Vaccinating Against Cancer: A conversation with Dr. Theodoros Teknos, President and Scientific Director, University Hospitals Seidman Cancer Center and Deputy Director of the Case Comprehensive Cancer Center
The public’s understanding of vaccines, especially for children and teens, continues to evolve – with science taking giant leaps forward in immunology and disease prevention that require clear communication and strong dialogue to educate consumers about vaccine advances. From recent news of a potential single-injection covering every childhood vaccine to the ongoing vaccine-autism debate to the HPV vaccine, helping parents makes sense of the mixed information available is critical to the health of all children.
We spoke with Theodoros N. Teknos, MD, President and Scientific Director of University Hospitals Seidman Cancer Center and Deputy Director of the NCI-designated Case Comprehensive Cancer Center at Case Western about the only approved cancer prevention vaccine on the market. Dr. Teknos is a passionate advocate who strongly urges parents to have their children vaccinated against the human papilloma virus (HPV) to prevent serious cancers later in life.
The HPV vaccine is a groundbreaking advance, protecting against many types of cancers, primarily cervical, anal and oropharynx (head/neck) cancers. And while there is screening for cervical cancer, there is no routine screening for the approximately 50,000 other cancers caused by the virus annually – including head/neck cancers that often develop in the back of the throat. Once attributed mainly to tobacco and alcohol use, the latest research shows that roughly 70 percent of these cancers may be linked to HPV; they develop at a younger age, striking healthy adults raising young families; and occur much more frequently in men than in women.
Finn Partners: Why is the HPV vaccination so important in the oncology sphere – how big of an advance was this?
Dr. Teknos: Interestingly, the vaccine was originally not presented from a cancer perspective, which actually became a marketing problem. Instead of focusing on the cancer malignancy prevention angle, it was developed and presented as a solution to genital warts caused by HPV. But it quickly became clear that the ability to prevent 99 percent of all cervical cancers, an increasing percentage of head/neck cancers and the majority of anal cancers was a game-changer. It completely changed the approach to preventative medicine and those specific cancers. Preventing cancer is much preferable to having to treat it once it has already developed.
Vaccination rates were lower than hoped early on, particularly among boys – despite medical professionals’ recommendations to vaccinate sons and daughters at ages 11-12. Are you starting to see a shift with greater numbers of children receiving the vaccine?
Newer education initiatives by both the pharmaceutical industry and the government have resulted in higher uptake rates of the vaccine. So over time rates are getting better, particularly among boys. But we’re still not where we need to be and HPV vaccination rates pale in comparison to other mandatory vaccinations (for infectious diseases that may not have the same lethal consequences). Preventing cancer is in the best interest of our society – both from a health and an economic standpoint.
What are the biggest misconceptions about the vaccine?
The biggest misconception is that the purpose of the vaccine is to prevent a sexually transmitted disease, and that if a child is not sexually active that they don’t need it. What people need to understand is that HPV is so common that nearly all men and women will get the virus at some point in their lives.
The second largest misconception is about safety. The fact is that millions upon millions of doses have been given to children and adults, and it’s an incredibly safe vaccine.
Many people think this is a vaccine for girls. What do you tell parents of boys?
I tell all parents that the HPV vaccine will keep their child from developing a cancer later in their life. I reassure them that it’s very safe. And I try to educate them about herd immunity. If we can get 80 percent of the population vaccinated – boys and girls – then we can virtually eliminate the HPV virus strains that cause cancer. There isn’t a parent in the world that wouldn’t vaccinate their child against meningitis before sending them to college – it should be the same with the HPV vaccine.
As a head/neck cancer expert, can you shed some light on how these cancers impact patients and their families?
Most patients – with a 3:1 male-to-female ratio – are typically younger: in their 30s, 40s and early 50s. But this is not only a young person’s disease – as people live longer, they are more likely to develop this cancer. These patients are also frequently nonsmokers, healthy overall, highly educated and from a higher socioeconomic class. There is a huge psychological consequence of HPV-related cancer – patients may feel guilty because they acquired the virus through behavior. They worry about infecting spouses, children and others in their lives. Further, there is a stigma attached to HPV-associated cancers; like herpes and HIV, people associate HPV – and the associated cancers – with negative connotations. Many patients who have done well with therapy and have a strong presence in their community don’t want to talk about it openly. The stigma paints perceptions, and makes it hard to understand that most people will be exposed to HPV during the course of their lifetime. If more people understood this fact, perhaps they would be more enthusiastic about the vaccine.
With regards to treatment, most head/neck cancer patients respond very well to chemo and radiation. If the patient is a nonsmoker – or has less than 10 years of a smoking history – cure rates are over 90 percent. So it is effective, but it is also very toxic and there are a lot of treatment-related problems – neuropathy, swallowing problems (which can lead to needing a feeding tube), and hearing loss, for example.
Finally, this was the first cancer prevention vaccine. Do you think there will be others?
Prevention is absolutely going to be the key and gold standard moving forward. According to the World Health Organization, 30 to 50 percent of all cancers could be prevented with lifestyle/behavior and environmental modifications – including preventing infections that can lead to cancer, such as HPV and hepatitis. Every day, more cancers are identified as viral or bacterial in origin – that’s an idea that was pursued in the 1800s and then fell out of favor, but new scientific discoveries are advancing the connections between virology and cancer. Helping the public understand this science and how it can help us all live longer, healthier lives will be a critical part of the success of this approach.
For more information about the HPV vaccine, the Centers for Disease Control and Prevention offers a range of resources, including these videos on what it's like to be a survivor of HPV cancer, a family member of someone struggling with HPV infection, or a provider that has seen the lasting effects of HPV: https://www.cdc.gov/hpv/hcp/hpv-important.html.
 Centers for Disease Control and Prevention