Cervical Cancer & HPV: Examining Gender-Based Vaccinations

Cervical cancer is an exemplary example of the conjunction between public health awareness, pharmaceutical influence, and women’s health. This cancer originates in the squamous cells of the cervix and is the third most common form of cancer to affect women worldwide (Kahn, 2009). This cancer has a slow progression and its precancerous condition known as dysplasia can be detected by routine Pap smear exams and is entirely treatable. Left untreated this condition can progress into cervical cancer, eventually affecting the bladder, intestines, lungs, and liver and may cause infertility and death.
The majority of cervical cancers have been determined to be caused by the Human Papilloma Virus (HPV). This virus is spread through sexual intercourse and has several risk factors including early onset of sexual activity, multiple sexual partners, and women whose mothers were prescribed diethylstilbestrol to prevent miscarriage. In June 2006, the FDA released the first vaccine to prevent cancer, Gardacil, which was specific to preventing HPV and subsequently cervical cancer (Kahn, 2009). The release of Gardacil into the market was coupled with widespread educational/marketing regarding the risks of HPV in the causation of cervical cancer (Merck, 2010). This coupling was unique not only in the revolutionary vaccine, but also in the level of awareness created about HPV by pharmaceutical promoters who lobbied for insurance companies and federal programs to routinize, subsidize, and cover the costs of vaccination in females aged 9-26 (Merck, 2010).
I understand why this vaccine targeted females as they are the only ones to suffer from cervical cancer. Yet, I was always perplexed why this vaccine was so heavily and exclusively promoted for females rather than including males as potential carriers of HPV. Recent studies have also examined the immunogenicity and safety of vaccinating males to prevent the spread of HPV and certain penile cancers associated with it (Petaja et. al., 2009). In Petaja et. al. (2009), males ages 10 to 18 years were randomized to receive HPV-16/18 AS04-adjuvanted vaccine (n = 181) or hepatitis B virus (HBV) control vaccine (n = 89) at 0, 1, and 6 months, and were followed for 7 months. Study research resulted in high antibody levels and seropositivity at the 7 month interval and concluded that the vaccine was well tolerated. The study did not specify recommendations regarding the vaccination of boys as they determined that the potential public health benefits required more data. Although I hesitate to conclude this for them, I am entirely supportive of the unilateral recommendation for vaccinating both male and females for HPV. The rationale that as predominantly carriers only, males should be excluded, is an affront to a basic public health tenant of prevention as integral and essential.
Kahn JA. (2009) HPV vaccination for the prevention of cervical intraepithelial neoplasia. New England Journal of Medicine. 16,361(3),271-278.

Merck & Co. (2010) Gardacil. Accessed April 21, 2011 from http://www.gardasil.com/

NCCN Clinical Practical Guidelines in Oncology: Cervical cancer. V.1.2010. National Comprehensive Cancer Network, Inc. Available at www.NCCN. org. Accessed December 28, 2009.
Petäjä T, Keränen H, Karppa T, Kawa A, Lantela S, Siitari-Mattila M, Levänen H, Tocklin T, Godeaux O, Lehtinen M, Dubin G. (2009) Immunogenicity and safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine in healthy boys aged 10-18 years. J Adolesc Health. 44(1):33-40.