HPV Vaccine: Cost-effective Way to Prevent Anal Cancer
Study Shows Benefits of HPV Vaccine in Men Who Have Sex With Men
"The risk of anal cancer is higher in men who have sex with other men, and there is no routine screening program in place," says Joel Palefsky, MD, a professor of medicine at the University of California at San Francisco. He wrote an editorial accompanying the new study.
"From a health standpoint, it is clear that this vaccine works pretty well to prevent anal warts and likely anal cancer," he tells WebMD. "The implementation of a vaccination program would be the only organized prevention effort available."
Some of the details still need to be worked out.
"Most men who have sex with men will not be self-identified or have identified themselves to their primary care providers at the age of 12, and we would hope males would be vaccinated as early as possible," Palefsky says.
That said, "the vaccine would be cost-effective up to the age of 26 when a much bigger chunk of men who have sex with men would be self-identified," he says.
"I am optimistic that FDA and the Advisory Committee on Immunization Practices (ACIP) will agree that anal cancer is a worthwhile indication for this vaccine in men and women, and the real question is should it be recommended for routine use in boys," Palefsky says.
"The vaccine won’t get serious uptake in males unless it is included in the routine vaccine schedule, but my crystal ball is not clear enough to predict that at this time," he says. The ACIP, which advises the CDC on vaccine matters, is currently reviewing the data and expected to make its recommendations soon.
Two HPV vaccines are now licensed by the FDA and recommended by CDC -- Cervarix and Gardasil.
These vaccines are now on the CDC's routine childhood vaccine schedule for girls aged 9 to 26. Gardasil is licensed for males aged 9 through 26.
"This is a rare cancer-prevention opportunity where anal cancer is known to be associated with HPV and we have a vaccine available against the virus," says Jaffer A. Ajani, MD, a professor of medicine in the department of gastrointestinal oncology at MD Anderson Cancer Center in Houston. "However, the challenge is in implementing the strategy," he says. "Complexities lie in identifying the relevant population and motivating them to accept immunization.”
"Anal cancer is an important condition, but not a prevalent one," says Abby Lippman, PhD, a professor of epidemiology at McGill University in Montreal. "The cost-effectiveness data is good to see, but that is a secondary issue. We need to figure out what our public health priorities are, and how best to address them," she says.
"Merely having what some allege to be a 'magic bullet,' -- and still much is not known about the vaccine given how new it is, and how almost all the data has been sponsored by the companies manufacturing it -- doesn’t mean we go out and shoot." Lippman publically criticized Canada for rushing to include Gardasil in their routine immunization schedule.