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Last summer, Scott Ward, 56, discovered a clod on the right side of the neck. His family doctor told him to give him some time. After a month, Ward had a scan. And then a biopsy. It was a cancer of the throat.
Human papillomavirus has been identified as the main cause.
Cancer of the central part of the throat, like the one Ward had had, is now the most common cancer related to HPV, according to the Centers for Disease Control and Prevention. In 2015, there were 15,479 cases for men and 3,438 for women in the United States. The virus is also associated with more than 90% of cancers of the cervix and anus, 70% of cancers of the vagina and vulva and more than 60% of penile cancers.
To help prevent HPV-related diseases in a broader age group, the Food and Drug Administration has expanded HPV vaccine approval for people aged 27 to 45 at the beginning of last month. This expansion was based on studies in men and women between the ages of 27 and 45, who had shown that the original Gardasil was very effective at preventing malignant tumors associated with viral strains covered by the vaccine. The latest version of the vaccine, Gardasil 9, protects people against nine strains of the virus causing genital warts and the majority of cancers and other HPV-related diseases.
The vaccine had already been approved for preadolescents and young adults aged 9 to 26 years, and the CDC has been recommending vaccination of preteens and young adults since 2007.
In high school, many people have already been exposed to HPV. More than 60% of the students will have been exposed at the end of their four years of university studies, said Mark Hunter, gynecologic oncologist at the Ellis Fischel Cancer Center. It is estimated that one in two adult Americans is currently infected with HPV.
The HPV vaccination rate in Missouri is one of the lowest in the country. Health professionals and advocates such as Ward share their experiences fighting against misconceptions and misinformation on the Internet, including the myth that the vaccine causes serious side effects (but this is not the case) .
Ward, who lives in Fulton and works in the construction industry, does not know when he was infected with the virus, but he's probably been wearing it for decades. What he knew was that he would do anything to improve his chances of survival.
A few weeks after the diagnosis, he underwent a six-hour surgery for the extraction of a tonsil malignant. The doctor then dissected the neck and removed 22 lymph nodes, including 14 malignant lymph nodes. The operation left him a scar on the chin, almost to the right ear.
It was not even the most difficult part. In the seven weeks following the operation, he underwent 32 cycles of radiotherapy and three cycles of chemotherapy.
"They basically want to bring you as close to death as possible to kill all your cells," Ward said.
The fight against cancer has become his new occupation. Every morning he dressed, cleaned himself and forced himself to eat despite the pain. He got to know all the health technicians who gave him chemotherapy because he saw them every day.
By the end of January, the treatment was over. Ward is now in his ninth month of remission. But the thin red line on half of his neck and the swelling under his chin are not the only reminders of his battle with cancer.
"I have neuropathy in my fingers and feet," Ward said. "I have dry mouth, I still have only a partial taste, and if you ever lose your taste, it's not fun and everything is bad."
If he could, he would be vaccinated against HPV.
"My nurse told me that there were other strains of HPV," he said. "Even if you went through this, that you had a treatment, then you're good with this one, you can still have another one, so it would help me even if I had less than 45 years."
Hunter, the gynecologic oncologist, said that a large number of patients, nurses and employees pay out of pocket for getting vaccinated. He hopes that insurance companies will soon cover the costs for people aged 27 to 45 years.
"If you are an insurance company and you prevent them from undergoing all the abnormal Pap tests, biopsies, loop electrosurgical excision procedures that we perform after the biopsy … if they can prevent all this it's really a cost saving, "Hunter said.
Meanwhile, teen vaccination in Missouri, which is covered by most insurance policies, is not widespread. In 2017, approximately 57% of Missouri 13-17 year olds received the first dose. About 40% of them alone are considered up to date.
One of the main reasons for the low rate of complete vaccinations is the lack of awareness of cancers caused by HPV, said Sharon Humiston, pediatrician affiliated with Children's Mercy Kansas City. As the HPV vaccine is not yet required for enrollment in Missouri schools, parents tend to think that the vaccine is not important.
"Parents ask," Is this really necessary? What are my child's chances of contracting this disease, and if he gets it, is it really such a big deal? "Humiston said.
People tend to underestimate prevention because they do not see the result of vaccination, which is not a disease, she said.
"For example, when there is not a lot of measles circulating in the community, it's easy to think that we no longer need the measles vaccine," Humiston said. "We forget that measles did not go off like a dinosaur, it's controlled only through the vaccination of almost every member of the community."
Boys and girls should be vaccinated before exposure because the vaccine does not suppress an already established HPV infection, Humiston said.
