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Morka et al., 2021. Prostate cancer and the human papilloma virus: causative association, role of vaccines, and the impact of the COVID-19 pandemic. Prostate Cancer and Prostatic Diseases 

Due to COVID-19, we are all more aware than ever of the importance of vaccination against infectious diseases. With efforts currently concentrated on vaccination against COVID-19, we must not lose sight of the importance of, and adherence to, other vaccination programs.

Australia leads the world with vaccination against HPV, having the first national vaccination program (commencing for females in 2007 and expanding to cover males in 2013) and current coverage of more than 80% of 15-year-old females and over 75% of 15-year-old males1.

HPV vaccination is important for males. This year, cancers of the penis, anus and oropharynx are expected to be diagnosed in at least 150, 240 and 790 Australian men, respectively2. HPV is likely causative in approximately 63%, 89% and 72% of these cases3, meaning that cancers caused by the virus in Australian males will total around 875 this year alone.

The ability of HPV vaccination to prevent cervical cancer in females4 and genital warts in males and females5 is well established. It is also likely that other gynaecological cancers and anal and oropharyngeal cancers will be prevented by HPV vaccination.

Accumulating evidence suggests HPV infection may be an initiating factor in some cases of prostate cancer6. Men with HPV infection are more than twice as likely to develop prostate cancer than uninfected males, and cancerous prostate lesions are more likely to harbour highly pathogenic types of the virus when compared to benign lesions. Several mechanisms of oncogenesis may be affected by HPV infection9.

Even though a role for HPV infection in the pathogenesis of prostate cancer is not certain, the prospect that HPV vaccination might prevent the disease in some men is compelling. We are still some years away from definitive proof that HPV vaccination prevents cervical cancer and saves women’s lives. It will be longer still until an effect on prostate cancer, if there is one, will be known.

We need not focus on the uncertainty that HPV vaccination might or might not protect against prostate cancer. What’s important is that the HPV vaccine is safe and extremely effective against HPV infection and related lesions in males (and females) for years7. Protection against prostate cancer would be a bonus.

In the United States and Europe, HPV vaccination programs have been interrupted by the COVID-19 pandemic8,9. It’s reasonable to expect Australia’s school-based HPV vaccination program may have been similarly affected by movement restrictions, school closures and other public health precautions. Some variation in the two or three-dose schedules for HPV vaccinations is likely possible without impairing efficacy, so if there is some interruption getting back on track should be possible.

In 2020, despite the COVID-19 pandemic, a record number of influenza vaccinations were delivered in Australia (32.5% of the population) and the coverage of routine childhood vaccination was not substantially affected10. Unfortunately, similar information about HPV vaccination is not available11.

If COVID-19 has interrupted our national HPV vaccination program, we must ensure catch-up as soon as possible.

 

[1] https://www.health.gov.au/resources/collections/historical-data-from-the-national-hpv-vaccination-program-register

[2] https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-incidence-by-age-visualisation

[3] Saraiya et al., 2015. US Assessment of HPV Types in Cancers: Implications for Current and 9-Valent HPV Vaccines. JNCI: Journal of the National Cancer Institute

[4] Leiet al., 2020. HPV Vaccination and the Risk of Invasive Cervical Cancer. New England Journal of Medicine

[5] Lukács et al., 2020. The quadrivalent HPV vaccine is protective against genital warts: a meta-analysis. BMC Public Health

[6] Morka et al., 2021. Prostate cancer and the human papilloma virus: causative association, role of vaccines, and the impact of the COVID-19 pandemic. Prostate Cancer and Prostatic Diseases

[7] Giuliano et al., 2011. Efficacy of Quadrivalent HPV Vaccine against HPV Infection and Disease in Males. New England Journal of Medicine

[8] Gilkey et al., 2020. Getting Human Papillomavirus Vaccination Back on Track: Protecting Our National Investment in Human Papillomavirus Vaccination in the COVID-19 Era. Journal of Adolescent Health

[9] Viral Protection: Achieving the Possible A Four Step Plan for Eliminating HPV Cancers in Europe. European Cancer Organisation, October 2020. [available at https://www.europeancancer.org/resources/159:viral-protection-achieving-the-possible-a-four-step-plan-for-eliminating-hpv-cancers-in-europe]

[10] ATAGI 2021 annual statement on immunisation. Australian Government Department of Health, April 2021. [available at https://www.health.gov.au/resources/publications/australian-technical-advisory-group-on-immunisation-atagi-annual-statement-on-immunisation-2021]

[11] https://data.gov.au/data/dataset/national-human-papilloma-vaccination-program-register/resource/0a97e4bf-dc77-4118-b0dd-d155ef78572c