Why every adult should get cancer-fighting HPV vaccination
Every person in should be given the cancer-fighting HPV jab to prevent a range of deadly tumours and save thousands of lives, world-renowned medical experts claimed last week.
HPV vaccines are vaccines that protect against infection with human papillomaviruses (HPV).
Until now, most discussion of the vaccine has focused on youngsters, as giving it at an early age offers life-long protection.
But according to the world’s leading HPV researchers, there is no evidence that giving the jab to adults from their 20s into middle age would also bring dramatic health benefits.
HPV – the human papilloma virus – is spread by intimate contact and, in some cases, kissing. It is terrifyingly prevalent: without vaccination, about 80 per cent of us will be infected at some point in our lives. In most cases, there will be few, if any symptoms.
The virus lurks in the basal cells beneath the surface of the skin or mucous membranes and in many cases does no damage.
But in other cases, it will trigger cancers – which may not emerge for decades.
HPV is known to cause cervical cancer, and a range of other cancers, including tumours of the mouth, tongue, throat, tonsils, penis and anus.
There are more than 4,000 new United Kingdom (UK) cases of these types of cancer each year and this figure is rising rapidly.
It was believed inoculation was likely to be effective only if given to children before they’d come into contact with the virus. By early adulthood, many people have already been exposed.
But new research suggests the jab can prevent patients who have been infected with the virus from going on to develop cancer. It produces an immune system response so powerful it stops the virus from spreading inside the body.
Currently, HPV vaccination is available only privately to anyone not given it at school – at a cost of £500 for the full course of three.
But the researchers suggest offering it to adults as part of a nationwide programme may be cost-effective, due to the huge reduction in the incidence of cancer it would bring about.
“Most people don’t realise that HPV infection is a global epidemic,” says Cambridge University’s Professor Margaret Stanley, President of the International Papillomavirus Society.
“And the easiest way to prevent the spread of this virus and the diseases it causes is to give everyone a vaccine shot.”
The new evidence that supports vaccinating older people is summarised in a paper to be published shortly in the International Journal Of Infectious Diseases.
Such a campaign, it says, would stop the virus being transmitted between adults and could reduce the incidence of cancers.
Patients who had already suffered HPV-related cancer could benefit too, as it could reduce the risk of a relapse.
One of the study co-authors is the Barcelona oncologist Xavier Bosch, the scientist who first demonstrated that HPV causes cancer.
He showed more than 20 years ago that HPV is the sole cause of tumours in the cervix, which still afflict some 3,200 women in the UK each year, causing about 850 deaths. It was his work that led to vaccination programmes for adolescent girls.
But he believes that now the time has come to expand the age range. “We have an excellent vaccine that certainly does protect girls, but also adults. People have a right to know this,” he says.
The vaccine, Bosch adds, “provides much better protection” than regular cervical screening.
Giving it to adult women could mean they would only need one or two smears in their lifetimes, instead of every three years.
The first version of the vaccine, Gardasil 4, was developed by the drug company Merck and licensed for use in 2006.
There are more than 100 strains of HPV and, as its name suggests, Gardasil 4 provides protection against four of them, including the two that cause 70 per cent of cancers, and the two that most commonly cause genital warts.
The latest version, Gardasil 9, covers nine strains and will prevent 85 per cent of cases.
Also, results from the first long-term cohort study of more than 36,000 Japanese men over decades suggest an association between eating mushrooms and a lower risk of prostate cancer.
Their findings were published on September 5, 2019, in the International Journal of Cancer.
Mushrooms are widely used in Asia, both for their nutritional value and medicinal properties.
“Test-tube studies and studies conducted on living organisms have shown that mushrooms have the potential to prevent prostate cancer,” said Shu Zhang, an assistant professor of epidemiology in the Department of Health Informatics and Public Health at Tohoku University School of Public Health, Graduate School of Medicine in Japan, and lead author of the study.
“However, the relationship between mushroom consumption and incident prostate cancer in humans has never been investigated before.”
