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Monday, Jul 28, 2014
Commentary

A dream come true: Cancer prevented by vaccines


Published:

If you overheard someone say that by giving three doses of a vaccine during adolescence, cancer could be prevented, you might think they were talking about a movie. But what you heard is not science fiction, nor is it a dream. This is reality!

In fact, there are two vaccines available in the United States to prevent cancer: the hepatitis B vaccine and the human papillomavirus (HPV) vaccine. The hepatitis B vaccine, given to infants in the first months of life, prevents liver cancer. Since its availability in 1984, the number of new liver cancer cases and deaths due to hepatitis B infections has substantially declined in countries like the U.S. that broadly disseminate the vaccine. This success story is due to the combination of two factors: the availability of a highly effective vaccine and the vaccination of the majority of children.

What about the relatively newer HPV vaccine licensed in 2006? HPV is a very common infection; about 80 percent of men and women have been infected at some point in their lifetime. Nearly 80 million Americans, or 1 in 4, are HPV positive. Although most HPV infections do not progress to cancer, there are no methods to predict who among us will develop cancer following an HPV infection. HPV causes cervical, vulvar and vaginal cancers in women, penile cancer in men, and anal and oral cancers in men and women. Like hepatitis B, and viruses that cause childhood illnesses such as measles, the HPV virus can be prevented with vaccines. Like measles and hepatitis B, the vaccine is best given prior to first exposure to the virus as it works by preventing infection. The HPV vaccine is given in three doses over a six-month period and has the potential to prevent up to six cancers from developing. Like the hepatitis B vaccine, the HPV vaccine is safe and highly effective, prompting the World Health Organization, the U.S. Preventive Task Force, the Centers for Disease Control and Prevention and several medical societies, most prominently, the American Academy of Pediatrics, to strongly endorse universal HPV vaccination of male and female adolescents.

Experts agree that the optimal age for HPV vaccination is between 11 and 12, but they also support the benefits of vaccinating as early as 9 and up to 26 for all females and 21 for males. The majority of health plans cover HPV vaccination, and for families with no or limited insurance coverage the vaccine is available at no cost to their children through the national Vaccines for Children Program.

For many of the cancers HPV causes, we have no other methods of prevention and few options for early detection. For example, for the sub-set of oral cancers caused by HPV (oropharyngeal cancer) we have no screening tests to identify these cancers at earlier, more treatable stages. Therefore, oropharyngeal cancers are usually diagnosed at a late stage, requiring intensive treatment that carries a high risk for serious complications and/or side effects that significantly reduce quality of life for patients. With timely vaccinations and completion of all needed doses in the majority of adolescent males and females, we could all but eliminate the HPV-related cancer experiences similar to how we have nearly eradicated measles. Just imagine: Near eradication of some cancers in future generations through vaccination.

Despite compelling evidence showing the safety, efficacy and public health benefits of the HPV vaccine for adolescents, only 33 percent of females in the U.S. have received the full HPV vaccine series, and less than 10 percent of males have been vaccinated. Unfortunately, the story in Florida is even grimmer, with only 25 percent of adolescent girls having been fully vaccinated against HPV. These rates are among the lowest in the country.

Having an effective vaccine in hand is half the battle in preventing cancer. If the vaccine does not get into the arms of adolescents, then the dream of preventing multiple cancers with one vaccine will not be achieved.

We at Moffitt Cancer Center, particularly our Center for Infection Research in Cancer, have joined forces with U.S. Rep. Kathy Castor, D-Tampa, to promote cancer prevention through HPV vaccination in Florida. The promise of eliminating multiple cancers with one vaccine can be achieved in our state. We each play a critical role in fulfilling this dream: health-care providers, researchers, policy makers, payors, families and community leaders working together to ensure future generations are protected against cancer. Unified, we can make this dream a reality by protecting our sons and daughters from cancer.

Anna R Giuliano, Ph.D, is director of the Center for Infection Research in Cancer at Moffitt Cancer Center in Tampa. Susan T. Vadaparampil, Ph.D, is an associate member of the Health and Behavior Program at Moffitt.

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