For the third consecutive year, the National Cancer Institute, the 70 NCI-designated cancer centers and partners — American Cancer Society, the American Association for Cancer Research, the American Society for Clinical Oncology, the Prevent Cancer Foundation, the American Society for Preventive Oncology and the Association of American Cancer Institutes – issued a joint statement that urged increased HPV vaccination and screening to eliminate HPV-related cancers, including cervical cancer.
Darron Brown, MD, professor of medicine in the Division of Infectious Diseases and professor of microbiology and immunology at IU School of Medicine and a researcher at the IU Simon Cancer Center, provided answers to questions about HPV. A leading authority on HPV, Dr. Brown has been studying the virus since 1985.
Q: What is HPV and what health threats does it pose?
Dr. Brown: Several types of human papillomavirus, HPV, are highly cancerous viruses. Most women become infected at some stage of adult life, but fortunately, only a small percentage of women infected with these viruses will develop cancer, thanks to screening programs. However, the World Health Organization estimates that HPV causes nearly 10 percent of all human cancers. HPV is the cause of all cervical cancers as well as a high percentage of anal and oropharyngeal cancer in both men and women. Nearly 90 percent of all cervical cancer deaths occur in poor countries, such as India, countries in South-East Asia and Sub-Saharan African countries.
Q: How common are these cancers?
Dr. Brown: Cervical cancer is the most common cancer in women living in poor countries and the most frequent cause of cancer-related mortality in these countries. In the U.S., cervical cancer is uncommon due to screening programs, but we spend billions of dollars each year on screening and treatment of pre-cancerous lesions. The incidence of anal cancer and the incidence of oropharyngeal cancer are rising in the U.S. at alarming rates, and there are no screening methods to detect these cancers.
Q: Until about 10 years ago, I had never heard of HPV. What happened to bring it to the forefront of conversations about health threats?
Dr. Brown: HPV was shown to cause cervical cancer in the late 1980s. Harold zur Hausen, a German scientist, was awarded the Nobel Prize in Medicine for this discovery. The medical community learned about HPV over the next decade or so, and when a vaccine was developed in the late 1990s that could prevent HPV infection, the lay press rapidly became interested in HPV. Now we know that cervical cancer is preventable through a combination of vaccination of children and young adults against HPV and screening of adult women.
Q: Do you encourage HPV vaccination?
Dr. Brown: Vaccination against HPV is safe and effective. We can completely prevent cervical cancer by vaccinating children and young adults against HPV and by screening adult women. Other cancers caused by HPV, such as anal cancer and oropharyngeal cancer, can only be prevented by vaccination against HPV since there are no screening methods available for these cancers. The HPV vaccines must be given before sexual exposure to the viruses because they prevent infection. I strongly encourage every parent to insist that their children are vaccinated against HPV. All three of my own children have been vaccinated.
Q: Why are vaccination rates so low in the United States compared to other countries?
Dr. Brown: People in the U.S. are beginning to understand the need for this vaccine and vaccination rates are improving. We currently are behind countries such as Australia and New Zealand, countries that utilize school-based programs for HPV vaccination. These countries will be the first to eliminate cervical cancer, anal cancer, oropharyngeal cancer, genital warts and other conditions caused by HPV. We need our medical communities to strongly recommend the HPV vaccine to families because a strong recommendation from a health care provider is the best way to assure that a family will accept the vaccine and allow their children to be protected against HPV.
Q: This is the third time that all NCI-designated cancer centers have supported a joint HPV statement. That seems significant. Is HPV an unnecessary public health threat?
Dr. Brown: HPV causes cancer. We have the means to prevent cervical cancer through a combination of vaccination of children and young adults against HPV and screening of adult women. The NCI’s mission — and the mission of the NCI-designated cancer centers — is to prevent cancer. It makes sense for the NCI, the cancer centers, and the various partners to support the use of this safe and effective vaccine.
Q: You have spent a significant amount of your career studying HPV. What have been your major contributions to HPV research?
Dr. Brown: I’ve been studying HPV since 1985. I began this work with no hint that a vaccine was possible. Thanks to the ground-breaking work of scientists in Australia, the University of Rochester and the NCI, we were able to begin work on a prototype vaccine here at IU School of Medicine. We developed a neutralization assay that could show if the new vaccine stimulated the production of antibodies against HPV. Dr. Kenneth Fife and I, working with scientists from Merck, performed the world’s first clinical trial of any HPV vaccine here at IU School of Medicine. After this successful trial, we continued to work on expanded versions of the vaccine, on larger clinical trials and on epidemiological and immunological studies related to HPV and HPV vaccination. We are continuing these studies at present, here and in Africa, where a large percentage of cervical cancer deaths occur.
The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
Michael Schug, an award-winning communicator, is the communications manager at the Indiana University Melvin and Bren Simon Comprehensive Cancer Center. In this role, he promotes the important research generated by the nearly 240 research members of the IU Simon Comprehensive Cancer Center.