Papilloma virus, more focus on prevention: how much vaccination is worth for males and females

For cervical cancer, the mortality rate has been reduced by 62% in about thirty years, with a drastic drop in new cases in young women. This is confirmed by research that appeared some time ago in JAMA, which focuses on prevention and early diagnosis of this form of cancer. If for the second aspect there are tests capable of identifying any changes in the cells and directing them towards recognising who is at risk, for the second the revolution is called vaccination. But beware: when we speak of vaccination prevention, we must think of both males and females. Because the Papillomavirus (or HPV) represents a great danger not only for women but also for men.

Among males in Italy it is the main cause of more than 2,400 cancer cases and 3,000 deaths each year. And above all, it can also compromise fertility, particularly male fertility, so much so that the prevalence of HPV DNA in sperm is almost double among infertile patients (20%) compared to the rest of the population (11%). In short, a special effort is needed, perhaps with an extraordinary plan to eliminate all HPV-related cancers. Because thanks to vaccinations and early diagnosis it is possible to completely avoid the onset of all these neoplasms, while the rates of adherence to screening and immunisation programmes are still unsatisfactory. This was said by representatives of medical specialists and patient associations gathered at a conference in the Senate entitled 'Commitment to an HPV-free Italy: protecting fertility and eliminating preventable cancers.

As mentioned, one should not only think of the female gender when talking about cancer risk. Because we are dealing with a pathogen that makes no difference between males and females and is transmitted during unprotected sexual intercourse. This is clearly recalled by Alessandra Fabi, National Councillor of the AIOM (Italian Association of Medical Oncology). "It should not only be considered a female problem because it determines, in both men and women, 88% of cancers of the anus and 30% of those of the oropharynx, oral cavity, and larynx," the expert points out. As for female cancers, on the other hand, it causes 90% of cervical cancers and 43% and 70% of vulvar and vaginal cancers. They are all curable diseases when recognised early and treated appropriately. In total, there are more than 7,500 cases of cancer per year that could be prevented by encouraging prevention as much as possible'. This is why it is important to incentivise HPV vaccinations and increase participation in screening, considering that only one in three women regularly undergoes the crucial HPV test.

In 2020, the World Health Organisation has launched a Call To Action to eliminate cervical cancer. The initiative calls for 90% of girls to be fully vaccinated by the age of 15 by 2030 and 70% of women to be screened with high-performance testing. Finally, 90% of patients with cervical neoplasia should be guaranteed timely access to follow-up treatment and examinations. "The first country to respond to the Call To Action was Australia," said Enrico Di Rosa, President of the Italian Society of Hygiene (SItI). Our national health service has all the cards in order to respond to this triple challenge. In Italy, the HPV vaccine has been available free of charge for many years for both males and females. Yet immunisation figures are unsatisfactory and far from the targets set by international health institutions'. The figures, for Italy, are certainly not encouraging. Among females for cohorts between 2009 and 2003 we are at just over 70%. The figures are worse among males in the 2004-2003 cohorts, where rates even drop below 20%. All this against the backdrop of undeniable benefits to both individual and societal health. This is stated by the observations of pharmacoeconomics that "show that extending vaccination to all women up to the age of 45 is cost-effective in the medium term and guarantees the greatest clinical benefits," emphasises Annalisa Calabrò, Professor of Hygiene and Public Health at the University of Cassino and Lazio Meridionale.