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‘Safe sexual practice’ reference is removed from HSE’s primary care cancer document

The Medical Independent (MI) understands the reference was contained in a draft version but was then removed from the finalised document.

In its section on prevention and early detection, the document says tobacco, alcohol and HPV are the main risk factors for head and neck cancer. “HPV vaccination should be encouraged,” it states.

Oropharyngeal cancers are now being diagnosed in younger men and women, notes the document. This group does not necessarily have all the classical risk factors and their illness may be associated with HPV infection.

A HSE spokesperson told MI the document was developed by a group of cancer specialists and endorsed by the ICGP and Irish Dental Association.

“This is a toolkit to assist medical, dental and pharmacy personnel in the early recognition of mouth, head and neck cancers and to encourage early referral. Urgent clinical conditions and referral criteria are documented and this is the focus of the toolkit. Therefore, the message of safe sexual practice in relation to HPV was not the key message for this particular piece of work and it was not included.”

Internationally, it is estimated that over 50 per cent of oropharyngeal cancers in developed countries may be related to HPV strains.  “But the overall proportion for oral cavity cancers related to HPV is much smaller… The combination of long-term smoking and alcohol can explain over 70 per cent of all head and neck cancers.”

 The NCCP encourages HPV vaccination for groups in the population for whom vaccination is recommended and in accordance with national policy, said the HSE spokesperson.

 Vaccination policy is “set by the Department of Health” and recommendations are made by the National Immunisation Advisory Committee (NIAC) in the RCPI.

“To date, NIAC has not specifically recommended that the [HPV vaccination] programme be extended to all boys. NIAC do recommend vaccination for certain at-risk groups. The HPV vaccine is not licensed for head and neck cancers.”

The Department has asked HIQA to conduct a health technology assessment of universal HPV vaccination. HIQA anticipates undertaking this work early next year.

The HSE and ICGP recently developed an e-learning module to increase awareness and understanding of HPV infections and the role of vaccination.

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