Gay men in the United Kingdom are being inoculated with a vaccine that was developed to prevent cervical cancer in women, the BBC reported in February.
The vaccine, which is called Gardasil and is the first cancer vaccine approved for widespread use, protects against the human papilloma virus (HPV). HPV, which is sexually transmitted, is responsible for virtually all cases of cervical cancer, but gay men are interested in the vaccine because it also prevents genital warts, and may prevent anal and penile cancers as well.
“It’s not surprising that many men are keen to take action that they think could help protect their health, but the fact is we don’t know if this vaccination makes a difference,” says Roger Pebody, program development officer at The Terrence Higgins Trust, the UK’s leading HIV/AIDS charity.
“We don’t yet have the research to say whether it would be feasible or cost effective,” Pebody continues. “It’s important that people understand that at present, there is no scientific evidence to say that this vaccination can help prevent cancers in males.”
“It’s probably premature for men to take [the vaccine],” agrees Dr Thomas Lampinen, clinical assistant professor, Department of Health Care and Epidemiology at the University of British Columbia. “There’s no reason to administer a vaccine if you have no data to suggest its effect. We don’t know fully that it’s safe.”
Sheila Murphy, a spokesperson for Merck Frosst, the company that sells the vaccine in Canada, says she assumes that, like men in the UK, Canadian gay men have asked their doctors for the vaccine.
“It certainly increases our sales if it’s happening here,” she laughs. “I can’t recommend that people do anything different from what the government has given us the indication for; that’s a question between a patient and his or her physician.
“We have studies [with men] ongoing in Canada,” reveals Murphy. “There is one in Toronto, and one in Montreal. As long as people want to participate and fit the criteria, we encourage [them] to present themselves. Gay men are only a part of the study. Obviously, we’re looking at all men.”
Murphy admits that Merck, which stands to make billions worldwide on the sale of the vaccine, has had trouble recruiting men between the ages of 16 and 26 for the studies. “It may be the age, and the fact people have to do things that are not comfortable,” she says. “If we don’t get the study done, then we won’t have the science that’s going to be able to allow us to go to the government and say this works in this community, so that the government gives us the right to sell it to that community.”
Gardasil received approval from Health Canada for use in women between the ages of nine and 26 last July. Murphy says 15,000 prescriptions for the vaccine were written in the first seven months.
Three doses must be administered over a six-month period for the vaccine to work. But because the it is not currently covered by provincial health care plans, patients have to pay for it themselves; approximately $135 per dose.
However, in light of the $300 million earmarked for cervical cancer prevention in the new federal budget, that situation may soon change, at least for women.
“Are men wise to spend money [on Gardasil]?” Lampinen asks. “I would say there are things with proven benefit that one would probably want to spend money on first, namely a hepatitis A and B vaccine for gay men.”
Studies vary widely on the prevalence of the virus in the population, but it’s likely that between 30 and 70 percent of people carry it. And there is clear evidence that HPV is of special concern for gay men.
“It’s generally thought that the prevalence of HPV is higher in gay men,” says Dr Mark Gilbert, physician and epidemiologist at the British Columbia Centre for Disease Control. “People who have HIV can be at increased risk of both being infected with HPV, and then possibly getting anal cancer. It is estimated that, for HIV-positive gay men, the risk of anal cancer is about twice that for HIV-negative men.
“There have been some studies in the US that have shown that there has been, over the past several decades, a reported increase in anal cancers for both men and women,” Gilbert clarifies. “However, overall in the total population the rate is still quite low; it was reported as being about two per 100,000 persons.
“Certainly gay men need to be aware that HPV infection is possible, and that [it] can have implications for health,” he offers. “We know it’s a sexually transmitted infection, so for gay men in particular, it’s related to anal sex. Condoms provide some protection, but not full protection,” he declares. “They only cover the penis, but the virus can be found around the penis and other parts.”