New Research on HPV: Some Good News, Some Bad News


Last month, actor Michael Douglas made headlines (and made TV anchors giggle) when he suggested that the throat cancer he battled a few years ago was caused not by cigarettes but by cunnilingus. His announcement helped bring to light the rising number of throat and neck cancers that have shown to be caused by the human papillomavirus (HPV)—a sexually transmitted infection that also causes genital warts and cervical cancer. The publicity also gave public health experts a chance to discuss vaccines that are available to prevent infection with those strains of HPV that are most likely to cause cervical cancer. Now, two new studies show just how timely and important Douglas’ announcement really was. The first finds that up to one-third of throat cancers are caused by HPV, while the other suggests that the vaccines can protect against those kind of cancers as well.

Released in the Journal of Clinical Oncology, the first study looked at plasma samples from participants in the European Prospective Investigation Into Cancer and Nutrition study who had been followed for many years. Specifically, the researchers compared 638 participants who had oropharyngeal cancer (cancer of the mouth, oropharynx, or larynx), 300 who had cancer of the esophagus, and 1,599 who did not have cancer. The tested samples were taken from participants before they had been diagnosed with cancer (on average, six years before diagnosis).

The researchers found that HPV 16, one of the strains also responsible for cervical cancer, was found in 34.8 percent of patients with oropharyngeal cancer and only 0.6 percent of patients in the control group. HPV was not correlated with cancers in other locations. Some participants had evidence of HPV 16 in their throats in samples taken as many as ten years before their cancer diagnosis. Dr. Ruth Travis, an Oxford cancer researcher and one of the study’s authors, said in a statement, “These striking results provide some evidence that HPV 16 infection may be a significant cause of oropharyngeal cancer.”

In fact, the findings suggest that about 7 percent of non-smoking women and 23 percent of non-smoking men who contract HPV of the throat will develop cancer over ten years. It is thought that men who perform oral sex on women have a higher risk of contracting HPV than either women or men who have sex with men because vaginal fluids have a higher concentration of the virus than the surface of the penis. Smokers and those who drink excessive amounts of alcohol also are at increased risk.

The second study, which was supported by the National Cancer Institutes and published in the journal PLOS One, looked at whether one of two HPV vaccines on the market could provide protection against cancers of the neck and throat. Researchers tested cells from the throats of 5,840 women in Costa Rica for presence of HPV strains 16 or 18. The women were part of a larger study on the vaccines that had begun four years earlier. Some were vaccinated with Cervarix, while others received a placebo. (The other vaccine on the market, Gardasil, was not used in this study, but researchers believe the results will apply to both.) Of the women who had been vaccinated, only one was infected, compared to 15 of the woman who had received placebo shots.

Researchers were very pleased with these results. Dr. Rolando Herrero, the study’s lead author as well as head of prevention for the World Health Organization’s International Agency for Research on Cancer, told the New York Times, “We were surprised at how big the effect was. It’s a very powerful vaccine.”

Herrero cautions, however, that the study does have a number of limitations. First, when it began it was designed only to test the vaccine’s efficacy in preventing cervical cancer. While all women were tested to be sure they did not already have a cervical infection at the start of the study, they were not tested to see if they had HPV in their throats. This means that some of the infections found either in the placebo or the vaccine group could have been present before the study started.

Another challenge in testing the vaccine’s ability to prevent cancer is how slow cancers of the neck and throat tend to grow. Cancers caused by HPV would not have grown during the four-year study, and, if the women were studied longer, it would not be ethical to ask those who had lesions that looked like they might become cancer to forgo treatment for the sake of the study. Moreover, it’s likely that the women who tested positive for HPV would never develop cancer even without intervention, because in many cases the body can clear itself of the virus before it becomes a problem.

Despite such limitations, researchers believe the study shows the potential of the vaccine. As Dr. Marshall Posner, medical director for head and neck cancer at Mount Sinai Medical Center in New York, told the New York Times, “We expected this—that’s why we want everyone to vaccinate both boys and girls. But there’s been no proof.”

