Earlier this month, every major cancer center and organization in the country released a joint statement calling for the elimination of cervical cancer, along with all other HPV-related cancers. The elimination of a large swath of cancers might sound like a tall order — so far, we’ve only eradicated two viruses from the planet: smallpox and rinderpest. And we’re on the brink of getting rid of a third, the virus that causes polio.
But doing away with human papillomavirus (HPV) would herald a new chapter in disease eradication, because HPV causes cancer, meaning that eradicating HPV will eradicate the cancers caused by it. And the good news is we have all the tools we need to wipe HPV off the face of the earth — we just need to use them.
The tools to wipe a large class of cancers off the face of the earth are right under our noses — we just have to use them.
A quick rundown on HPV is in order. It’s the most common sexually transmitted infection in the world, and causes multiple cancers — cervical, head and neck, anal, vulvar, vaginal, and penile. While it’s most well-known for causing cervical cancer, here in the United States it is transitioning away from its old job, causing more head-and-neck cancers than cervical cancers. Nearly all sexually active people will be infected with HPV at least once in their lives, and though only a fraction of infections progress to cancer, its ubiquity means it still causes hundreds of thousands of cancers every year. In the United States, around 41,000 HPV-related cancers are diagnosed annually, while more than 600,000 are diagnosed worldwide.
Wanted: High Vaccination Rates
HPV has been vaccine-preventable since 2006, when Gardasil came onto the market. In countries with high rates of HPV vaccination, the incidence of HPV infections, genital warts, and precancerous cervical lesions is plummeting. The United States, however, has a relatively low HPV vaccination rate. Nationally, 49.5 percent of girls and 37.5 percent of boys have completed the HPV vaccine series — numbers that fall short of our goal of 80 percent by 2020.
Other nations have already surpassed this goal — Rwanda has a 99 percent vaccination rate, and countries whose vaccination coverage exceeds 80 percent include Portugal, the United Kingdom, Australia, Belgium, and Denmark. Studies have predicted that HPV vaccination rates in excess of 80 percent can obliterate the virus from the planet — we just need to duplicate these countries’ successes worldwide.
Eliminating HPV-Related Cancers, Starting with Cervical Cancer
In 2016, UN Secretary General Ban Ki-moon announced the ambitious — but feasible — goal to eliminate cervical cancer. Our weapons are at the ready: vaccination for tweens and teens, and Pap testing for adults. Widespread vaccination will help take HPV out of circulation, and if HPV can’t get a foothold in someone’s cervix, it can’t cause cancer there. Pap testing, which screens for cervical cancer, can catch “precancer” in those who have already been exposed to HPV. At this stage, abnormal cells can be removed before they have a chance to grow into cancer.
What about other cancers? Head-and-neck cancer is reaching epidemic levels in the United States, an increase that is driven by HPV rather than this cancer’s more traditional risk factors, such as smoking and drinking. Last year, scientists reported that 7 million U.S. men and 1.4 million U.S. women had oral HPV infections with cancer-causing strains of the virus. That five times as many men as women have potentially cancer-causing oral HPV infections was not surprising — previous studies have also found oral HPV is more common in males, as are HPV-related head-and-neck cancers. In the United States, the conception of HPV as a women’s health issue is being upended by the greater damage it is doing to men.
HPV causes virtually all cervical cancers and about 95 percent of anal cancers, 70 percent of head-and-neck cancers, 65 percent of vaginal cancers, half of vulvar cancers, and 35 percent of penile cancers. If we drive the virus to extinction, we’ll take a huge chunk out of cancer as a whole.
Developing Countries Bear the Brunt of the HPV Burden
While eliminating HPV-related cancers from the United States would be a major victory, the burden of HPV weighs heaviest on developing nations. This stark contrast is laid bare by the numbers: For example, Australia and New Zealand have the lowest cervical cancer rate, at 1.5 cases per 100,000 women, while Eastern Africa has the highest rate, at 27.6 per 100,000 — an 18-fold difference. Cervical cancer might be rare in the developed world, but there are 38 countries where it’s the most common women’s cancer.
Penile cancer is also rare in the developed world, where it accounts for less than 1 percent of cancer diagnoses. It is more common in developing countries, such as Brazil, where it is the fourth-most common cancer in men. (For comparison, bladder cancer is the No. 4 cancer in U.S. men.) HPV vaccination will decrease risk for penile cancer, as will other interventions, such as increasing circumcision and decreasing smoking rates.
Worldwide, the virus is responsible for 5 percent of cancers, so eradicating it would mean eliminating 1 out of 20 cancers. Allowing cancer to tear families apart is unacceptable when we have the tools to save millions of lives by spearheading vaccination campaigns and bringing cancer screening and treatment to those who need it most. Promoting HPV vaccination shows we value the lives of women and men around the world — and that we honor their contributions to our families and societies.
Never before has humanity had the opportunity to eradicate a large category of cancers. We have the tools; now is the time to use them. Globally, we must advocate for widespread access to lifesaving health care like vaccination and cancer screening. Nationally, we must push for equal access to health care, regardless of geography or income. Individually, health-care providers need to promote HPV vaccination for their young patients, and parents need to be aware of its cancer-prevention powers. Together, we can put HPV where it belongs — in history books alongside smallpox.
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