Canadian docs recommend HPV vaccine for boys

By Dr. Ananya Mandal, MDApr 16 2012

Canadian doctors believe boys should have free access to immunization against the human papilloma virus (HPV).

Girls have had access to free HPV vaccinations for five years - administered to protect them against cervical cancer - and this week, the Canadian Cancer Advocacy Coalition called on provincial governments to pay for the vaccine for boys as well. In January, the National Advisory Committee on Immunization recommended HPV vaccination for males aged nine to 25.

Physicians point out that HPV causes disease and death from cancer in both men and women, and that vaccinating men will contribute to protecting women from certain strains of HPV as well.

“Now is the time for governments to apply universal vaccine coverage for our boys and our girls to protect them from disease in the future,” the coalition's report concluded.

The more common HPV vaccine, Gardasil, was initially only approved in Canada for use in girls and young women, but Health Canada expanded approval to males in 2010. Another vaccine, Cervarix, is only approved for use in females.

“The thought is if we vaccinate men, that will contribute to protecting women as well,” said London, Ont.-based physician Marina Salvadori, the Canadian Pediatric Society’s representative to the National Advisory Committee on Immunization. “So they don’t spread the viruses to each other, both groups are protected from cancer and it’s a win-win all round.”

HPV refers to a group of viruses that cause skin warts, genital warts and some cancers. Two strains of HPV are thought be responsible for 80 per cent to 90 per cent of anal cancers, 40 per cent to 50 per cent of penile cancers, 35 per cent of oropharyngeal cancers and 25 per cent of oral cavity cancers.

Australian doctors however differ in their opinion. Writing in today’s Medical Journal of Australia, University of Newcastle School of Medicine and Public Health Professor David Durrheim and University of New England School of Health adjunct senior lecturer Peter Massey said it was not a sensible use of public health resources.

Professor Durrheim is also a Hunter New England public health physician. Their letter said that, based on analysis of US programs, an extended Australian program would not be cost-effective.

Modelling also showed limited community immunity gains. It would be preferable to consider selective vaccination of higher-risk groups, especially men who had sex with men, to reduce incidence of oropharyngeal cancer, a type of oral cancer, and anal cancer.

In resource-constrained settings, the first priority in reducing HPV-related cancer mortality was to vaccinate preadolescent girls, the letter said. The authors said Australia had one of the lowest cervical cancer rates in the world and high rates of cervical cancer screening.