"My adolescent patient is more likely to have a serious health problem because of HPV than almost every other virus that I'm trying to prevent with vaccination," she said. "I can not present this as an" optional "vaccine – it's a necessary vaccine if what concerns me, it's health."
Another reason that some patients have not received the vaccine is that the pediatrician or family doctor has not mentioned it, Humiston said.
"There is so much to cover during a teen visit, and the doctor may have thought:" Oh, that can wait until the next visit. " But then, there was no next visit & # 39; & # 39; said Humiston. "As you get older, teens are less and less likely to be seen in a primary health care facility."
To make matters worse, misinformation on the Internet unnecessarily scares parents. Some of the "information" that appears is anecdotal and emotional and affects people unconsciously.
"Fear is like purple ink – even a little bit of dirt on everything," she said. "And it's a lasting stain."
Pediatrician John Wilson tries to follow the misinformation that circulates in the anti-vaccine community in order to answer questions and doubts of patients. What he sees is some people who make a lot of money with clickbait, books, movies and lecture tours that stir up fear.
"A lot of that sells supplements," Wilson said, "they convince parents that if you're not going to vaccinate, you have to boost children's immune systems otherwise, by buying their supplements."
Since Andrew Wakefield's fraudulent study linking vaccines and autism in 1998, conspiracy theories on vaccine safety have been developed and refuted, but they keep coming back, Wilson said. This is despite the many studies that show that vaccines are safe and effective.
"We are more likely to know the risks of vaccines than the antibiotics we use daily in children," Wilson said.
Before all three HPV vaccines were FDA approved, each of them had undergone years of trials using clinical trials, according to the CDC. Together, vaccines have been studied in more than 74,000 men and women. Results from trials and subsequent studies show that the vaccine is safe and effective. The most common side effects are pain and redness in the area where the shot was given, as well as sometimes fever, dizziness and nausea, usually mild and rapidly disappearing.
And yet, the facts are not enough to convince a frightened parent.
Victoria Shaffer, Associate Professor MU in the Department of Psychology, studies how stories affect health communication. She found that after reading stories about what others saw as negative vaccine outcomes, people's decision-making was affected – but they were not aware of it.
In one study, researchers provided participants with data from the vaccine-related adverse event registration system, including stories of bad things that happened in vaccinated individuals. Although participants said the stories were not convincing, they were affected, Shaffer said.
"Just hearing the stories has changed their attitude and made them more negative about HPV vaccines, so even if you hear false stories, you can be influenced," he says. said Shaffer.
The use of stories leads to what psychologists call the decision "base rate neglect", according to which people are more influenced by the liveliness of the event than by its probability of occurring, Shaffer explained. .
"We are storytellers and we collect our vision of the world based on the story we have lived and stories that others have told us about," said Shaffer.
Shaffer said that she and other researchers had found it difficult to tell a positive story about vaccination, which is usually an event.
"The difficult part of this story is that HPV and its consequences are so far from the vaccination window," said Shaffer. "There are not many stories about people saying," I love vaccines, I never got sick. "
The current low vaccination rate is shocking Hunter, who deals with HPV-related cancers every day for women of all ages. He sees women in their thirties or forties suffering from cervical cancer at stage three or four, and most of them will not survive the disease, he said.
"They will leave behind young children," said Hunter, "and these are diseases that could have been entirely avoided."
Wherever he has an audience, he usually gives a way to vaccinate children with the first successful cancer vaccine, Hunter said.
Hunter also played an advisory role in the HPV vaccination program launched last year by the Ellis Fischel Cancer Center. The University Hospital, in partnership with the Texas-based Anderson MD Cancer Center, is participating in the Moon Shots program, which aims to improve prevention, early detection and cancer treatment across the country.
Ward said that he was very lucky because the doctors had caught his cancer early enough. He is now telling his story to his family and friends. One of the misconceptions that he has faced is that many people still do not know that men need to be vaccinated.
"I talked to my neighbors," Ward said, "She said," Boys? HPV? "
"I said, you have to talk to your doctor," Ward said. "All I can do is tell you what I know and experience that I live in. That's what caused this, and I can tell you first-hand. "
"You get it, you know, you're done.You do not get it, you're in luck," he says.
He will not know until five years old when he is cured. Looking back, Ward would like to have received an HPV vaccine when he was a child.
"If there was a vaccine, I would have it," he says. "I hope myself that my parents would have wanted me to get it."
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Information from: Columbia Missourian, http://www.columbiamissourian.com
An exchange of AP members shared by Columbia Missourian.
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