“To the best of our knowledge, this is the first cohort study indicating the prostate cancer-preventive potential of mushrooms at a population level,” said Zhang. “Although our study suggests regular consumption of mushrooms may reduce the risk of prostate cancer, we also want to emphasize that eating a healthy and balanced diet is much more important than filling your shopping basket with mushrooms,” said Zhang.
According to Zhang, “mushrooms are a good source of vitamins, minerals and antioxidants, especially L-ergothioneine” — which is believed to mitigate against oxidative stress, a cellular imbalance resulting from poor diet and lifestyle choices and exposure to environmental toxins that can lead to chronic inflammation that is responsible for chronic diseases such as cancer.
“The results of our study suggest mushrooms may have a positive health effect on humans,” said Zhang. “Based on these findings, further studies that provide more information on dietary intake of mushrooms in other populations and settings are required to confirm this relationship.”
Meanwhile, patients with cancer should receive a tailored exercise prescription to protect their heart, reports a paper published in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).
“Cancer patients are often less active than adults without cancer,” said author Dr Flavio D’Ascenzi, University of Siena, Italy. “However, exercise is essential for patients diagnosed with cancer who are under treatment, irrespective of the type of treatment.”
“Endurance training is more effective for improving cardiovascular performance and reducing inflammation, but resistance training may be a better starting point for frail cancer patients,” he continued. “Other types of exercise, such as inspiratory muscle training, are safe and effective, particularly in those with thoracic cancer; therefore, the specific exercise should be chosen based on individual characteristics.”
Cardiovascular diseases are common side effects in patients with cancer. This is the result of cardiotoxicity, whereby cancer treatment impairs heart function and structure, or accelerated development of cardiovascular disease, especially when risk factors such as high blood pressure are present. Furthermore, cardiovascular diseases and cancer often share the same risk factors. Therefore, cancer patients are advised to eat healthily, quit smoking, control their weight, and exercise.
The paper highlights the importance of an individual exercise plan for each patient, taking into account personal history, cancer treatment, response to exercise, and personal preferences. Exercise should start as soon as possible, even before starting treatment such as chemotherapy.
Meanwhile, pioneering one-blast radiotherapy is offering new hope to pancreatic cancer patients given just months left to live.
Using a portable machine, surgeons can deliver intense cancer-killing radiation while patients lie on the operating table to have their tumours removed.
The approach means treatment is given exactly where it is needed and destroys any leftover cancer cells in hard-to-reach areas – which reduces the chances of the disease returning.
Since 2017, 11 patients with pancreatic cancer who would previously have been considered unsuitable for surgery have been treated at University Hospital Southampton British Health Service (NHS) Trust, the only place in the United Kingdom (UK) with the high-tech equipment.
Not one of this group so far has seen their tumours grow back in the targeted area.
Arjun Takhar, a consultant surgeon at the hospital, says: “Pancreatic cancer often spreads to nearby organs and can encroach on major blood vessels. Previously it would have been difficult to remove the tumour without leaving small cancer cells behind, which increases the risk of the disease returning. Using intraoperative radiotherapy, we can mop up leftover cancer cells.”
Pancreatic cancer, diagnosed in 10,000 Britons every year, is notoriously difficult to treat. It rarely causes early symptoms, meaning cases are often only picked up once the disease has spread. In more than 80 per cent of cases, it is too late to operate by the time the tumour is discovered and only five per cent of those diagnosed survive longer than five years.
The pancreas is a gland that forms part of the digestive system, producing enzymes that break down food and hormones that control blood sugar. It sits high in the abdomen, close to the stomach, liver and vital blood vessels. If cancer spreads to these areas, it is usually considered too difficult to remove. Instead, patients are offered chemotherapy, which can halt the tumour growth and buy them some time.
But they will normally die within 18 months.
However, using a combination of chemotherapy, intricate surgery and intraoperative radiotherapy, surgeons believe it may be possible to remove pancreatic tumours that have spread close to blood vessels – and to stop them from growing back in this area.
