HPV vaccine for anal cancer

Marck Sharp & Dohme's (MSD) human papillomavirus (HPV) vaccine has now been approved for an extension of indication to include prevention of anal cancer in both males and females aged nine through 26 years. It is now the only vaccine indicated for prevention of cervical, vulvar and vaginal cancer in women; as well as genital warts and anal cancer prevention in both men and women.

This serves as a significant step forward, as more diseases are being linked to HPV infection, such as HPV-related anal cancer and oropharyngeal cancer. Epidemiological data has shown that anal cancer cases are on the rise worldwide and locally. Now, through clinical trials, the vaccine has been shown to provide the added benefit of prevention against anal cancer.

MSD's HPV vaccine is a quadrivalent vaccine that prevents against HPV types 6, 11, 16 and 18, which are responsible for causing most HPV-related diseases.

HPV is the leading cause of cervical cancer in women - types 16 and 18 cause about 70 per cent of all cervical cancer cases.

In addition, HPV types 16 and 18 are responsible for more than half of all vulvar and vaginal cancer cases. These two types are also responsible for a majority of anal cancer cases. Types 6 and 11 can cause genital warts in both women and men.

HPV types 6, 11, 16 and 18 also lead to abnormal pap smears in women - with precancerous and dysplastic lesions in women and men.

According to the World Health Organisation (WHO), HPV infection is associated with up to 85 per cent of cases of anal cancer worldwide. HPV type 16 represents 87 per cent of all HPV-positive tumours, while HPV type 18 is found in approximately 9 per cent of all anal cancer cases in the world.

According to the WHO, there has been an upward trend in the number of anal cancers worldwide, in both men and women, over the last five decades. In 2002, there were an estimated 99,000 new cases in the world - 40 per cent cases in men and 60 per cent in women.

Additionally, in 2010, WHO world estimates of HPV prevalence among heterosexual individuals was reported to be about 69 per cent.

"At this moment, anal cancer incidence is reported to be low in Malaysia as there is no routine screening recommended for anal cancer in Malaysia," said Dr Suresh Kumarasamy, past president of the Obstetrical & Gynaecological Society of Malaysia and consultant gynaecological oncologist.

"Preventative measures will play a key role in ensuring anal cancer disease burden remains low in Malaysia.

"As a result, vaccination is an important means of prevention, as it may result in fewer diagnoses, and subsequent surgeries and radiation or chemotherapy, that affected individuals may have to endure," Dr Suresh added.

In 2010, the US Food and Drug Administration (FDA) approved the vaccine for the prevention of anal cancer, which is also caused by the same HPV types. This year, Malaysia followed suit and the Drug Control Authority has approved the vaccine for the prevention of anal cancer in males and females.

Dr Suresh also commented: "The recent approval for the prevention of anal cancer is an important development because HPV infection affects men, as well as women. HPV is a common sexually-transmitted infection, passed from one person to another during sexual contact.

"According to the US Centre for Disease Control and Prevention, it is estimated that one in every two sexually-active women and men will be infected by HPV in their lives. Everyone who is sexually active is at risk and it doesn't matter how many sexual partners a person has had. There are more than 100 types of HPV, and about 40 affect the genital areas," he added.

Therefore, parents should consider vaccinating their sons, as well their daughters. Young women and men are also strongly encouraged to get vaccinated.

Public health departments worldwide and here in Malaysia recognise the importance of cervical cancer prevention. As a result, many countries are funding HPV vaccination programmes for adolescent girls.

Currently in Malaysia, HPV vaccination is provided free for 13-year-old girls in schools by the Health Ministry, and 18-year-old girls through the National Population & Family Development Board catch-up programme in Malaysia.

Talk to your doctor about vaccinating against HPV today.