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Human papillomavirus vaccination advised for boys

WEDNESDAY, OCT. 26, 2011

A vaccine that protects against the sexually transmitted human papillomavirus should be routinely given to boys ages 11 and 12 to prevent anal cancer, a government advisory committee has decided.

Though many parents may not wish to contemplate the future sex lives of their pre-adolescent children, vaccinating them young is the best way to avoid the risk of the cancer-causing virus, experts said Tuesday.

The recommendation is sure to ignite further debate among the Republican presidential candidates who have focused intently on whether the controversial vaccine, called Gardasil, is appropriate for girls – who receive it for prevention of cervical cancer – let alone for boys.

Texas Gov. Rick Perry was criticized by his fellow Republican presidential candidates for ordering mandatory HPV vaccination in girls in his state in 2007. The mandate was overturned by the state Legislature and Perry eventually withdrew his support for the idea.

The Advisory Committee on Immunization Practices’ Tuesday vote of 13-0 (with one abstention) in favor of routine HPV vaccination of boys supercedes a 2009 vote by the panel recommending Gardasil be available to males ages 9 to 26 to prevent genital warts but not recommending routine vaccinations.

Since then, several studies have shown that the human papillomavirus is responsible for many cases of anal cancer in addition to cervical cancer and genital warts, and that the vaccine can curb this risk, warranting a shift to stronger recommendations, the panel members said. The vaccination of boys also will help protect unvaccinated females, the panel added.

Gardasil, administered as a three-shot regimen, has been advised since 2006 for girls ages 11-12 as well as for older unvaccinated females to prevent cervical cancer.

In addition to routinely administering Gardasil to boys ages 11-12, the panel, which advises the Centers for Disease Control and Prevention, also advised vaccination for boys as young as age 9 and for males ages 13-21 who have missed the ideal vaccination age window of 11-12.

Although CDC officials do not have to follow the committee’s guidance, they often do – and a CDC vaccination recommendation is significant because health insurers typically shape their coverage to be in line with such recommendations.

“I think this a major step forward in prevention of HPV-related cancers,” said Dr. Joel Palefsky, a professor of medicine at the University of California, San Francisco, and director of the UCSF Anal Neoplasia Clinic. Palefsky’s lab reported last year that Gardasil curbs the development of precancerous anal lesions that can evolve into cancers; he has received grants from Merck, the maker of Gardasil, and has served as an adviser to the company.

“It also serves to equalize the burden of vaccination to not just one gender – and recognizes the responsibility of both males and females,” Palefsky said.

Anal precancers are difficult to treat and there is no routine screening test for the early diagnosis of the disease as there is for cervical cancer. The four strains of HPV that Gardasil protects against account for about 90 percent of all cases of anal cancers, he added.

More than 5,000 cases of anal cancer are reported per year, and about 700 people die from it annually, according to the American Cancer Society. Rates have doubled in the United States since 1980 and are increasing about 2 percent per year.

Men who have sex with men are at highest risk for anal cancer. For that reason, some health experts proposed recommending HPV vaccination only to gay or bisexual men.

But, as with girls, the vaccine would be most effective if delivered before initiation of sexual activity – and trying to target the vaccine based on sexual orientation for school-age males would be a practical and ethical morass, health experts have noted.

“A routine vaccination recommendation de-stigmatizes the vaccine and makes it likely that those people who would benefit the most will also get the vaccine,” Palefsky said.

Heterosexual men will also benefit from vaccination, in any case, by a reduction in the risk of genital warts, anal cancer and, possibly, some oral cancers, he added.


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