Together, these studies seem to create a bad news-good news situation. The bad news is that head and neck cancers are on the rise, and HPV appears to be the culprit. The good news is that we have a way to prevent HPV infection. As with most developments in science around HPV, these studies provide more good reasons to get both girls and boys vaccinated before they become sexually active.

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  • Kari O’Driscoll

    I think these studies are important, but given the fact that there are so many negative side effects of the vaccine, I think it is just as important to talk honestly about those risks. Especially when many of the studies saying that the risks are minimal have been done by the pharmaceutical company that makes the vaccine (or physicians and labs on their payroll). I for one will encourage my daughters to engage in safe sex with partners who are honest about their history for now instead of subjecting them to the possible health risks of a vaccine that hasn’t been around for long enough or tested by independent labs enough to know if it’s safe.

    • Craig Roberts

      Your concerns are unwarranted. HPV vaccine is one of the safest vaccines ever produced. Safety has in fact been evaluated by independent researchers and CDC — and it’s well established that any serious adverse reactions from this vaccine are extremely rare. With over 100 million doses administered since approval and 10+ years of safety data on file, it’s clear it’s a very safe vaccine. Just how long do you think we need to study it before it’s “around long enough”? I do feel sorry for your daughters though. Being honest about one’s sexual history doesn’t do much to prevent infection with HPV.

      • cjvg

        According to the most recent research the two types covered in this vaccine only account for 30% of all HPV infections, so obviously just relying on a vaccine causes a false sense of security!

        http://www.ncbi.nlm.nih.gov/pu

        ” HPV16 and 18, the two HR types prevented by current HPV vaccines, accounted for 30% (range 19-43%) and 12% (range 0-22%) of all HR HPV positives, respectively, and varied according to the presence of cervical lesions. Based on an updated meta-analysis of HPV type distribution in the whole of Europe, HPV16 and/or 18 are estimated to be present in 52%, 61% and 76% of cytologically detected high-grade squamous intraepithelial lesions, histologically confirmed cervical intraepithelial neoplasia grade 2/3, and invasive cervical carcinoma, respectively.”

        For now safe sex practices are still the best way to go!

        Also there are most certainly safety concerns because of some very strong indications of serious neurological risks (atypical juvenile ALS as well as Guillain-Barre syndrome) with the use of this vaccine, as acknowledged by the CDC and its equivalent agencies in the European countries.
        (Europe uses cervarix instead of Gardasil)
        http://bmartinmd.com/2009/10/a

        Furthermore there are some very concerning ethical lapses that took place during the development, approval and mass marketing of gardasil

        “NIH (the American governmental National Institutes of Health which is the world’s largest single sponsor of biological research) , for example, launched its own “Program on Public-Private Partnerships” in 2005, shortly before Gardasil’s launch. On the web-site describing this program, the NIH program managers concede that the kind of technology transfer involved with Gardasil carries unavoidable ethical risks, acknowledging that “The potential for conflict of interest exists any time the NIH and NIH staff engage with non-Federal entities to achieve mutual goals.” They provide little more than a pro forma solution for such conflicts, however: any concerned NIH staffers are encouraged to “contact their Deputy Ethics Counselor.”

        “NIH’s Office of Technology Transfer (OTT) was created to grant commercial licenses for such DHHS patents to commercial partners, including vaccine manufacturers. When new products invented at NIH clear the requisite regulatory hurdles at the Food and Drug Administration (FDA) and reach the market, OTT then shares in the profits. They also distribute the rewards back to the scientific teams whose products have succeeded in reaching the commercial stage: when license fees flow into OTT’s coffers, the Federal employees (Lowy and Schiller) who invented the technology are entitled by NIH policy to a share of the royalties.”

