I received an email from a close friend who has been battling neck and throat caner. He is the second person I know who has had this problem one being an MC Alum many of you know. The cause of the cancer is now preventable through vaccine. I will cite his message here:
Most on this mailing list know that I had a form of squamous cell carcinoma of the head-and-neck caused by HPV-16--I know this because my removed tumors were tested and they showed up HPV-16 positive. HPV is human papilloma virus, a virus that causes warts.
I've been encouraging friends with children, male and female, to have them vaccinated for HPV with Gardisil. And so I post this here. If you yourself don't have children, but have friends or family that do, please ask them to consider vaccinating their children before puberty. Forward this email if you like, I'm not shy.
HPV is a very common virus. It is thought that over 80% of adults are infected. It is spread most frequently by sex, and I mean ANY sex--oral, vaginal and anal, heterosexual and homosexual, male and female. You can get it from french kissing and even plain-old skin-to-skin contact. Studies have shown that 30% to 50% of teens who have had sex have HPV, so it is important to vaccinate early.
Gardisil can prevent several strains of HPV, and in particular it protects against HPV-16, the form of the virus most likely to cause squamous cell carcinoma.
You have likely heard the news that HPV causes cervical cancer in women, and that Gardisil should be provided to pre-pubescent girls to prevent it. It is now thought to cause many cases of head-and-neck cancer, as well. In particular, a growing increase in cases of squamous cell carcinoma among younger, non-smokers, non-drinkers, like me, is associated with HPV infection.
If you are infected with HPV-16, you are more than 50 TIMES more likely to get cervical or head-and-neck cancer. The HPV form of this cancer is easily preventable by this vaccine. I'm guessing that's about half of head-and-neck cancers, and probably most of the cervical cancers.
I've appended a bit of detail talking more about what is known about HPV cancers of the head-and-neck. It's interesting that surgery is less recommended now, even just a few months after my treatment. (But frankly, the major complications in my treatment are more the result of radiation rather than surgery.)
Anyway, please strongly consider Gardisil vaccination for your children. Suggest it to your pals with children. Feel free to forward this email. Thanks.
Date: Wed, 14 Nov 2007 13:56:57 +0000
From: "Gail B. Mackiernan"
Subject: Re: HPV+ vs HPV- treatment differences in tonsil SCC
Right now there is no significant difference in initial treatment (that is, chemoradiation) since the issue of HPV+ head/neck cancer is relatively newly recognized. Researchers are just determining how this cancer differs biologically from that caused by smoking, and if these biological differences can be employed to better treat the virally-caused disease.
Most current studies are looking at differences in response to treatment and prognosis, & there is also the serious issue that earlier studies did not distinquish between the two cancers and thus, results which compare one treatment regime or drug to another may well be compromised, since the two cancers could respond differently. This was discussed by Dr. Maura Gillison in her J. Oncology editorial last December and was also addressed in the 2007 ASCO HPV/HNC summary document.
However, having said that, oncologists are concerned with the fact that many patients with HPV+ HNC are young and have no other serious health issues, & since this cancer responds better to treatment and is far less likely to recur, the survivor has to live with the effects of treatment for decades. Our RO discussed this at some length with us earlier this month and it has also been addressed in several summary papers on HPV+ HNC. Thus the recognized need to do enough to eliminate the cancer but not to "over-treat", which is, as our RO said, a very delicate balancing act!
The one place where a change in treatment has occurred, at least at our institution (Hopkins), is not doing routine neck dissections on HPV+ patients who have shown what is called a "complete clinical response" to the chemoradiation. Because they were seeing no added benefit and lots of negative issues. This is, in fact, a change from when my husband was diagnosed in 2005 as then his ENT had recommended a "planned ND" after treatment and was a little miffed when Barry declined it. At a meeting earlier this month, Barry's RO also discussed the possibility of reduced radiation dose, and other possible changes in approach, but these of course await careful study due to the risk of under-treatment.
Certainly the potential of a therapeutic vaccine or other means to eliminate the virus will be the treatment of the future, since very preliminary research indicates that once the virus is gone the abnormal cells regain "normal cell death" and die. This is, in fact, the crux of the difference between HPV+ and HPV- cancers, in that the former retain a normal gene for apoptosis ("cell death") but it is inhibited by the viral genes, whereas in the latter the gene for cell death is damaged or mutated, and does not function. Thus the cells continue to grow uncontrollably. But such treatment is years away, the vaccines are just in Phase I trial now.
The growing risk of HPV cancer is the reason that The Oral Cancer Foundation and others have strongly recommended that boys as well as girls receive the prophylactic vaccine Gardisil (there are some other vaccines coming on market as well).