Keywords
HPV, LGBTQ , health disparities, HPV vaccines, underserved populations, Poland
Abstract
Introduction: Social campaigns concerning vaccinations against human papillomavirus (HPV) in Poland are mainly addressed to women. In addition to cervical cancer, anal, penile, and oropharyngeal cancers can be caused by the virus, which clearly affects men as well. HPV vaccinations are voluntary and mostly not refunded in Poland.
Methods: A survey was published on social media’s group gathering males and contained questions concerning epidemiological data, knowledge about HPV, and opinions of HPV vaccination. A questionnaire was enriched with educational note regarding HPV-dependent cancers and available vaccines against HPV in Poland.
Results: Because of age limitations, 169 males (115 heterosexuals, 48 homosexuals) aged 14-39 were chosen for the study. Seventy-five percent of heterosexual and 88% of homosexual men were aware of HPV, but less than 4% and 17% (respectively) were vaccinated against the virus. Main sources of knowledge about HPV were the Internet (61%), media (28%) and relatives (27%). HPV infection was linked with the development of anal and oropharyngeal cancers by 28%, and 37% of heterosexual males, compared with 56.3% and 43.8% of homosexual males. The majority of respondents (88%) indicated that all genders should be vaccinated, although only 57% were aware of HPV vaccination availability in Poland.
Conclusions: The men are at risk of HPV-related cancers and the danger is poorly understood amongst Polish men. Despite awareness of HPV vaccines, the vaccination rate is low. Consequently, there is a serious need to broaden educational with a special attention to LGBTQ+ communities.
References
[1] Teter Z, Majkut G, Wierzba W, Śliwczyński A, Brzozowska M, Jacyna A, Marczak M, Myśliwiec M. Syphilis in Poland is on the rise and underreported. Postepy Dermatol Alergol. 2019 Apr;36(2):192-195. doi: 10.5114/ada.2019.84595.
[2] Millner DA. Diagnostic pathology: Infectious Diseases: Viral infections, 40. Philadelphia: Elsevier, 2015.
[3] Alexander KA, Giuliano AR. HPV-beyond cervical cancer (online resource center). Am J Med. 2012 Jul;125(7):S1. doi: 10.1016/j.amjmed.2012.03.005.
[4] Wang CJ, Palefsky JM. Human Papillomavirus (HPV) Infections and the Importance of HPV Vaccination. Curr Epidemiol Rep. 2015 Jun;2(2):101-109. doi: 10.1007/s40471-015-0039-3.
[5] Didkowska J, Wojciechowska U. Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Narodowy Instytut Onkologii im. Marii Skłodowskiej-Curie – Państwowy Instytut Badawczy. Available at http://onkologia.org.pl/k/epidemiologia/ Accessed on 06/06/2020.
[6] International Agency for Research on Cancer. Human papillomaviruses. In: IARC monographs on the evaluation of carcinogenic risks to humans, volume 90. Lyon, France: IARC, 2007.
[7] Saraiya M, Unger ER, Thompson TD, Lynch CF, Hernandez BY, Lyu CW, Steinau M, Watson M, Wilkinson EJ, Hopenhayn C, Copeland G, Cozen W, Peters ES, Huang Y, Saber MS, Altekruse S, Goodman MT; HPV Typing of Cancers Workgroup. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst. 2015 Apr 29;107(6):djv086. doi: 10.1093/jnci/djv086.
[8] Glick SN, Feng Q, Popov V, Koutsky LA, Golden MR. High rates of incident and prevalent anal human papillomavirus infection among young men who have sex with men. J Infect Dis. 2014 Feb 1;209(3):369-76. doi: 10.1093/infdis/jit441.
[9] Lee SM, Park JS, Norwitz ER, Koo JN, Oh IH, Park JW, Kim SM, Kim YH, Park CW, Song YS. Risk of vertical transmission of human papillomavirus throughout pregnancy: a prospective study. PLoS One. 2013 Jun 13;8(6):e66368. doi: 10.1371/journal.pone.0066368.
