Vaccination to help prevent oral cancer

Dentist MP Sir Paul Beresford called for a vaccination against human papillomavirus (HPV) to be extended to men to help prevent oral cancer. He raised the issue on 14 January during an adjournment debate in the House of Commons. Replying, the Minister Jane Ellison, said the matter was being considered by the relevant committee and that the Government would act if this action was recommended.

The debate followed a letter from Dr Graham Stokes, chair of the British Dental Association’s (BDA) Health and Science committee, in the British Dental Journal earlier this month and an editorial by Stephen Hancocks in the same issue. Both called for an extension of the vaccination programme, which is currently restricted to 12/13 year old girls to protect them from cervical cancer. The BDA believes this should be done ‘both for reasons of equality and on the basis that it will significantly improve overall immunity in the general population’.

In his speech Sir Paul pointed out that last November, there were two cancer campaigns. The campaign on prostate cancer—Movember—caught the public imagination. But the other campaign, to improve awareness of oral cancer, although very successful within the dental profession, ‘did not catch the public awareness’. He said this was ‘deeply disturbing’, because prevention and cure is possible if the disease is found easily and early, and also because of the increasing prevalence of the disease.

Sir Paul’s main point was the incongruity of vaccinating only women, when new cases of HPV-related cancers in the UK affected 7,538 females and 6,484 males in 2009. He said that Australia’s policy of vaccinating both males and females was producing ‘herd immunity’. The effect on HPV diseases, including cancers, had been quite dramatic. He pointed out that HPV vaccines protect against HPV infection and disease, including cancers, in men as well as women.

Replying, health minister Jane Ellison, said the Government was committed to making England among the best in Europe in improving all cancer outcomes, including oral cancers. She reported that in 2011 more than 6,000 people in England were diagnosed with oral cancer, and in the same year, more than 1,600 people died of the disease. She described it as ‘a milestone in a significant and worrying increase in incidence since the 1970s’.

Talking of Sir Paul’s request that HPV vaccination should become universal, she said that when the Joint Committee on Vaccination and Immunisation (JCVI) first developed its recommendations, it concluded that should vaccine uptake among girls be high, ‘the vaccination of boys was likely to provide little additional benefit in preventing cervical cancer in girls’.

The Minister then stressed the importance of early-stage diagnosis. With spotting such cancers early, five-year survival rates are more than 80%. She also stressed that all dentists are now aware that patients presenting for dental care is an opportunity to assess any symptoms that might suggest oral cancer and refer them if appropriate. The new patient pathway being piloted in 94 practices, includes an oral health assessment requiring dentists to examine the soft tissue of the mouth, assess a patient’s risk factor in relation to oral cancer and offer advice on lifestyle changes.

Once a cancer has been diagnosed, both dentists and General Practitioner's can use an urgent referral pathway to ensure patients get rapid treatment. The latest data showed that 95.5% of patients urgently referred with suspected head and neck cancer, including oral cancer, were seen by a specialist within two weeks, which the minister described as excellent progress. 

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