewer: How bad can it get? I would imagine most people are concerned, "Is this going to kill me?"

Dr. Monroe: So the good news for HPV or oropharynx cancer is that when we look at that in comparison to other types of head and neck cancers, typically cancers that are caused by tobacco and alcohol use, the overall survival is better. In fact, if we look at for cancer specifically of the tonsil and the base of the tongue, the increase in survival is 25% absolute percentage points across all stages, so very significant increase in survival.

So I think the first take-home message is that if you're starting to search the Internet and you're at some of what has been recorded for head and neck cancer, you realize that, in many times, HPV-related cancers have an improved prognosis. And that's because of that some of . . . because it's a relatively new phenomenon, some of the data that we do have on there on survival is outdated and doesn't really apply to oropharynx cancer. Now, that being said, treatment in this area does carry some toxicity.

Interviewer: What does that mean?

Dr. Monroe: So toxicity means side effects from the treatment.

Interviewer: Okay. Typically, what is the treatment? Is it surgery? Is it chemotherapy?

Dr. Monroe: The treatment that's curative includes surgery and radiation. Chemotherapy given by itself . . . while the responses are high, meaning the tumor strings down, the long-term control is very, very low. So chemotherapy is typically not given by itself. The two treatments that have been shown to be associated with the cure of the diseases, surgery and radiation, are both used and it depends upon the individual patient and the individual tumor characteristics.

Across the US, the most common treatment is probably radiation based, the combination of radiation and chemotherapy. Chemotherapy is often given along with radiation to make the radiation work better. For patients with lower volume disease, meaning smaller tumors in the back part of their throat, we're beginning to evaluate the role of surgery to remove the tumors mainly so that we can achieve, one, the elimination of chemotherapy or, two, the reduction in the dose of radiation with the goal being of minimizing some of the long-term side effects of treatment. So the side effects of treatment can include difficulty swallowing long term. The radiation therapy also affects the salivary glands and so most patients will experience dry mouth.

Interviewer: So this is for the rest of their life or just immediately after treatment?

Dr. Monroe: Yeah, for the rest of their life.

Interviewer: Okay.

Dr. Monroe: And so most patients who undergo radiation treatment for the oropharynx will have increases salivary production. Now, the good news is that some of it returns over time, but it never returns to the level that it was prior to treatment. And that has important implications only just from a quality of life perspective, but the saliva has important function particularly in preserving our teeth. And so patients who undergo radiation therapy also are at higher risk of developing dental decay and it's one of the reasons why having a dentist onboard who is trained in treating patients who have radiation therapy to their mouth is important. There are specific dental precautions that can be done to minimize the risk of dental decay in patients.

Interviewer: What are some of the other concerns or considerations you get from patients after being diagnosed with HPV head and mouth cancer?

Dr. Monroe: Yes, I think that one of the most frequent questions that we get is not from the patient itself but from their loved ones or spouses. Many have gone online and read that HPV is a sexually transmitted disease and there are fears of, one, that they may acquire the infection or, two, that there's infidelity on the part of their loved one. I think there are a couple of important points to consider.

The first is that HPV is a ubiquitous infection, while over 80% of the population is exposed and many times, these infections occur decades before the actual onset of cancer. Many people have already been exposed if their loved one has HPV. The increased risk of cancer for loved ones has been demonstrated, but it's incredibly small. So we do know from studies that have done in the Scandinavian countries that women who have cervical cancer, there's a slight increase in the risk of developing oropharynx cancer or head and neck in their spouses.

Interviewer: And then you said a slight.

Dr. Monroe: A slight. It's a very small percentage of patients.

Interviewer: Okay. So not likely.

Dr. Monroe: Not likely, generally speaking.

Dr. Monroe: In Utah, studies that we have done here have demonstrated that patients with oropharyngeal cancer, there is a higher risk of cervical cancer in their spouses above the population so the converse of the studies that have been done in Europe.

So I think what this points to is that what you might expect from a disease that's sexually transmitted is that if one partner has HPV exposure then the other partner is likely to be exposed to HPV. And if they're exposed, there's a very small risk of developing cancer. As of right now, there are no recommended guidelines other than many people will have recommended spouses, female spouses of patients with head and neck . . . to undergo their already recommended cervical cancer screening.

Interviewer: I think kind of the final point then would be also that this is a completely preventable if you have vaccination when you're young before you're exposed to it. And that's kind of a tough thing, especially here in Utah. We're not getting these vaccinations taken care of.