[10] Bodaghi S, Wood LV, Roby G, Ryder C, Steinberg SM, Zheng ZM. Could human papillomaviruses be spread through blood? J Clin Microbiol. 2005 Nov;43(11):5428-34. doi: 10.1128/JCM.43.11.5428-5434.2005.
[11] Centers for Disease Control and Prevention. 2017. Genital HPV Infection - Fact Sheet. Available at https://www.cdc.gov/std/hpv/HPV-FS-print.pdf. Accessed on 06/06/2020.
[12] Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):698-702. doi: 10.15585/mmwr.mm6832a3.
[13] World Health Organization. Electronic address: sageexecsec@who.int. Human papillomavirus vaccines: WHO position paper, May 2017-Recommendations. Vaccine. 2017 Oct 13;35(43):5753-5755. doi: 10.1016/j.vaccine.2017.05.069.
[14] Dziennik Urzędowy Ministra Zdrowia. Poz. 104. Komunikat Głównego Inspektora Sanitarnego w sprawie Programu Szczepień ochronnych na rok 2019. Warszawa dnia 25 października 2018. Available at https://gis.gov.pl/wp-content/uploads/2018/01/akt.pdf. Accessed on 07/06/2020.
[15] Olejniczak D, Wodzyńska K, Religioni U: The high school graduates knowledge of sexually transmitted diseases. Nursing Problems / Problemy Pielęgniarstwa. 2012;20(3):317-326.
[16] Ministerstwo Edukacji Narodowej. Podstawa programowa kształcenia ogólnego z komentarzem. Szkoła podstawowa. Wychowanie do życia w rodzinie. Available at https://www.ore.edu.pl/wp-content/uploads/2017/05/wychowanie-do-zycia-w-rodzinie.-pp-z-komentarzem.-szkola-podstawowa-1.pdf. Accessed on 07/06/2020.
[17] Ministerstwo Edukacji Narodowej. Podstawa programowa kształcenia ogólnego z komentarzem Szkoła ponadpodstawowa: liceum ogólnokształcące, technikum oraz branżowa szkoła I stopnia. Available at https://www.ore.edu.pl/wp-content/plugins/download-attachments/includes/download.php?id=23142. Accessed on 07/06/2020.
[18] Palmer T, Wallace L, Pollock KG, Cuschieri K, Robertson C, Kavanagh K, Cruickshank M. Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study. BMJ. 2019 Apr 3;365:l1161. doi: 10.1136/bmj.l1161.
[19] Beachler DC, Kreimer AR, Schiffman M, Herrero R, Wacholder S, Rodriguez AC, Lowy DR, Porras C, Schiller JT, Quint W, Jimenez S, Safaeian M, Struijk L, Schussler J, Hildesheim A, Gonzalez P; Costa Rica HPV Vaccine Trial (CVT) Group. Multisite HPV16/18 Vaccine Efficacy Against Cervical, Anal, and Oral HPV Infection. J Natl Cancer Inst. 2015 Oct 14;108(1):djv302. doi: 10.1093/jnci/djv302.
[20] St Laurent J, Luckett R, Feldman S. HPV vaccination and the effects on rates of HPV-related cancers. Curr Probl Cancer. 2018 Sep;42(5):493-506. doi: 10.1016/j.currproblcancer.2018.06.004.
[21] Giuliano AR, Palefsky JM, Goldstone S, Moreira ED Jr, Penny ME, Aranda C, Vardas E, Moi H, Jessen H, Hillman R, Chang YH, Ferris D, Rouleau D, Bryan J, Marshall JB, Vuocolo S, Barr E, Radley D, Haupt RM, Guris D. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med. 2011 Feb 3;364(5):401-11. doi: 10.1056/NEJMoa0909537. Erratum in: N Engl J Med. 2011 Apr 14;364(15):1481.
