Preventing cancer by vaccinating young people, including boys

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A year ago the World Health Organization (WHO) started a prevention campaign on the transmission and risks of HPV to encourage young men and women to get vaccinated. The virus, called HPV, is responsible for hundreds of thousands of cancers each year.

On this occasion we met Dr. Oceane interviewed Sorel, a virologist who works with the United Nations to disseminate popularized and verified scientific information. She is mostly active on Instagram (@TheFrenchVirologist), where she uses humor to help combat misinformation.

What is HPV and how is it transmitted?

Human papillomavirus, also known as HPV, is a family of viruses that infect humans. There are more than 150 different types of HPV, around 40 of which are transmitted through sexual contact. Some of these HPVs (but not all!) Are considered “high risk oncogenic” and can cause cancers such as cervical, penile, anal or oropharyngeal cancer … HPV accounts for around 600,000 new cancers each year worldwide, including cervical cancer.

HPV is highly contagious and is transmitted through skin or mucosal contact, especially through sexual contact with or without penetrative sex. Simple skin-to-skin or genital contact is sufficient, so condoms do not offer complete protection against HPV infection.

How do I know if I have HPV, are there any signs of infection?

HPV infection is often asymptomatic and temporary, which means that in most cases the immune system will clear the infection. Most men and women become infected with HPV at some point in their lives. Some temporary infections can cause lesions in the cervix, but 85% of the time, these abnormalities go away spontaneously after a few months or years, when the immune system finally gets rid of the virus. In some cases, high-risk oncogenic HPV, if persisted in the body, can cause cancer in women (primarily cervical cancer, but also vulvar, vaginal, anal, or oropharyngeal cancer) and men (penile, anal, and oropharyngeal cancer).

How can HPV lead to cervical cancer? Is that systematic?

Associated with persistent infection with an oncogenic HPV and when the immune system has not been able to clear the infection, abnormal cells may appear in the cervix, which can lead to precancerous lesions and then cancer. This progression is slow and takes several years (approximately 10-20 years between the time of infection and cancer development).

What are the risk factors for developing cervical cancer?

The main risk factor is infection with one or more of the 14 types of HPV that can cause cancer. These include HPV 16 and 18, which are responsible for around 70% of cervical cancers.

Other factors significantly increase your risk of developing cervical cancer, such as: B. Sexual intercourse at a young age, multiple sexual partners, smoking, prolonged use of the oral contraceptive pill, immunosuppression, chlamydial infections, multiple pregnancies …

How can cervical cancer be prevented and recognized? How often should i be tested?

Vaccines recommended to young adolescents to prevent HPV infections and thus protect them from developing cancers associated with these viruses have existed since 2006. HPV vaccination is a primary prevention method against cervical cancer, but it is not enough to prevent 100% of cervical cancers. The vaccination therefore does not replace the preventive medical check-up for cervical cancer.

In France, all women aged 25 to 65 (vaccinated or not) are recommended to have regular screening for cervical cancer by taking some cells and mucus from the cervix to check for the presence of the virus (HPV test) or abnormal cells (Cervical cytology, also called Pap test). Contact your doctor for more information about the types of tests and recommended intervals.

Why is HPV testing not recommended for women under 30?

In France, cytological screening is recommended for women aged 25 and over to detect the presence of abnormal cells. However, HPV testing is not recommended before the age of 30 because HPV infections are very common in young people. The peak of HPV infection occurs shortly after sexual activity. However, most of these infections are temporary and go away after a few months when the immune system finally clears the infection. HPV testing in young women under 30 years of age would lead to a significant number of unnecessary testing and potentially invasive treatments that could increase the risk of complications in future pregnancies if most of these infections cleared on their own without treatment.

Are there multiple vaccines? Why are there different vaccines? How effective are they?

There are 3 vaccines: Cervarix, Gardasil and Gardasil9 and all of them protect against HPV 16 and 18, which are responsible for most of the HPV-related cancers. Gardasil and Gardasil9 also protect against several HPVs that can cause genital warts. Finally, Gardasil9, which replaced its predecessor Gardasil in the market, also targets other additional HPVs that are responsible for another 20% of cervical cancers. When given prior to first sexual contact, HPV vaccines are more than 90% effective in preventing targeted HPV-related infections.

Who should be vaccinated and when?

In France, the High Authority for Health recommends vaccination against HPV:

– All children: girls and boys between the ages of 11 and 14 using a 2-dose regimen.

– Re-vaccination is possible for all adolescents and young adults between the ages of 15 and 19 according to a 3-dose scheme.

– The vaccination recommendation can be extended to 26 years for men who have sex with men.

Does the vaccine have any known side effects?

Overall, the reported side effects of HPV vaccines are classic side effects of immune response initiation such as injection site pain, fever, fatigue, etc. Recent studies have not found a link between vaccination and the development of autoimmune diseases.

Is it possible to get the HPV vaccination after the first sexual intercourse?

Yes, up to a certain age. However, the effectiveness of the vaccine drops to 50-60% when given after the first sexual contact, since the peak of HPV infection occurs shortly after sexual activity, hence the importance of age at the time of vaccination.

Should I get tested if I am vaccinated?

Yes, vaccination is a primary layer of protection against cervical cancer, but no vaccine is 100% effective and vaccines do not protect against all types of oncogenic HPV and are therefore not sufficient to prevent all types of cervical cancers. In other words, vaccination is not a substitute for regular cervical cancer screening.

Should boys also be vaccinated?

HPV vaccination has recently been extended to boys in France and other countries around the world for a number of reasons. First, 4 out of 10 HPV-related cancers occur in men, and vaccination can prevent most HPV-related cancers in men. In fact, HPV infections can cause genital warts, penile, anal, and oropharyngeal cancers in men. In addition, vaccinating boys protects girls from HPV infections. Finally, gender-neutral vaccination can help prevent the spread of HPV in the population and could ultimately lead to the eradication of high-risk oncogenic HPVs.

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