Calls to immunise teenage boys against throat cancer
The Department of Health is being urged to review the national immunisation programme against the commonest sexually transmitted infection in response to a dramatic rise in cancer linked to oral sex.
Cases of oropharyngeal cancer [of the throat] have more than doubled to over 1,000 annually since the mid-1990s after remaining stable for many years.
More than 70 per cent of cases are caused by human papilloma virus (HPV), compared with less than a third a decade ago. HPV is transmitted during sex and may also be spread by open-mouth kissing. It is the main cause of cervical cancer in women, affecting almost 3,000 women a year in the UK.
Cancer typically takes 20 to 30 years to develop and the rise in HPV-related throat cancer is being seen as the legacy of the sexual revolution that began in the 1960s. Experts say oral sex is seen by teenagers as safer than sexual intercourse as carrying no risk of pregnancy or infections.
Since 2008 all girls aged 12 to 13 in the UK have been offered a vaccination to protect them from HPV. Specialists are now calling for boys to be offered the vaccine too, so both sexes are protected against throat cancer as well as further reducing the risk of cervical cancer in girls and of other cancers caused by HPV. Research suggests boys are more prone to get throat cancer from oral sex because the virus is found in higher concentrations in the female genital tract.
The Department of Health requested the latest figures from Professor Hisham Mehanna, director of the Institute of Head and Neck Studies in Coventry, who has surveyed the incidence of HPV-related oropharyngeal cancer in the UK and other countries.
Professor Mehanna said: "We are experiencing a very significant rise in oropharyngeal cancer. It used to be rare in our practice – now it is the most common [head and neck] cancer we see. All the studies show there is a strong association with oral sex."
The typical victim has also changed from older patients in lower socio-economic groups who smoked to those who are younger and middle class. "What is striking about the cancer is that we are seeing it in younger patients. We regularly get people of 45 and sometimes in their 30s. Oropharyngeal cancer was stable until 1996 – then it very definitely took off. This tumour takes 20 to 30 years to develop – it is probably linked to the sexual revolution."
The Department of Health decided in the mid-2000s to limit HPV vaccination to girls on the basis of the best estimates of HPV-related cancers at the time. "They asked for my data so they can look again at their assessment. There is definitely enough evidence to warrant looking at it again. The question is whether the new figures make it cost-effective [to extend the vaccination to boys]."
Professor Andy Hall, chair of the Joint Committee on Vaccination and Immunisation, said he had not seen the latest figures. "Clearly a change in cancer is always a concern," he said.
Professor David Salisbury, director of immunisation at the Department of Health, said: "We asked the Health Protection Agency to look at HPV-related oral and throat cancers in 2011. The conclusions continued to support the vaccination of females but not males. Any new information would be considered by the JCVI."
HPV vaccination: The girls-only jab
Many specialists criticised the Department of Health's decision to restrict HPV vaccination to girls when it was introduced in 2008. They argued that giving it to boys would reduce the prevalence of the infection in the population by increasing "herd" immunity, offer added protection to girls, and prevent genital warts and anal cancer in both sexes. The department said vaccinating boys could not be justified on cost-benefit grounds – but that was before the scale of the rise in HPV-related throat cancer was known. If the rapid increase in this cancer continues, the case for vaccinating boys will become overwhelming.