[22] Drolet M, Bénard É, Boily MC, Ali H, Baandrup L, Bauer H, Beddows S, Brisson J, Brotherton JM, Cummings T, Donovan B, Fairley CK, Flagg EW, Johnson AM, Kahn JA, Kavanagh K, Kjaer SK, Kliewer EV, Lemieux-Mellouki P, Markowitz L, Mboup A, Mesher D, Niccolai L, Oliphant J, Pollock KG, Soldan K, Sonnenberg P, Tabrizi SN, Tanton C, Brisson M. Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis. 2015 May;15(5):565-80. doi: 10.1016/S1473-3099(14)71073-4.
[23] Hall MT, Simms KT, Lew JB, Smith MA, Brotherton JM, Saville M, Frazer IH, Canfell K. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health. 2019 Jan;4(1):e19-e27. doi: 10.1016/S2468-2667(18)30183-X.
[24] Agency for Health Technology Assessment and Tariff System. 2019. Profilaktyka zakażeń wirusem brodawczaka ludzkiego (HPV) w ramach programów polityki zdrowotnej. Available at https://bipold.aotm.gov.pl/assets/files/ppz/2019/RPT/19.10.29_raport_zalec_techn_art_48aa_profilaktyka_hpv.pdf. Accessed on 19/05/2020.
[25] Grupa Luxmed. Vaccination Programmes. Vaccinations against HPV. About the program. Available at https://www.luxmed.pl/en/for-patients/of/vaccines/vaccinations-against-hpv.html. Accessed in 20/05/2020.
[26] Statistics Poland. 2019. Pracujący i wynagrodzenia w gospodarce narodowej w 2018 r. – dane wstępne. Available at https://stat.gov.pl/download/gfx/portalinformacyjny/pl/defaultaktualnosci/5474/18/1/1/pracujacy_i_wynagrodzenia_w_gospodarce_narodowej_w_2018_r.__dane_wstepn....pdf. Accessed on 19/05/2020.
[27] National Institute of Public Health in Poland. 2019. Available at https://szczepienia.pzh.gov.pl/faq/gdzie-realizowane-sa-samorzadowe-programy-szczepien-przeciw-hpv/. Accessed on 17/05/2020.
[28] Strategic Advisory Group of Experts on Immunization Working Group on Human Papillomavirus (HPV) immunization, Report to SAGE. 2018. Available at https://www.who.int/immunization/sage/meetings/2018/october/3_SAGE2018_WG_recommendation_FINAL.pdf?ua=1. Accessed on 19/05/2020.
[29] Grace D, Gaspar M, Rosenes R, Grewal R, Burchell AN, Grennan T, Salit IE. Economic barriers, evidentiary gaps, and ethical conundrums: a qualitative study of physicians' challenges recommending HPV vaccination to older gay, bisexual, and other men who have sex with men. Int J Equity Health. 2019 Oct 17;18(1):159. doi: 10.1186/s12939-019-1067-2.
[2] Millner DA. Diagnostic pathology: Infectious Diseases: Viral infections, 40. Philadelphia: Elsevier, 2015.
[3] Alexander KA, Giuliano AR. HPV-beyond cervical cancer (online resource center). Am J Med. 2012 Jul;125(7):S1. doi: 10.1016/j.amjmed.2012.03.005.
[4] Wang CJ, Palefsky JM. Human Papillomavirus (HPV) Infections and the Importance of HPV Vaccination. Curr Epidemiol Rep. 2015 Jun;2(2):101-109. doi: 10.1007/s40471-015-0039-3.
[5] Didkowska J, Wojciechowska U. Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Narodowy Instytut Onkologii im. Marii Skłodowskiej-Curie – Państwowy Instytut Badawczy. Available at http://onkologia.org.pl/k/epidemiologia/ Accessed on 06/06/2020.
[6] International Agency for Research on Cancer. Human papillomaviruses. In: IARC monographs on the evaluation of carcinogenic risks to humans, volume 90. Lyon, France: IARC, 2007.
