Cancer Prevention Begins in Middle School

By Jenny Gordon & Jennifer Bail

There is a sexually transmitted infection (STI) so common that the average American will contract it at some point and likely never know they were infected. If they are unaware of the infection, they will also be unaware of its transmission to others. This STI is the human papillomavirus (HPV), and while many people’s natural immune systems can fight off and clear the infection, this is not always the case. When the body’s immune systems fail to clear the infection, the consequences can be devastating.

Currently, the only routine screening for HPV is with gynecologic examinations in women. However, boys and men are equally affected by the human papillomavirus and have little knowledge of their personal risks. HPV is concerning because it causes changes to skin cell structures that, over time, can lead to cancer in affected tissues. For males, these affected tissues include the mouth and throat, anus, and penis. The most common HPV-contributing cancer in men is oropharyngeal cancer, with a more than triple incidence in men compared to women. Currently, there are no screening procedures for HPV detection in the mouth, throat, or penis. HPV is also strongly associated with anal cancer. While HPV anal cancer screening is possible, there are no formal guidelines, and it is rarely performed in heterosexual males. Screening helps mitigate disease progression and allows for early-stage treatment.

Men are at risk for delayed diagnosis and treatment without knowledge of their infection status and without screening for early cellular changes. However, there is an excellent primary prevention method for most HPV-caused cancers. In the United States, this is the HPV vaccine Gardasil. Gardasil can prevent over 90% of HPV cancers when it is given before sexual contact. Historically the HPV vaccine was targeted for the prevention of cervical cancer in women but with scientific advancements, more knowledge has come to light related to the advantages of HPV protection in men.

In use since 2006, HPV vaccines have a proven history of safety and effectiveness. Despite this, vaccination rates continue to fall far behind goals, especially in males. Boys are commonly offered vaccination at age 11 years and are recommended to be vaccinated up to age 26 years. Vaccination is most effective before sexual exposure but can still provide protection for HPV strains that have not yet been encountered. It is critical to have conversations around this topic and increase awareness of HPV cancer risks in males.

School-based HPV vaccination programs have been very successful in achieving high vaccine completion rates. School nurses are well positioned to promote and lead HPV vaccination programs and to urge decision-makers (e.g., school administrators and local and state political leaders) to support the implementation of no-cost in-school HPV vaccination program in their schools. As a trusted resource for healthcare information, school nurses can engage in conversations with students/parents about HPV vaccination, which is vital for facilitating vaccine uptake.