Knut Arne received a shock message: – Could have a fatal outcome

It started with difficulty swallowing, then the food started to taste unusual. Finally, he coughed up blood.

In 2019, Knut Arne Gravingen (54) received the message he feared: cancer in the throat with spread.

– When I got that message, my first thought was: What is the worst scenario? he says.

The cause of cancer is HPV, which is a virus. In recent years, the number of men who get cancer related to the virus has increased.

And in the future, it seems that the number will increase even more, according to the Cancer Register.

Women, but not men

The virus, called human papillomavirus, is a sexually transmitted infection.

There is a vaccine against the virus.

Since 2009, all girls in the 7th grade have been offered a free HPV vaccine. Boys received the same offer nine years later.

From 2016 to 2018, women born in 1991 and later were also offered a free HPV vaccine, in a so-called catch-up program.

However, men did not receive this offer.

It is discriminatory, believes Professor Emeritus Ole-Erik Iversen at the University of Bergen.

HPV is one of the most important reasons why women develop cervical cancer.

But the virus can also lead to cancer that mainly affects men, such as in the mouth, throat, anus and penis.

– The proportion of men who get HPV-related cancer will increase in the coming years. This can be largely avoided by offering young men a free HPV vaccine, says Iversen.

He believes that we do not have good enough methods to detect preliminary stages and treat the diseases that affect men to the greatest extent.

– We have a vaccine, but we don’t use it. It costs money, but it is a pittance compared to what it protects later in life when we have to treat cancer, says Iversen.

– What have I done?

For Knut Arne Gravingen, life was turned upside down after the cancer announcement.

– Sitting here in the living room with a four-year-old on your lap, and saying you’re going to hospital and will be gone for Christmas. It was nothing fancy, says the 54-year-old.

When he received the shock message, he thought like most people: How long do I have left?

– The doctors said that they see the form of cancer I had more often. Fortunately, they also said they would get me well, says Gravingen.

He received follow-up at Radiumhospitalet in Oslo, where some of the country’s leading cancer experts work.

– I wasn’t afraid or worried, but I also didn’t know what everyday life would be like after the treatment, says the 54-year-old.

Four years later

The reason why men have not received the same offer of the HPV vaccine as women is due to two things, according to the Folkehelseinstiuttet.

One is that the vaccine has the best effect when it is given early, i.e. before sexual debut. In addition, three out of four people who get HPV-related cancer are women, while a quarter are men.

– Therefore, there has been a greater rationale behind giving it to litters with women, says senior physician Margrethe Greve-Isdahl, who heads the child vaccination program at FHI.

The reason why girls were offered vaccines long before boys in the 7th grade is that the vaccine at this time only had a documented effect on women, according to the senior doctor.

Investigation is pending

In 2019, FHI started a investigation about the HPV vaccine for risk groups, including men who have sex with men.

Four years later, the investigation is still not finished. And it is also not certain that it will be finished this year.

– We have dealt with a pandemic, and resources have been turned to working with it. Now after the pandemic, we are in a downsizing situation, which means that we have few available resources to make that assessment, says Greve-Isdahl.

– We don’t know when it will be completed, she says.

– How serious is it?

– It is serious that someone who could benefit from it does not get it, she says.

– Impatient

The Norwegian Cancer Society says that they have been urging the FHI about the investigation, most recently last autumn.

They believe that the HPV vaccine is essential for reducing HPV infection in society, which has increased and increased in recent years.

Secretary General of the Norwegian Cancer Society, Ingrid Stenstadvold Ross, says that she understands that FHI has concentrated on the pandemic, but that it is now no longer an excuse.

– Now they have to take up the investigation and come to an end with it. We expect it to go quite quickly now. We are impatient, says Stenstadvold Ross.

Like Professor Iversen, the Cancer Society believes that a catch-up program should be established such as women received in 2016 to 2018.

The first boys who were vaccinated in the child vaccination program will turn 17 this year.

Iversen believes that boys between the ages of 17 and 26 should become part of such a programme, regardless of sexual orientation.

– There are some risk groups for whom the vaccine is particularly important, men who have sex with men, among others. But we want a catch-up program for all men. Then we will reduce the HPV infection as much as possible, and that is what we are concerned with, says the general secretary of the Cancer Association.

According to the Swedish authorities, the incidence of HPV infections and serious cell changes at population level has decreased after the HPV vaccine was introduced.

– Fatal outcome

The Norwegian Cancer Society is concerned about the consequences if the investigation continues to drag on.

– In the worst case, the delays can mean that cancer, which can be fatal, cannot be prevented. It is very serious. This is precisely why it is so important that it is prioritized, says Stenstadvold Ross.

The Norwegian Institute of Public Health says that the reason they have an investigation going on for risk groups is because they believe they can benefit most from an HPV vaccine, even after sexual debut.

The risk groups concerned are men who have sex with men and people who are on immunosuppressive medication.

– Men who have sex with men are a group we have not reached in the vaccination programme. They do not have herd protection as the girls have been vaccinated for many years, says Greve-Isdahl in FHI.

– Fish in the aquarium

After 36 radiation treatments and 6 chemotherapy courses after cancer in the tonsils, Gravingen became cancer-free. But today he struggles with tendon injuries.

He would prefer to work, but concentration difficulties and fatigue make it difficult. It was a life he was not prepared for.

– You have to get to know your body again. What you could do before, I can’t do now. Everything takes longer, says the 54-year-old.

Gravingen says that he would without a doubt have taken the vaccine if the offer had been available when he was young.

Three doses of Cervarix, which are used in the children’s vaccination programme, cost around NOK 3,000. Three doses of a similar vaccine, Gardasil 9, cost around NOK 4,800.

Gravengen believes society can afford to give young men the vaccine, especially considering what his treatment has cost.

– The four thousand kroner will be like a fish in the aquarium, or a fish in Mjøsa, for that matter, says Gravingen, who lives in Hamar.

– I don’t wish anyone to walk this route I have walked.

– Very uncertain

The Ministry of Health and Care Services (HOD) sees the benefit in putting in place a wider offer of the HPV vaccine for men.

– The HPV vaccine will probably prevent the cancers caused by HPV if the vaccine is given before one is exposed to infection, writes State Secretary Karl Kristian Bekeng (Ap) in the Ministry of Health and Care in an email.

Bekeng that the investigation only deals with the HPV vaccine for men who have sex with men, and not all.

The State Secretary, like FHI, cannot answer when the investigation will be completed.

– It is very uncertain when this assessment will be completed given the demanding situation FHI is in, says Bekeng.