HPV Vaccine is Cancer Prevention

HPV Vaccine is Cancer Prevention   NCSR update May 2016 Dr Jane Morgan, Waikato DHB

Disclosures & acknowledgements   I have no conflicts of interest to disclose   I gratefully acknowledge shared teaching materials from these sources:

75% coverage by 2017   75% dose-3 uptake for all 12-year old girls by Dec’17   With higher vaccine coverage, New Zealand would see similar benefits already achieved in Australia, including near eradication of genital warts in under 21s & less CIN in young women   Move to primary HPV testing, with smears from a later age & less often

How to improve HPV vaccine uptake

I want to convince you:   HPV vaccination is worth your passionate advocacy   HPV vaccine is worth giving long before infection   Your recommendation can make all the difference to the family’s acceptance We have an opportunity to prevent HPV related cancers. NOW is the time to protect our community

What is HPV?   A virus that infects human skin and mucosal surfaces   Transmitted easily by touching   >80% of people are exposed during their lifetime   Classified as a carcinogen

Why do we vaccinate?   To prevent HPV-associated cancer   Current screening is good but NOT enough to prevent all HPV-associated cancers   To improve equity

In NZ, 160 women get cervical cancer each year & about 50 die from it

Treatment may cause problems   Treatment is associated with obstetric morbidity   Preterm delivery   Preterm rupture of membranes   Low birth weight   Long term developmental outcomes

Why remove part of the cervix, when you can get a shot in the arm instead?

New Cancers likely caused by HPV, US 2006-10 Vagina n=600 3%

Vulva Anus n=2,200 n=2,600 13% 15%

Oropharynx n=1,800 10% Cervix n=10,400 59%

17,600 Women

CDC, United States Cancer Statistics (USCS), 2006-2010

Penis n=700 8% Anus n=1,400 15%

Oropharynx n=7,200 77%

9,300 Men

What about boys/men?   Oropharyngeal cancers more common in men   Smoking-related oral SCC is declining, HPV increasing   90% of HPV-related oral SS are due to HPV-16   HPV-related oral SCC responds better to treatment   No screening test for oropharyngeal cancers

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a V P H f o PV k H s o t i d R se o p x g e lifelon ill be w be e y n a o y m r s ve n e o i t t s c o e inf Alm e m o S

HPV transmission   ~ 80% of people will be infected with HPV   Intimate skin-to-skin contact   Most common route is sexual intercourse  genital-genital, anal-genital, oral-genital, manual-genital   Nearly 50% of high school students have engaged in intimate genital contact

HPV is found in ‘virgins’   Research studies of HPV & sexual behaviour   25% of young women infected with their 1st partner   10-46% of 14-17 year old ‘virgins’ had detectable genital HPV: intimate genital contact

  Early vaccination to prevent initial infection

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HPV vaccine is safe   No virus in the vaccine, so vaccine cannot cause cancer   Many millions of doses given worldwide already   Most common adverse events are mild   For serious adverse reported events, no unusual pattern or clustering to suggest caused by the HPV vaccine   These findings are similar to the safety reviews of Tdap (Tetanus/Diphtheria/Pertussis) vaccines

HPV vaccine is safe

HPV vaccine is safe   A 2011 study found women & girls who received Gardasil were no more at risk of allergic reactions, anaphylaxis, Guillain–Barre Syndrome, stroke, blood clots, appendicitis, or seizures than those who were unvaccinated or who received other vaccines.   A 2013 study that included almost 1 million girls found Gardasil was not associated with blood clots or adverse events related to the autoimmune and brain systems.   A 2015 study found women & girls who received Gardasil were not more likely than those who were unvaccinated to develop multiple sclerosis or other similar diseases http://www.cdc.gov/vaccinesafety/pdf/data-summary-hpv-gardasil-vaccineis-safe.pdf

e n i c c a v HPV s s e n e v i t c e f f e

12 10 8 6 4

Percent reporting genital warts

14

Near-disappearance of genital warts in Australia following introduction of HPV vaccination & 3-dose 70% coverage

93% reduction in girls