Boys may be next target for HPV vaccine; studies ongoing

The shot is now only approved for girls, but many experts would like to see everyone get it.

By Victoria Stagg Elliott — Posted Aug. 28, 2006

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Elisabeth Righter, MD, a family physician in Dayton, Ohio, has found that the male partners of her patients with cervical cancer are often distraught. Their reaction is not just because someone they love is very sick, but also because the virus that may have caused the illness, the human papillomavirus, may have come from them.

"The men feel awful that they might have given their loved one this infection. They are really upset," said Dr. Righter, the associate director of the Dayton Community Family Medicine Residency.

It is situations like this one that have many experts suggesting that the HPV vaccine, approved by the Food and Drug Administration and recommended in June by the Advisory Committee on Immunization Practices for girls ages 9 to 26, should be considered for boys, too. The hope is that a recommendation for universal vaccination would translate into fewer men transmitting the virus to their partners. Men may also be protected from genital warts and their own HPV-related cancers.

"Boys get HPV-related diseases. But, most important, they're the vector for this virus to women. People need to get this vaccine," said Bradley J. Monk, MD, associate professor in the division of gynecologic oncology at the University of California, Irvine. He wrote a commentary in the August Obstetrics and Gynecology advocating this approach.

Recommending the vaccine universally, some suspect, could also lead more girls to receive it. Many experts point to the history of rubella vaccination, which also benefits girls more and was initially only recommended for this group, as an example. Efforts against that disease only made inroads when the shot was recommended to everyone. Both sexes were more likely to get the vaccine. The herd immunity achieved also reduced the overall prevalence of the virus in the target population.

"[Universal vaccination] is a more enlightened approach," Michael Bookman, MD, director of medical gynecologic oncology at the Fox Chase Cancer Center in Philadelphia.

Opposition never gelled

Proponents of the vaccine's expanded use also feel that parents would be just as receptive to allowing their sons to receive it as their daughters. The long-discussed possible opposition, which stems from the fact that it protects against a virus primarily transmitted by sexual contact, never materialized.

The American Medical Association policy states that students and parents should be educated about HPV and the availability of a vaccine. Meanwhile, conservative organizations such as Focus on the Family support its widespread use while opposing making it mandatory for school entry. Physicians who have been administering the vaccine's first doses say they have met little, if any, resistance.

"[Parents] are requesting it. They want it," said Robert Revelette, MD, a pediatrician in Lexington, Ky.

But while there is a lot of support for using this vaccine in boys, many physicians say it is too soon to start doing so now. Though some say it makes scientific sense that the immunization would work well for everyone, the studies reviewed by the FDA and used for granting approval only included girls. And, although the data available on boys suggest that the shot creates a robust immune response, whether it is safe and prevents disease and viral transmission among males is still an open question.

"We all think it's a good idea, but we should see the data first," said Philip LaRussa, MD, professor of clinical pediatrics at Columbia University in New York and a member of the FDA's Vaccines and Related Biological Products Advisory Committee, which endorsed the vaccine's approval for use in girls. The committee did not vote on whether it should be approved for boys because data were lacking.

Merck & Co., the vaccine's manufacturer, is conducting research to answer the related questions and expects results in 2008. "The studies are ongoing, and we will continue working with the FDA," said Mary Elizabeth Blake, a Merck spokeswoman.

Significant concerns also persist about the cost of expanding the number of people who would receive this vaccine. The series of shots is expensive. For women, the cost is expected to be outweighed by the reduced need for Pap smears and follow-ups of abnormal ones as well as the reduction in cervical cancer deaths. It is unknown how cost-effective it would be to vaccinate boys who are not regularly screened for HPV-related cancers. These diseases are also less common in boys than in girls, and it is not clear how much disease this practice would actually prevent -- either in males themselves or by reducing transmission to others.

"There will be some benefit to boys, but I don't think it will be huge. Giving it to boys would basically double the cost of the vaccine, and the cost per case of cervical cancer prevented is going to be higher," said John Modlin, MD, chair of the Dept. of Pediatrics at Dartmouth Medical School in Hanover, N.H. "We need to understand what the cost effectiveness would be."

Back to top


The extended reach of HPV

The vaccine that provides protection against the human papillomavirus is expected to reduce the incidence of genital warts and, most importantly, mortality and morbidity associated with cervical cancer. Experts also predict that the vaccine will make an impact on several other carcinomas associated with HPV.

316,000 doctor visits in 2004 were due to genital warts.

Estimated for 2006

9,710 Cervical cancers (3,700 deaths)

6,160 Vulvar and vaginal cancers (1,700 deaths)

4,660 Anal cancers (660 deaths)

1,530 Penile cancers (280 deaths)

Source: National Cancer Institute, Centers for Disease Control and Prevention, American Cancer Society

Back to top

External links

"Will Widespread Human Papillomavirus Prophylactic Vaccination Change Sexual Practices of Adolescent and Young Adult Women in America?" abstract, Obstetrics & Gynecology, August (link)

Food and Drug Administration's product approval and licensing action for the quadrivalent human papillomavirus recombinant vaccine (link)

Presentations on HPV vaccine made to the Advisory Committee on Immunization Practices meeting, June 29 (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn