HPV vaccination slow-down puts men at cancer risk

Lack of capacity to deliver “game-changing” HPV vaccines in Scotland during the pandemic will have led to some men contracting cancer, says a sexual health academic.

Men who have sex with men (MSM) aged 45 or younger who attend a sexual health or HIV clinic in Scotland have been offered the HPV vaccine since July 2017.

But just 70% of 17,460 eligible men received at least one dose, and only half of those who started the programme went onto complete the full course. Completion rates have been much lower during the pandemic, with fewer than one in eight starting and finishing the programme in the year since July 2020.

Professor Claudia Estcourt, Professor of Sexual Health & HIV at Glasgow Caledonian University, warned some men will have contracted HPV as a result:

“Clinics have not had the capacity to recover routine vaccination clinic slots, and therefore some people will become infected with high-risk HPV who would not have done if there hadn’t been a pandemic.

“This is one of the many, many adverse impacts of the pandemic hitting a health care system already at maximum stretch.”

There are over 200 types of HPV or human papillomavirus, and most people will get infected at some point in their lives.

With no symptoms, most cases pass undetected but those that persist can lead to cervical, anal, throat and penile cancers.

The vaccine is considered the best protection from high-risk HPV, with the first major study into immunisation showing thousands of women had been prevented from developing cervical cancer after being vaccinated as young teenagers.

Professor Estcourt says similar results could be in store for MSM, who are currently up to 20 times more likely than heterosexual men to develop anal cancer.

She told healthandcare.scot: “The HPV vaccine is a game-changer in many HPV-related cancers and we would expect important benefits in cancer reduction in MSM.

“This has been shown in Australia where HPV vaccination was introduced earlier than in UK.”

MSM do not benefit from the indirect protection that heterosexual men get from the girls’ immunisation programme that has operated in Scotland since 2008.

All pupils have been offered the HPV vaccine in their first year of secondary school since 2019, but it will take a number of years before direct protection from this programme is seen in MSM.

There will also be a gap for MSM who missed the vaccination programme at age 12 until such time as they attend sexual health services.

A number of organisations, like the Terrence Higgins Trust, are campaigning for a national “catch-up” programme for older boys so no one is left vulnerable.

Professor Estcourt says she would support expanding access to all young men aged 12-18, once routine vaccination under the existing programme has restarted.

Issues in take-up and completion will be hampered not only by a stretched healthcare system but also by a lack of awareness and the absence of a formal re-call notification system to encourage men to return to clinics to complete the programme.

She said: Men eligible for vaccination were vaccinated during routine visits for STI testing, treatment or PrEP review but no formal call-recall system was implemented.

“People can find it hard to attend all their vaccination appointments, with three needed for most adults over a four-month period.

“Lack of awareness of the risks of HPV may well be an issue for MSM who have not attended sexual health clinics [since 2017].

“Awareness-raising could include mass media messaging, inclusion in school-based sex and relationship education and through general practice.”

This story has been supplied through our partnership with our friends at healthandcare.scot. Click here to head over and have a look if you haven’t already.

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