This story has been updated.
“As a cancer patient with a terminal prognosis, I find it infuriating that the HPV vaccine is tragically underutilized more than a decade since its introduction,” says Michael D. Becker, 49, who is terminally ill with head and neck cancer that resulted from human papilloma virus, or HPV.
The author of A Walk With Purpose: Memoir of a Bioentrepreneur, Becker has been fighting advanced head and neck — or oropharyngeal — cancer, while advocating for HPV vaccination of children and young adults. The former New Jersey biotech company chief is spending what is possibly the last year of his life writing and speaking publicly about HPV vaccination.
In addition to head and neck cancer, HPVs are the cause of most cervical cancer in women. In the U.S., more than 12,000 cases of cervical cancer were diagnosed in 2017, and more than 4,000 diagnosed women died.
Vaccines have been available for girls and women aged 11-26 since 2006, and for boys since 2011. A series of three shots given to pre-teens can reduce their risk of getting HPV-linked cancer later in life. “However, only 49.5 percent of girls and 37.5 percent of boys in the United States were up-to-date with this potentially lifesaving vaccination series, according to a 2017 Centers for Disease Control and Prevention report,” says Becker, who is the father of two teenage daughters.
Some parents believe that vaccinating their children against a sexually transmitted infection leads to promiscuous behavior. “We must counter untrue, exposed and discredited research that keeps some parents from having their children vaccinated, and put an end to the campaign of misinformation,” Becker says.
A 2016 CDC report shows that more than 270 million doses of HPV vaccine distributed around the world have proven to be safe. “Cancers that are preventable through HPV vaccination should be prevented,” Becker said.
“I only wish my parents had that opportunity when I was young, as it could have prevented the cancer that’s killing me.”
Dr. Joshua G. Cohen, an assistant professor in the Division of Gynecologic Oncology at UCLA’s David Geffen School of Medicine, sees patients at the Westlake Village Obstetrics and Gynecology office of UCLA Heath. He has not seen much resistance to vaccination due to fear of promiscuity. “The vast majority of parents I meet in Ventura County recognize the importance of cancer prevention and indicate their children are going to be vaccinated with the HPV vaccine,” Cohen wrote to the VCReporter in an email. “As a doctor who cares for women with gynecologic malignancies, I believe the HPV vaccine is a very important part of cancer prevention. I plan on vaccinating both of my children at age 11 as recommended by the CDC.
“There are still patients who are not getting appropriate cervical cancer screening and adolescents who are not receiving the HPV vaccine,” Cohen wrote. “I highly recommend women see their OB/GYN and/or primary care doctors for regular well-woman care, including cervical cancer screening. As health care professionals, we need to be advocates for our patients, which includes recommending strongly the HPV vaccine to prevent cancer. I take care of many patients already impacted by cervical cancer, but we now have a way to prevent this with the HPV vaccine. I strongly recommend it as a cancer doctor, surgeon, health-care professional and father.”
In California, 78 percent of girls age 13-17 and 67 percent of boys age 13-17 received at least one dose of the HPV vaccine, Cohen notes. Previously boys had been receiving the vaccine at a lower rate than girls, but that gap is now closing.
“Approximately 80 percent of the general population has been exposed to HPV, a virus transmitted through oral and genital contact,” Cohen wrote. “The HPV vaccine is most effective in preventing cancer when given before sexual debut. It is meant to prevent cancers that are directly caused by HPV. Clinical data for the HPV vaccine has been developed in patients 26 or younger for these reasons. At this time, there is no recommendation for patients over the age of 26 to receive the HPV vaccine.”
Prior to his illness, Becker thought that only cervical cancer in women was HPV-based: “I’d worked in the biomedical industry for more than 20 years, but until my diagnosis, I had no real appreciation for the connection between HPV and cancer in men. I had always associated it with cervical cancer (in women).”
Historically, that was the case. The 40,000 Americans who are diagnosed annually with HPV-related cancers are 60 percent female. The number of men with HPV-related head and neck cancers is rising, however. HPV-linked cancer in men is now more prevalent than HPV-linked cervical cancer in women. Scientists know that 70 percent of head and neck cancers are caused by HPV, but they do not know why so many more men than women have it.
There are no FDA-approved tests to detect HPV infection in men, but research is ongoing.
For women, cervical cancer forms in the cervix, the organ that connects the uterus and vagina. There are more than 100 different strains of HPVs, and they are a common cause of sexually transmitted infection. Most people will have some type of HPV infection — either temporary or persistent — during their lifetimes. HPV is estimated to be linked to about 31,500 cases of cancer in the U.S. each year. The vaccine can end the occurrence of the majority of cancers caused by the virus.
The CDC recommends starting the HPV vaccine at age 11-12 for both boys and girls. After age 26, most insurance plans no longer cover the approximately $450 cost. The series of three shots should be completed within six months of the first vaccination. HPV vaccination before sexual activity begins can reduce the risk of infection. HPV vaccination rates remain low in the U.S. nationally in part because all three shots are not completed. In 2016, 60 percent of 13-17 year olds received at least one dose of the vaccine but only 43 percent completed all three doses.
Vaccinations do not treat cancer that is already present or existing HPV infection. Younger patients’ strong immune systems often fight off HPV infections, but as patients age, they become more vulnerable to persistent HPV in their bodies. Although clinical trials have shown the vaccine can be effective for some women over 26 years of age, experts differ in their views about its usefulness for older people.
“While the HPV vaccination is recommended for those under age 26, there is benefit for getting it at an older age even if you’ve already been exposed,” Dr. Nicole Abell, D.O., an obstetrician/gynecologist at Dignity Medical Group in the Ventura region, wrote to the VCReporter in an email. “For most people, your immune system fights it off — but occasionally it can stick around and cause issues. During a Pap test we can see if your immune system is fighting it off. I tell my patients that vaccines plus a Pap are so important.”
“California has one of the best vaccination rates in the nation,” Abell notes. Yet statistics show that within ethnic groups, Hispanic women are most likely to get cervical cancer, followed by black women, Asians and whites.
“The unfortunate reality is that women of color in the U.S. face more barriers to accessing health care than white women, and so are less likely to get preventive screenings, more likely to be diagnosed at later stages, and more likely to experience worse health outcomes when it comes to breast and cervical cancer because of these barriers,” Dr. Jenna Tosh, President and CEO of Planned Parenthood California Central Coast, wrote in an email. Planned Parenthood provides more than 5,600 cervical cancer screenings in Ventura County each year, and administered 109 HPV vaccinations in the county during the year 2016.