        An truly unprecedented web of conflict, one in which the same departments that are tasked with regulating the health and safety of medical products are also profiting from them. As Lowy and Schiller conceded (in the small print) in published review article disclosure, this conflict of interest came into play directly on Gardasil: both men are named inventors on the technology that makes Gardasil possible; NIH filed for and received patents on their invention of the VLP technology; DHHS ( Department of Health and Human Services) is the owner of the patent family that protects the commercial rights to the invention; in order to bring the product to market, OTT licensed the vaccine technology to Merck; and as Merck has generated billions in Gardasil revenue, OTT has received millions in Gardasil profits.

        But DHHS is also responsible for regulating Gardasil in numerous ways. The FDA reviewed the clinical trials in which Gardasil was tested in human populations and passed judgment on Gardasil’s safety. An Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) decided whether or not to recommend Gardasil for young women and children. The FDA and CDC together now conduct the surveillance to decide whether or not Gardasil is proving safe in larger populations. And as some families are now beginning to seek compensation based on claims that Gardasil caused injury in some of its recipients, the division of the Health Resources and Services Administration (HRSA) that oversees the Vaccine Injury Compensation Program (VICP) will soon sit in judgment as to whether, to whom, and how much compensation will be provided to Gardasil’s victims

        All this is supervised in a single department by one Cabinet official, the Secretary of Health and Human Services. The sole non-governmental agency involved in this commercial enterprise is Merck’s Vaccine Division. In effect, the Merck-DHHS partnership leaves the business side to Merck while DHHS is solely responsible for:
        -Creating the market for Gardasil by funding commercial research, supervising the conduct of clinical trials, judging the outcome of those trials and promoting a policy of universal vaccination;
        -Collecting the license fees that result from Gardasil revenues from Merck and other vaccine manufacturers and then distributing these financial benefits to Federal employees; and
        -Deciding whether or not to protect the policy decisions and profit streams of their sister DHHS agencies through postlicensure safety monitoring and vaccine injury compensation rulings.
        I worked for many years in pharmaceutical research.
        Most people are not aware of the incestuous nature of the relationship between the regulatory agencies and big pharma.
        Personally I find it unconscionable.

    • http://littlemisshaldol.tumblr.com/ LittleMissMellaril

      How will she know is they are really honest? Everybody lies.

    • cjvg

      According to the most recent research the two types covered in this vaccine only account for 30% of all HPV infections, so obviously just relying on a vaccine causes a false sense of security!

      http://www.ncbi.nlm.nih.gov/pubmed/19709878

      ” HPV16 and 18, the two HR types prevented by current HPV vaccines, accounted for 30% (range 19-43%) and 12% (range 0-22%) of all HR HPV positives, respectively, and varied according to the presence of cervical lesions. Based on an updated meta-analysis of HPV type distribution in the whole of Europe, HPV16 and/or 18 are estimated to be present in 52%, 61% and 76% of cytologically detected high-grade squamous intraepithelial lesions, histologically confirmed cervical intraepithelial neoplasia grade 2/3, and invasive cervical carcinoma, respectively.”

      For now safe sex practices are still the best way to go!

      Also there are most certainly safety concerns because of some very strong indications of serious neurological risks (atypical juvenile ALS as well as Guillain-Barre syndrome) with the use of this vaccine, as acknowledged by the CDC and its equivalent agencies in the European countries.
      (Europe uses cervarix instead of Gardasil)
      http://bmartinmd.com/2009/10/als-like-disease-with-gardasil.html

      Furthermore there are some very concerning ethical lapses that took place during the development, approval and mass marketing of gardasil

      “NIH (the American governmental National Institutes of Health which is the world’s largest single sponsor of biological research) , for example, launched its own “Program on Public-Private Partnerships” in 2005, shortly before Gardasil’s launch. On the web-site describing this program, the NIH program managers concede that the kind of technology transfer involved with Gardasil carries unavoidable ethical risks, acknowledging that “The potential for conflict of interest exists any time the NIH and NIH staff engage with non-Federal entities to achieve mutual goals.” They provide little more than a pro forma solution for such conflicts, however: any concerned NIH staffers are encouraged to “contact their Deputy Ethics Counselor.”