[7] Saraiya M, Unger ER, Thompson TD, Lynch CF, Hernandez BY, Lyu CW, Steinau M, Watson M, Wilkinson EJ, Hopenhayn C, Copeland G, Cozen W, Peters ES, Huang Y, Saber MS, Altekruse S, Goodman MT; HPV Typing of Cancers Workgroup. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst. 2015 Apr 29;107(6):djv086. doi: 10.1093/jnci/djv086.
[8] Glick SN, Feng Q, Popov V, Koutsky LA, Golden MR. High rates of incident and prevalent anal human papillomavirus infection among young men who have sex with men. J Infect Dis. 2014 Feb 1;209(3):369-76. doi: 10.1093/infdis/jit441.
[9] Lee SM, Park JS, Norwitz ER, Koo JN, Oh IH, Park JW, Kim SM, Kim YH, Park CW, Song YS. Risk of vertical transmission of human papillomavirus throughout pregnancy: a prospective study. PLoS One. 2013 Jun 13;8(6):e66368. doi: 10.1371/journal.pone.0066368.
[10] Bodaghi S, Wood LV, Roby G, Ryder C, Steinberg SM, Zheng ZM. Could human papillomaviruses be spread through blood? J Clin Microbiol. 2005 Nov;43(11):5428-34. doi: 10.1128/JCM.43.11.5428-5434.2005.
[11] Centers for Disease Control and Prevention. 2017. Genital HPV Infection - Fact Sheet. Available at https://www.cdc.gov/std/hpv/HPV-FS-print.pdf. Accessed on 06/06/2020.
[12] Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):698-702. doi: 10.15585/mmwr.mm6832a3.
[13] World Health Organization. Electronic address: sageexecsec@who.int. Human papillomavirus vaccines: WHO position paper, May 2017-Recommendations. Vaccine. 2017 Oct 13;35(43):5753-5755. doi: 10.1016/j.vaccine.2017.05.069.
[14] Dziennik Urzędowy Ministra Zdrowia. Poz. 104. Komunikat Głównego Inspektora Sanitarnego w sprawie Programu Szczepień ochronnych na rok 2019. Warszawa dnia 25 października 2018. Available at https://gis.gov.pl/wp-content/uploads/2018/01/akt.pdf. Accessed on 07/06/2020.
[15] Olejniczak D, Wodzyńska K, Religioni U: The high school graduates knowledge of sexually transmitted diseases. Nursing Problems / Problemy Pielęgniarstwa. 2012;20(3):317-326.
[16] Ministerstwo Edukacji Narodowej. Podstawa programowa kształcenia ogólnego z komentarzem. Szkoła podstawowa. Wychowanie do życia w rodzinie. Available at https://www.ore.edu.pl/wp-content/uploads/2017/05/wychowanie-do-zycia-w-rodzinie.-pp-z-komentarzem.-szkola-podstawowa-1.pdf. Accessed on 07/06/2020.
[17] Ministerstwo Edukacji Narodowej. Podstawa programowa kształcenia ogólnego z komentarzem Szkoła ponadpodstawowa: liceum ogólnokształcące, technikum oraz branżowa szkoła I stopnia. Available at https://www.ore.edu.pl/wp-content/plugins/download-attachments/includes/download.php?id=23142. Accessed on 07/06/2020.
[18] Palmer T, Wallace L, Pollock KG, Cuschieri K, Robertson C, Kavanagh K, Cruickshank M. Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study. BMJ. 2019 Apr 3;365:l1161. doi: 10.1136/bmj.l1161.
[19] Beachler DC, Kreimer AR, Schiffman M, Herrero R, Wacholder S, Rodriguez AC, Lowy DR, Porras C, Schiller JT, Quint W, Jimenez S, Safaeian M, Struijk L, Schussler J, Hildesheim A, Gonzalez P; Costa Rica HPV Vaccine Trial (CVT) Group. Multisite HPV16/18 Vaccine Efficacy Against Cervical, Anal, and Oral HPV Infection. J Natl Cancer Inst. 2015 Oct 14;108(1):djv302. doi: 10.1093/jnci/djv302.