Dr. Monroe: I think that's an incredibly important point. So vaccination rates in Utah are lower than the national average. This is a really important preventable, not just from the head and neck cancer perspective, but there are many other cancers and non-cancer conditions caused by HPV. So, prevention is really key.

Interviewer: And there's a prevention out there. It's just that we're not using it to scale.

Dr. Monroe: We're not using it, yes.

Interviewer: So if you have been diagnosed with the head and neck cancer because of the HPV virus and you have young children, then really be sure you get that vaccination taken care of.

Dr. Monroe: That's true. So I encourage all of your loved ones and children of the appropriate age to become HPV vaccinated. It's something that's relatively easy to do and has been shown to be effective for many other cancers and is thought to be effective for oropharyngeal cancer as well.

Announcer: thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: If you're listening to this podcast, it's because you want to learn more about the HPV virus and the cancer that causes it and probably more specifically because you've heard that it's causing more cases of head and neck cancer. We're with Dr. Marcus Monroe. He is a head and neck cancer expert and let's talk about HPV. There is one type of HPV that maybe more people are familiar with, not so much the head/neck aspect. So first of all, what is HPV? Just give us the basics.

Dr. Monroe: Yeah, sure. So HPV stands for Human Papilloma Virus. It's actually a group of well over a hundred different viruses of which, about 40 are known to be transmitted in humans and of these, a few of these subtypes are known to cause cancer in humans. The most well-known association, which has been known for decades, is the link between HPV and cervical cancer. That's the reason why women are recommended to get yearly screening pap smears.

Dr. Gellner: The HPV vaccine, should you get it and is it safe? I'm Dr. Cindy Gellner and let's explore that today on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Gellner: So you may have recently seen Katie Couric talking about this vaccine on her show, and you were maybe wondering, is this something I should get for my kids? Is it safe? Why is it important?

So this vaccine comes in many different names, Cervarix and Gardasil, and the bottom line is it protects against human papillomavirus. Now human papillomavirus is the most commonly sexually transmitted infection. Currently, based on the 2013 CDC data, 79 million Americans have HPV and 14 million people become newly infected each year.

So not only does HPV cause genital warts, but it also is the major virus that causes cervical cancer. It causes other cancers as well, including vulvar cancer in women, and penile cancer in men. HPV can also cause a rare condition called recurrent respiratory papillomatosis. It's a disease where warts will actually grow in a persons' throat, it can actually affect a persons' ability to breath because they become so large, these papillomas, they're like big warts, the warts become so big in the persons throat, that they will block the persons airway.

Now, kids can be affected by this too. If the Mom has human papillomavirus while she's pregnant, she can actually transmit this to children. It can only be diagnosed by someone actually taking the child to the operating room and looking down their throat and looking for these warts, and these are one thing, the child is going to have to have them cauterized or burned off or frozen off recurrently, over and over and over, to keep their airway open as they go through life. So it's not something to really take lightly. So the vaccine actually can prevent most cases of cervical cancer and these other cancers.

The important thing is your child would need to get the entire series before they start having sexual activity. HPV actually is pretty easy to acquire, again, there's so many people that have it. Even if you only have one sexual partner and that person has it, you can get it.

So who should receive this vaccine and why? Pediatricians currently recommend that both boys and girls get the vaccine around age 11 to 12 when junior high vaccines are given. So what do I recommend to my patients at Parents, who are unsure about the vaccine. I always advice that the parents and the patients, the kids themselves, seriously consider getting this vaccine. It's the first vaccine developed to prevent a major type of cancer. Think about that. If we just give three shots and we eliminate several different types of cancers, or significantly reduce the amount of cancer, how awesome would that be?

The other thing to remember is a person can be infected with HPV for up to 10 years before symptoms appear, again, why it's so important to get the kids vaccinated before they start having sex so they get vaccinated before they even come in contact with this virus. Treatment, once a patient has it and has symptoms, can include anything from cryotherapy, which is freezing off of the warts, to actually surgically removing part of the reproductive system, again, something to think about. Three shots, versus something that could be extraordinarily painful. And even if a person is asymptomatic, if they are infected they spread HPV to others through unprotected sex.

The safety of the vaccine has been studied in clinical trials of 30,000 males and females before the FDA even approved its' license for general public use. The vaccine has been shown to be highly effective and research shows that the protection is long lasting. You may need boosters of this vaccine in the future, but three vaccines are all that's needed. So with concerns about the side effects of this vaccine, the bottom line is, the benefits of vaccines outweigh the risk. So your pediatrician will be able to answer any other questions that you have, but I can't stress enough how important it is to protect your child against this virus that actually can cause a lot of serious harm in the future if it's not taken seriously.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.