How to Stop a Future Cancer Epidemic

The theory of preventative care, including inoculations, is that we spend a little money now to offset big expenses later in life.  But sometimes behavioral friction keeps this from happening, even when the technologies and approaches are proven.  We are witnessing such a failure right now with regard to Human Papilloma Virus (HPV).

Here’s the story, from MGH’s James Michaelson, PH.D., arguably one of the most thoughtful, trustworthy, and sensible researchers in the field of analysis of cancer survival.  Jim and his team develop sophisticated mathematical methods for predicting the risk of local, regional, and distant recurrence.  He says:

There are a couple of good papers about Human Papilloma Virus (HPV), and the coming epidemic (yes, an overused term, but truly applicable here) of head and neck cancer. As Chaturvedi et al say in a recent paper: “If recent incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020.”

I get to see this problem from two angles: From my work as the the manager of the MGH/MEEI Head and Neck Cancer Database, and  from my experiments in using computer telephone messages to get patients in for preventive health services, such as the fabulous HPV Vaccines: Cervarix (from GlaxoSmithKline) and Gardasil (from Merck). The vaccines are incredibly underutilized. Only about 1% of eligible boys and only 50% of eligible girls get one shot.  Only about 25% of girls get all three shots.

Beyond the misplaced reluctance of parents to have their children inoculated–or the lack of understanding of the importance of this for boys as well as girls–I wonder if part of the problem here is that insurance companies see no real payback in helping to promote this.  After all, what is the chance that a child I am covering today with insurance is likely to be my subscriber by the time he or she gets cancer?  Unlike polio, measles, and mumps, which show up during childhood, the head and neck cancers are not likely to show up until adulthood.  While the cost per delivered dosage would be remarkably small, especially measured against the societal savings, there is currently no way to internalize that cost-benefit equation into insurance practice.

Two remedies come to mind:

1) As being explored by Jim, use voice-recognition telephone calls and other media to spread the word to parents.  Funding for this could logically come from the pharma companies producing the drugs, or from chains like CVS or Walgreen’s. Maybe, also, some multi-specialty practices will choose out of a sense of responsibility to take it on as part of their regular family medicine practices.

2)  Less likely, especially given the sensitive politics, make this inoculation a legal requirement like polio and other vaccines.  As an economist would say, this would internalize the externalities by government fiat.

Paul Levy is the former President and CEO Beth Israel Deaconess Medical Center in Boston. For the past five years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement at Not Running a Hospital.

5 replies »

  1. Another thing, the “there is no test for men” isn’t quite true ..

    I think this may be CDC politics at play again – I’m guessing this has to do with the controversy around the HPV vaccine.

    A quick google finds an organization in san diego that is offering a set of DNA screens for men. If Paul’s predictions are true, this one is likely to be popular.

    “HPV testing has not really been available for men except for a basic physical examination to visually look for obvious signs of genital warts.” says Gage. “HPV DNA testing has really increased testing options for both men and women. We are very happy that we can now offer HPV DNA testing for men.”

    Progressive Health Services currently provides men HPV DNA testing of the throat and anus, as well as the acetic acid screening test for HPV of the penis. Like HPV testing in Pap smears, HPV DNA tests look for high-risk strains known to cause cancers as well as the most common low risk strains not associated with cancers. Both high and low risk HPV are contagious and can be sexually transmitted. Throat specimens are collected using a mild salt-water gargle solution that is spit into a test tube. Anal specimens are collected using a gentle painless swab. The HPV acetic acid (vinegar) screening test, also painless, checks the penis using a high magnification colposcope to help identify HPV genital warts.”


  2. This is a lack of education *as well as* a lack of research issue. From what I understand there’s significantly less research on oral cancers compared to other cancers

  3. Also little known but important, there is a test now on the market to test for these rare cancers – apparently so new that many specialists and dentists are unaware that it is out there . Not sure who maker is but if interested you can google oral hpv test to learn more I’m sure …

  4. ‘Less likely, especially given the sensitive politics, make this inoculation a legal requirement like polio and other vaccines.”

    In the current Todd Akin et al ‘esqe “Keep An Aspirin Between Your Knees / Wages of Sin” Clown Car environment?

    That you’re right on all of the merits will matter not one whit to this ignorant, sanctimonious bunch.