2023-08-21 15:16:00
31% of men in the world are carriers of one of the approximately 200 forms of papillomavirus, and 21% of a “high risk” form, potentially carcinogenic. This conclusion of a study published in the journal The Lancet Global Health illustrates the major public health issue around men and “HPV” (for “Human Papillomavirus”), in the hope of achieving a drastic reduction, if not the eradication , diseases such as cervical cancer. Indeed, if regarding three quarters of cancers linked to papillomaviruses affect women, the proportion of men carrying the virus remains a worrying vector of propagation. For Nathalie Broutet, co-author of the study and who until recently was head of the program for the elimination of cervical cancer at the World Health Organization, these results underline the importance of integrate the male public into global prevention and vaccination strategies. Liberation takes stock of this file.
The papillomavirus, the first STI in France
The human papillomavirus belongs to an extremely contagious family of viruses, comprising nearly 200 distinct forms, including a dozen considered to be “high risk”. Affecting nearly 80% of people at least once in their lifetime, regardless of gender or sexual orientation, it is the most common sexually transmitted infection (STI) in France. But beware, not all papillomavirus infections are an STI: only regarding forty forms of “HPV” are transmitted through sexual contact.
The papillomavirus is “a virus essentially transmitted sexually, but without the need for a penetrating report”, alerts Nathalie Broutet. As it is through the skin or the mucous membranes that the virus is transmitted, the condom is not enough to protect. However, the author of the study recalls the need for its use, which avoids in particular “deposits on the cervix”.
While the vast majority of infected men remain asymptomatic, and they develop fewer cancers than women – men represent only 25% of HPV-related cancers – they are a “reservoir” for infection, underlines Nathalie Broutet, continuing to be vectors of the virus without necessarily knowing that they are contagious. And this until old age. This is one of the findings of the study: if infections are strong in women at the start of their sexual life and generally decrease with age, they remain numerous in men until their 50s. For Nathalie Broutet, “if we want to complete the elimination before the end of the century of cancer of the cervix in women, we must study what is happening in men, but also vaccinate them”.
The papillomavirus, responsible for 6,000 new cancers each year in France
In the event of transmission, the infections, which are often asymptomatic, “eliminate naturally most of the time”, explains Nathalie Broutet. However, an infection can cause two types of lesions: benign and precancerous. Benign lesions, such as anogenital warts (also called condyloma), affect approximately 50,000 women and 50,000 men each year. Other lesions, precancerous, can occur. 30,000 women each year suffer from such lesions of the cervix, and less than 3,000 of the vulva, vagina or anus. More serious, the papillomavirus can also evolve into real cancer, affecting the cervix, anus, penis, vulva or oropharynx (tonsils, palate, back of the tongue and throat). In total, according to data from the High Authority for Health in France, more than 6,000 new cancers per year in France result from infection with the papillomavirus.
About 99% of cervical cancers are caused by HPV infection. In women, it is the 11th most common cancer (3,000 new cases each year), and the 12th deadliest (more than 1,000 deaths per year). Anal cancer, 90% of cases of which are linked to the papillomavirus, affects approximately 2,000 people in France each year, 75% of whom are women. If this cancer affects only 25% of men, those having homosexual relationships are overrepresented in the affected population. Oropharyngeal cancers mainly affect men (in 2015, 1,300 cases in men, 400 in women). Rarer, there are also cancers of the penis (100 cases due to the papillomavirus in 2015), and of the vulva and vagina (200 cases in 2015).
Can HPV be treated?
Since there is no treatment for the infection as such, only for its consequences (warts, precancerous lesions, cancers, etc.), and the condom is not enough, only vaccination, then coupled with regular screening , reduces the risk of high-risk infection. In France, it is possible to have a two-dose vaccination when the first injection is administered between 11 and 14 years old, or a three-dose vaccination when the first dose is given between 15 and 19 years old. Men who have sex with men can benefit from vaccination until they are 26 years old. Vaccination (optional), the price of which is around 100 euros, is reimbursed at 65% by health insurance, the rest can be covered by mutual insurance companies. Vaccination may also be free in certain places, such as free information, screening and diagnosis centres.
If the whole population might in theory be vaccinated at any age, the effectiveness of the vaccine decreases following the first sexual relations. In addition, “the vaccine is still quite expensive, its production is long and complicated, explains Nathalie Broutet. There have already been shortages of vaccines for the target population in several countries, so we must prioritize, it is also a question of cost effectiveness. This is why following the recommended age (19 years for women, 26 years maximum for men), vaccination remains possible, but is no longer reimbursed.
In adulthood, screenings also make it possible to highlight the consequences of an infection: warts, pre-cancers, cancers. In the majority of cases, people become HPV negative once more once the lesion is treated, and the risk of transmitting the infection becomes low once more. Anyway, recalls Nathalie Broutet, “even if a partner infects a woman, for example, it takes regarding fifteen, twenty years for cervical cancer to develop, and this woman will be screened from the age of 25” , thus making it possible to be treated if precancerous lesions were detected.
To prevent the development of uterine cancer, two tests are available in France: the cytological examination (between 25 and 29 years old), and the HPV HR test (from 30 years old), which can be performed via a smear. Both are fully reimbursed by health insurance. Among men, systematic screening is only offered to those having homosexual relationships. In case of doubt, however, patients can consult specialists to carry out examinations of the anus, throat or penis to detect lesions.
France tries to catch up on vaccination
If vaccination has been recommended in France since 2007 for young girls, it has only been recommended for young boys since 2021. This difference explains why at the end of 2021, 15-year-old girls were 45.8%, according to Inserm, to have received at least one dose of the vaccine, once morest barely 6% for young boys. “Vaccinating young men means improving the acceptability of the vaccine for young girls” while protecting some from lesions and others from cancer, analyzes Nathalie Broutet. France has one of the lowest vaccination coverages of industrialized countries.
In a press release in favor of vaccination once morest the papillomavirus, the national academy of medicine reports that in 2020, while vaccination coverage did not exceed 30% in France (very mainly women), it was more than 75% in ten European countries such as Portugal, Spain or the United Kingdom. United. Australia, a model in the fight once morest the papillomavirus, should eliminate cervical cancer by 2035 thanks to a vast vaccination campaign started in 2007 for girls, and 2013 for boys.
If France is late, the State sets itself objectives to improve its vaccination coverage. The national sexual health strategy provided for 60% of adolescent girls to be vaccinated this year, and 80% in 2030. In February, Emmanuel Macron announced a “generalized” vaccination campaign for middle school students in 5th grade from the start of the 2023 school year. which remains optional and with parental consent, will be free and all doses will be administered at school.
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