As Wednesday 27th of July marks World Head and Neck
Cancer Day, health agencies say it’s a timely opportunity
to raise awareness about the devastating health impacts of
head and neck cancers, including oropharyngeal (throat)
cancer caused by Human Papillomavirus Virus (HPV).
The
Head and Neck Cancer Foundation Aotearoa (HNCFA), the Head
and Neck Cancer Support Network (HNCSN) and the Sexually
Transmitted Infections Education Foundation (STIEF) is also
reminding New Zealanders that prevention is available for
free in the form of the Gardasil vaccine. This highly
effective and safe vaccine prevents infection with HPV, and
significantly reduces the risk of developing many different
forms of cancer, including oropharyngeal cancer, cervical
cancer and penile cancer.
This year, it is even more
important because a significant proportion of our children
have been missing out on this health prevention opportunity,
due to the disruption brought by COVID-19, which is of great
concern. In 2021, 53,000 fewer vaccines were delivered than
in 2019, and the total reduction in doses over two years has
been approximately 78,000 – that’s more than 30,000
Tamariki who have missed out.
HPV Head and Neck Cancer
Survivor, Doug Russell, says “it was a no-brainer to
vaccinate my children against HPV – they are all fully
vaccinated with Gardasil. Knowing that they are protected
from HPV-related cancers is one less worry on my mind.”
“As a parent I do not want to be in a position later in
life when our children could come to us with HPV and ask why
they did not get vaccinated for this entirely preventable
disease.”
HPV is one of the world’s most
widespread viral infections, usually resulting from direct
skin-to-skin contact during intimate sexual contact with
someone who has HPV. Without immunisation, around 80 per
cent of people who have ever had penetrative, or
non-penetrative sexual (vaginal, oral, or anal) contact will
be infected by at least one type of HPV at some point in
their lives. Unfortunately, condom use during sex doesn’t
reliably prevent transmission of this virus.
Although
there are over 150 types of HPV, only a small number of
these are ‘high-risk HPV’ strains that have the
potential to lead to cancerous changes in cells. HPV is a
bit of an “unlucky dip” really: in many people, HPV is
naturally cleared by the body’s immune system, some people
will retain the virus but have low-risk strains that may
lead to genital warts, whilst others may have the high-risk
strains and develop devastating cancers – sometimes
decades later – having never known about the original
infection. It isn’t possible to predict which
group your child will fall into if/when exposed to HPV, but
it is possible to protect them by getting them
vaccinated.
The virus is most commonly associated with
cervical cancer, but can also cause other cancers in the
genital area of people of all genders, specifically the
vagina, vulva, penis, and anus. In recent years, medical
professionals have also observed a rapid rise in HPV-related
oropharyngeal cancer in heterosexual people who are
otherwise healthy. For this group, the main risk is
oropharyngeal cancer, which affects the throat (tonsils,
base of tongue and soft palate). Although this type of
cancer has traditionally been linked to smoking and heavy
drinking, in recent years HPV has become the leading cause.
Oropharyngeal cancers caused by HPV are rapidly rising in
developed countries. In New Zealand, 95 new cases of
HPV-related oropharyngeal cancer with 25 deaths were
estimated for 2018. In 2020, there were 334 oropharyngeal
cancer cases caused by HPV.
Doug Russell, an otherwise
healthy 58-year-old, describes the lead-up to “the single
toughest day” of his life in 2017. “I had a shave one
lazy Sunday morning and there was nothing wrong with me. And
at lunchtime, I was sitting in the kitchen having a
sandwich, and I put my hand on my throat and I said to my
wife Sarah “what is that lump?” And there was a big
lump. “So on Monday, I went to the doctor and that started
this whole thing, it just appeared overnight like
that.”
Doug was infected with a high-risk strain of
HPV, which he had never been aware of until it led to his
cancer. “I thought I was living my life to the fullest,
and I thought cancer was something that happened to other
people. I really struggled, and still do struggle a little
bit, to understand why this happened to me, and what the
implications would be for my family.”
Doug’s
experience of it happening ‘overnight’ is not uncommon.
Head and neck cancers including oropharyngeal cancer are
notoriously difficult to detect and, as a consequence, are
often only discovered in advanced stages. Symptoms will
often be very mild initially and will depend on where
exactly the cancer is situated, how big it is and how far it
has spread in the body.
