SINGAPORE: The incidence of penile and anal cancers in men in Singapore is low, but there is protection against these diseases in the form of vaccination against the human papillomavirus (HPV).



Deputy head and senior consultant in the Division of Medical Oncology at the National Cancer Centre Singapore Associate Professor Ravindran Kanesvaran told CNA that there have been 19 cases of penile cancer at the centre over the past five years, and 63 cases of anal cancer in men over the same period.

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Certain strains of HPV can lead to these cancers in men, although the vaccination is typically encouraged for women as protection against cervical cancer.

“While HPV-related cancers are less common in men compared to cervical cancer in women, men will also benefit from HPV vaccination as it will prevent them from getting cancers like anal cancer, penile cancer and certain head and throat cancers,” Dr Ravindran said.



It will also reduce the risk of transmitting HPV to their female partners, he added.

However, HPV vaccination for men has not been part of the national vaccination programme in many countries even though it has been included for women, he said.

This is the situation in Singapore, where the Ministry of Health (MOH) has introduced fully subsidised school-based HPV vaccination programme for female secondary school students.

BENEFITS OF VACCINATION SEEN IN BOTH BOYS AND GIRLS

Dr Ida Ismail-Pratt, consultant in the Division of Gynaecologic Oncology at National University Hospital and National University Cancer Institute, Singapore said that in some countries like Australia, gender-neutral school HPV vaccination has been provided due to the benefit seen in both boys and girls.

She added that in Singapore, two types of HPV vaccinations are licensed to be given to boys and men aged nine to 26 years for future protection from anal cancer, premalignant anal lesions and genital warts, although it is not covered by Medisave for men - unlike those for women.

She said that males should go for HPV vaccination because there is currently no effective screening for HPV-related cancers other than cervical cancers, and the only way to protect males from anal cancer, penile cancer and oropharyngeal cancer- a type of head and neck cancer - is with HPV vaccination.

Dr Tan Kok Kuan, chief medical officer at the Doctor Tan And Partners Clinics Group said that among eight clinics in Singapore, they vaccinate between 50 and 80 men a month against HPV.

While he feels the awareness on HPV vaccination for men is “certainly improving”, he said there is space to educate men on the benefits of the vaccination, given that “all disease awareness campaigns only mention HPV vaccination in the context of protecting women against cervical cancer”.

MISCONCEPTIONS SURROUNDING HPV VACCINATION FOR MEN

Many men believe that HPV only causes cervical cancer and so it is exclusively for women, said Dr Tan. In fact, HPV is a virus that is just as infectious to men as to women, he said.

Dr Ida echoed his point.

“It is as common as the flu virus. It is transmitted by skin to skin contact including sexual intercourse,” she said.

She said that while a majority of HPV infections are transient and can be rid of by the immune system, certain types can persist and increase the risk of HPV-related diseases.

Another misconceptions is that it is only men who have sex with men that are at increased risk of HPV related cancers and pre-cancers, she said.

“The incidence of anal cancer and pre-cancer are not exclusively increased in men who have sex in men only,” she said, adding that the the highest risk of anal cancer and precancer is seen in both men and women who are HIV-positive, practising anal receptive intercourse, and previous history of genital cancers or pre-cancers.

MALES SHOULD CONSULT DOCTOR ON NEED FOR VACCINATION: MOH

The Ministry of Health (MOH) said that in consultation with the Expert Committee on Immunisation (ECI), it takes into account criteria such as the disease burden in Singapore, the need for herd immunity as protection against outbreaks of potentially serious infectious diseases, and the clinical and cost-effectiveness of the vaccine, when including vaccines in the national schedules and school-based vaccination programmes.

Cervical cancer is the tenth most common cancer, and eighth most common cause of cancer death among females in Singapore, a spokesperson said.

As cervical cancer is mainly caused by the HPV, vaccination is recommended for females as it can protect against infection mainly from two of the HPV types that account for 70 per cent of cervical cancer cases.

While HPV vaccination confers protection for prevention of genital warts, as well as some other cancers in males like anal, penile and oropharyngeal cancer, these cancers have low incidence rates in Singapore, she added.

“Males who have specific concerns on HPV infection or the risk of acquiring HPV should consult their doctor on the need for vaccination,” MOH said.

One male who has gone for the vaccination is 15-year-old Euan Lim. He is aware of the benefits that apply to men.

“The male receiving the vaccination will not just benefit himself. Therefore, it is an important vaccination for males to receive too,” he said.