Radiotherapy is given to some cancer patients following surgery to try to stop it coming back. But because of the positioning of the pancreas, external beam radiotherapy can damage surrounding tissue. Intraoperative radiotherapy delivers a precise dose of radiation to the pancreas safely. Research suggests this reduces the risk of cancer returning at the previous site of the tumour.
“We have shown that this approach is safe, we can get these patients home and it could have a much more longer-lasting effect on their survival,” Mr. Takhar says. Patients who opt to have the procedure are given a combination of three chemotherapy drugs over up to nine months to shrink their tumour. If it reduces the patient then has an operation under general anaesthetic, involving a cut in the abdomen, which usually takes up to eight hours.
The surgeons must first remove the end of the stomach, part of the small intestine, part of the pancreas and part of the bile duct – the tube that connects the liver to the bowel – to get rid of the tumour. The patient is then wheeled under the Mobetron electron beam radiotherapy machine. A blast of radiation is delivered to the targeted area. This ‘mops up’ any leftover cancer cells near to the blood vessels. Afterwards, the remaining pancreas, bile duct and stomach are stitched back together and rejoined to the small intestine. Patients are usually home within nine days.
The operation is suitable for patients with locally advanced pancreatic cancer that is touching the blood vessels but not intertwined with them. For patients with pancreatic cancer which aren’t yet affecting nearby blood vessels – treatment is usually surgery to remove the tumour, followed by chemotherapy, sometimes in combination with external radiotherapy.
Dan Brown, 42, from Southampton, was diagnosed with pancreatic cancer in February 2018. ‘When I tried to eat and drink I was feeling a bit sick,’ he says. ‘The doctor gave me medication for heartburn, but I noticed my skin was starting to turn yellow.’
The father-of-two had jaundice – a sign of pancreatic cancer – and tests revealed he had the disease. After six months of chemotherapy, he underwent the radiotherapy operation at University Hospital Southampton NHS Trust in October.
“The operation lasted 12 hours and I was back home in seven days,’ he says. In April, scans showed Mr. Brown’s pancreas was still free from cancer and he’s back at work in traffic management. University Hospital Southampton NHS Trust is using the same technology to treat bowel, bladder, cervical and head and neck cancers.
The treatment is not funded by the NHS, owing to a lack of long-term evidence, and the equipment for Mr. Brown’s procedure was financed by PLANETS Cancer Charity, which needs to raise £10,000 a month to keep delivering treatment.
Meanwhile, over half of the people prescribed the targeted blood cancer-fighting drug ibrutinib developed new or worsened high blood pressure within six months of starting the medication, according to a new study published online in the journal Blood.
The analysis is also the first to tie ibrutinib-related hypertension to a heightened risk of heart problems, particularly atrial fibrillation. Moreover, the association of ibrutinib with cardiovascular complications remained regardless of the prescribed dose.
Also, with many diseases, women receive procedures and drugs that were largely tested in men. Breast cancer has the opposite problem: Men make up less than one percent of breast cancer cases and often receive treatment based on data collected in women.
What is more, breast cancer in men has been rising. Diagnoses have gone from 0.85 per 100,000 men in the United States (U.S.) in 1975 to 1.21 per 100,000 in 2016. This year, an estimated 2,670 U.S. males will develop the disease. And a new analysis confirms what smaller studies have suggested: Men with breast cancer fare worse than their female counterparts.
The study, published September 19 in JAMA Oncology, is the largest of its kind. It analyzed registry data on 1,816,733 U.S. patients — including 16,025 men — who were diagnosed with breast cancer from January 2004 to December 2014. At three and five years after diagnosis, as well as at the end of the study period, men had lower survival rates than women. The disparity remained “even after we adjusted for known contributing factors including clinical predictors, socioeconomic status and access to care,” says Xiao-Ou Shu, an epidemiologist at Vanderbilt University Medical Center in Nashville who led the research.