[20] St Laurent J, Luckett R, Feldman S. HPV vaccination and the effects on rates of HPV-related cancers. Curr Probl Cancer. 2018 Sep;42(5):493-506. doi: 10.1016/j.currproblcancer.2018.06.004.
[21] Giuliano AR, Palefsky JM, Goldstone S, Moreira ED Jr, Penny ME, Aranda C, Vardas E, Moi H, Jessen H, Hillman R, Chang YH, Ferris D, Rouleau D, Bryan J, Marshall JB, Vuocolo S, Barr E, Radley D, Haupt RM, Guris D. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med. 2011 Feb 3;364(5):401-11. doi: 10.1056/NEJMoa0909537. Erratum in: N Engl J Med. 2011 Apr 14;364(15):1481.
[22] Drolet M, Bénard É, Boily MC, Ali H, Baandrup L, Bauer H, Beddows S, Brisson J, Brotherton JM, Cummings T, Donovan B, Fairley CK, Flagg EW, Johnson AM, Kahn JA, Kavanagh K, Kjaer SK, Kliewer EV, Lemieux-Mellouki P, Markowitz L, Mboup A, Mesher D, Niccolai L, Oliphant J, Pollock KG, Soldan K, Sonnenberg P, Tabrizi SN, Tanton C, Brisson M. Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis. 2015 May;15(5):565-80. doi: 10.1016/S1473-3099(14)71073-4.
[23] Hall MT, Simms KT, Lew JB, Smith MA, Brotherton JM, Saville M, Frazer IH, Canfell K. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health. 2019 Jan;4(1):e19-e27. doi: 10.1016/S2468-2667(18)30183-X.
[24] Agency for Health Technology Assessment and Tariff System. 2019. Profilaktyka zakażeń wirusem brodawczaka ludzkiego (HPV) w ramach programów polityki zdrowotnej. Available at https://bipold.aotm.gov.pl/assets/files/ppz/2019/RPT/19.10.29_raport_zalec_techn_art_48aa_profilaktyka_hpv.pdf. Accessed on 19/05/2020.
[25] Grupa Luxmed. Vaccination Programmes. Vaccinations against HPV. About the program. Available at https://www.luxmed.pl/en/for-patients/of/vaccines/vaccinations-against-hpv.html. Accessed in 20/05/2020.
[26] Statistics Poland. 2019. Pracujący i wynagrodzenia w gospodarce narodowej w 2018 r. – dane wstępne. Available at https://stat.gov.pl/download/gfx/portalinformacyjny/pl/defaultaktualnosci/5474/18/1/1/pracujacy_i_wynagrodzenia_w_gospodarce_narodowej_w_2018_r.__dane_wstepn....pdf. Accessed on 19/05/2020.
[27] National Institute of Public Health in Poland. 2019. Available at https://szczepienia.pzh.gov.pl/faq/gdzie-realizowane-sa-samorzadowe-programy-szczepien-przeciw-hpv/. Accessed on 17/05/2020.
[28] Strategic Advisory Group of Experts on Immunization Working Group on Human Papillomavirus (HPV) immunization, Report to SAGE. 2018. Available at https://www.who.int/immunization/sage/meetings/2018/october/3_SAGE2018_WG_recommendation_FINAL.pdf?ua=1. Accessed on 19/05/2020.
[29] Grace D, Gaspar M, Rosenes R, Grewal R, Burchell AN, Grennan T, Salit IE. Economic barriers, evidentiary gaps, and ethical conundrums: a qualitative study of physicians' challenges recommending HPV vaccination to older gay, bisexual, and other men who have sex with men. Int J Equity Health. 2019 Oct 17;18(1):159. doi: 10.1186/s12939-019-1067-2.