The most common symptoms
are:
- a painless lump in the neck or in
front of the ear - a lump or ulcer in the mouth, such
as the tongue, gum, or inside the cheek - a persistent
white or red patch in the mouth - a one-sided sore
throat which may be associated with earache - pain or
difficulty with swallowing - a hoarse voice,
especially in a smoker - difficult or noisy
breathing - a lump or sore on the
face - numbness or weakness on one side of the
face - one-sided blocked nose with
bleeding
Many less serious conditions
(apart from cancer) can cause these symptoms, but it is
important to consult your doctor if they persist for more
than 3 weeks.
Although many people with
HPV-related oropharyngeal cancer survive following
treatment, many patients suffer from long-lasting effects of
the treatment.
Unlike cervical cancer, which can be
screened for with a smear test, there is no simple way to
screen for oropharyngeal cancer – but the great news,
especially for young people, is that HPV infection
and the cancers it causes are largely preventable.
Vaccination
against HPV infection has been available for many years
and is highly effective and safe, with millions of doses
administered worldwide. In New Zealand the HPV vaccine,
known as Gardasil, is free for people aged from 9 years up
to their 27th birthday. For those who have missed the school
vaccination programme (year 8 students), the vaccine is
available free of charge through their GP or health care
provider. It is also safe to be given at the same time as
other vaccines. As Dr John Chaplin, head and neck cancer
surgeon and Board Member of the HNCFA, says “HPV-related
oropharyngeal cancer affects both men and women. It is a
devastating disease that can be prevented by HPV
vaccination.”
Dr Cathy Stephenson, a GP with a
special interest in youth health, says “I truly can’t
think of a single reason not to get this vaccine. It’s
safe, it’s free, it’s been extensively used and analysed
around the world, and it prevents cancer. The average
21-year-old is unlikely to be thinking, ‘If I don’t get
this vaccine now, I’m going to be at risk of cancer in 20
years’ time.’ But that is the reality – that’s when
it’s going to hit you. Ask one of the increasing number of
middle-aged men being diagnosed with cancers directly caused
by exposure to HPV in their teens and 20s if it’s a
vaccine worth having – had it been available for them,
they wouldn’t be suffering now.”
While New Zealand
is currently working towards a 75% HPV vaccination rate,
uptake in Australia and the Pacific is around 90%. HNCFA and
STIEF have been working collaboratively with Te Whatu Ora –
Health New Zealand, to increase vaccination uptake and some
exciting initiatives are currently being
explored.
Rachel Mackay, Group Manager of Te Whatu
Ora’s National Immunisation Programme, says: “We are
committed to ensuring Tamariki and Rangatahi have equitable
access to this cancer-preventing vaccine, and are working
closely with our partners across the sector towards this
goal. If the World Health Organization can implement a
global strategy to eliminate cervical cancer through HPV
vaccination, we have an opportunity to achieve the same
outcome for HPV-related oropharyngeal cancer in New Zealand
too.”
“We have a lot of work to do but there is no
reason why we can’t achieve a 90% vaccination rate as our
immediate neighbours have done, or more, as we have done
with COVID-19, if we all collectively work towards this
goal.” Says Dr Swee Tan, Chair of HNCFA. “Cancer
diagnosis is devastating, and its treatment is harsh with
short-term and long-term consequences. Prevention is better
than cure.”
So, on Wednesday, as the world
acknowledges the impact that head and neck cancers have on
so many lives, HNCFA, HNCSN, and STIEF urge you to consider
the young people in your lives – is your child one of the
30,000 that have missed out on the school-based vaccination
programme? If they haven’t had their Gardasil immunisations,
book them in now!
For more information
visit:
About the Sexually
Transmitted Infections Education Foundation
(STIEF):
The Sexually
Transmitted Infections Education Foundation (STIEF) is a
registered charity providing governance and project
management to the HPV Project,
Herpes Foundation and
Just the Facts
(about sexual health and STIs). The organisation provides
medically accurate information, support, education and
resources based on current international best practice,
regarding the optimal management of HPV, herpes and other
STIs.
About the Head and Neck Cancer Foundation
Aotearoa (HNCFA)
The vision of the Head and Neck
Cancer Foundation Aotearoa (HNCFA) is to promote
prevention, early detection, and improved treatment of
patients with cancer in the head and neck area.
About
the Head and Neck Cancer Support Network (HNCSN)
The
Head and Neck Cancer
Support Network (HNCSN) connects, supports, and
advocates for people affected by head and neck cancer in New
Zealand. The Network is there to support patients and their
whānau throughout their cancer
journey.
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