Ignorance and taboo about human papillomavirus (HPV)

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Population screening does not reach everyone

Every year, nearly 1,600 men and women develop cancer from the human papillomavirus (HPV). Cervical cancer is the best known, but people also get cancer in the oral cavity, anus, vagina, labia and penis. ‘Get your children vaccinated,’ say doctors from the Erasmus MC Cancer Institute.

Grab the recently published Cancer Atlas of the Integrated Cancer Registry, type in cervical cancer, and it is immediately visible: in Rotterdam, Hellevoetsluis and Groningen the map turns bright red. It is a sign that cervical cancer occurs in these areas above average.

It is not about hundreds of extra cases, emphasize pathologist Folkert van Kemenade and gynecologist Heleen van Beekhuizen on behalf of the Netherlands HPV Cancer Free Taskforce. ‘Cervical cancer is perhaps 2 extra cases per 100,000 inhabitants. But you do see a clear difference with the east of the country, where it occurs less often on average.’

It is not entirely clear why HPV cancer is more common in some areas of the Netherlands than in others. Most obvious is that in areas where it occurs more often, fewer women have a smear taken for the population screening for cervical cancer.

The ‘red’ areas are often neighborhoods and villages where there is a health gap between highly educated, well-to-do people and people who are less well off, have a lower education and more often have a non-Western cultural background.

‘Of the 1600 people who get a form of HPV cancer every year, 567 die’

‘There is ignorance about HPV and it is taboo,’ say Van Beekhuizen and Van Kemenade. ‘People mistakenly think: if you’re monogamous, you can’t have it. Plus: the population screening does not reach everyone. People don’t understand the invitation letter, or they put it away and postpone making an appointment. Or they find the smear annoying. And the latter in particular is a pity, because nowadays you can easily request a self-test.’

HPV cancer causes misery, they know. ‘You can die from it. But treatment for this type of cancer is also difficult. For example, mouth and throat cancer is often treated with chemoradiation. That is a heavy treatment of radiation and chemotherapy at the same time. Your saliva production decreases, making talking and tasting more difficult.’

Good news
The good news: HPV cancer could be out of the country within a few decades. But then parents must be prepared to have their children vaccinated. The HPV vaccination has been part of the National Immunization Program since 2010 and the invitation falls on the mat in the year that the children turn 10 years old. ‘We don’t expect any really noticeable effects of this until 2042,’ the duo say. “In Australia, where they have been vaccinating for some time and where almost everyone participates, they expect HPV cancer to be a rare disease from 2028.”

Australian children are vaccinated at school. Parents are more or less obliged to participate. If they do not vaccinate, they will not have access to all kinds of services. “We are not in favor of that, but more should certainly be done to educate parents about vaccination. It would be nice if all healthcare professionals, from the dentist to the pharmacist to the obstetrician, asked their patients about the HPV vaccination from time to time.’

Cervical cancer and five other types of cancer are caused by the human papillomavirus (HPV), a virus that infects at least 80 percent of the population at least once in their lives. Usually the body clears the virus itself, but if that fails, cancer can develop.

It is estimated that nearly 1,200 women in the Netherlands contract HPV cancer every year, and at least 74% of these (more than 800 cases) can be prevented with HPV vaccination.

Nearly 400 men also get cancer from HPV. At least 81% of these (about 300 cases) can be prevented with the HPV vaccination. (Source RIVM 2023)

Source: Erasmus MC / Joyce de Bruijn

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