      “NIH’s Office of Technology Transfer (OTT) was created to grant commercial licenses for such DHHS patents to commercial partners, including vaccine manufacturers. When new products invented at NIH clear the requisite regulatory hurdles at the Food and Drug Administration (FDA) and reach the market, OTT then shares in the profits. They also distribute the rewards back to the scientific teams whose products have succeeded in reaching the commercial stage: when license fees flow into OTT’s coffers, the Federal employees (Lowy and Schiller) who invented the technology are entitled by NIH policy to a share of the royalties.”

      An truly unprecedented web of conflict, one in which the same departments that are tasked with regulating the health and safety of medical products are also profiting from them. As Lowy and Schiller conceded (in the small print) in published review article disclosure, this conflict of interest came into play directly on Gardasil: both men are named inventors on the technology that makes Gardasil possible; NIH filed for and received patents on their invention of the VLP technology; DHHS ( Department of Health and Human Services) is the owner of the patent family that protects the commercial rights to the invention; in order to bring the product to market, OTT licensed the vaccine technology to Merck; and as Merck has generated billions in Gardasil revenue, OTT has received millions in Gardasil profits.

      But DHHS is also responsible for regulating Gardasil in numerous ways. The FDA reviewed the clinical trials in which Gardasil was tested in human populations and passed judgment on Gardasil’s safety. An Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) decided whether or not to recommend Gardasil for young women and children. The FDA and CDC together now conduct the surveillance to decide whether or not Gardasil is proving safe in larger populations. And as some families are now beginning to seek compensation based on claims that Gardasil caused injury in some of its recipients, the division of the Health Resources and Services Administration (HRSA) that oversees the Vaccine Injury Compensation Program (VICP) will soon sit in judgment as to whether, to whom, and how much compensation will be provided to Gardasil’s victims

      All this is supervised in a single department by one Cabinet official, the Secretary of Health and Human Services. The sole non-governmental agency involved in this commercial enterprise is Merck’s Vaccine Division. In effect, the Merck-DHHS partnership leaves the business side to Merck while DHHS is solely responsible for:
      -Creating the market for Gardasil by funding commercial research, supervising the conduct of clinical trials, judging the outcome of those trials and promoting a policy of universal vaccination;
      -Collecting the license fees that result from Gardasil revenues from Merck and other vaccine manufacturers and then distributing these financial benefits to Federal employees; and
      -Deciding whether or not to protect the policy decisions and profit streams of their sister DHHS agencies through postlicensure safety monitoring and vaccine injury compensation rulings.
      I worked for many years in pharmaceutical research.
      Most people are not aware of the incestuous nature of the relationship between the regulatory agencies and big pharma.
      Personally I find it unconscionable.

  • cjvg

    Many patients/parents rely on the willingness and education of their doctors, unfortunately many are burned out by the business of providing health care in America.
    Many doctors practice in a way that they are able to pay the bills, they are no longer doctors first and foremost!

    I myself and many of my fellow researchers are burned out by the often blatant displays of disinterest for patient well being when big money is involved.
    Safety data research should never be under the control and guidance of the company producing the “cure” in question.
    Unfortunately under our current system ALL of it is. The regulatory agencies only “review” the data brought to them by the producing company!
    It is better to educate yourself and make some common sense decisions.

    Cancer is a scary disease, but it is treatable, ALS and some of the more severe neurological symptoms really have no treatment at all.
    Also there are other ways to prevent HPV infections, and for now the seriousness of the possible side effects do not out way the risks.
    Japan, and I believe south Korea have stopped including this vaccine in their recommended inoculations for their citizens by order of their health departments.

    I believe you are a conscientious and concerned mother who is taking the additional steps needed.
    Ultimately you are their mother and your first obligation is to protect your childrens health in a way you can honestly say you educated yourself and made an informed well evaluated decision that you can stand behind!
    It is up to you, not a doctor,to safe guard their health.