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Our latest Pieces of the Continent series features Richard Gallagher, Director of Cancer Services at St Vincent’s Hospital Campus in Sydney, Australia.

Q. Please introduce yourself and tell us a bit about your background Richard Gallagher, Head and Neck Surgeon and Surgical Oncologist, Director of Cancer Services, St Vincent’s Hospital Campus, Sydney, Australia. I have been treating head and neck cancer patients for more than twenty years as part of a multidisciplinary team (MDT) which includes otolaryngology – head and neck surgeons, radiation oncologists, medical oncologists, plastic and reconstructive surgeons, nuclear medicine physicians, anatomical pathologists, speech pathologists, specialist nurses and nurse practitioners, dieticians, dentists and cancer care coordinators. I am also a trans oral robotic surgeon (TORS).

Q. What was your reasoning behind writing an article on oropharyngeal cancer for HPV Awareness Day? I wanted to challenge the misconception that cervical cancer is the only HPV related cancer. In high to middle income countries oropharyngeal squamous cell carcinoma is now the most common HPV related cancer. More common than cervical cancer. Yet we still have a worldwide HPV conversation dominated by cervical cancer. I wanted to not only challenge the HPV cancer conversation but also to explain why HPV related oropharyngeal cancer is not getting the attention it deserves.

Q. What do you wish more people knew about HPV? - HPV causes six different cancers in both men and women. - Four out of five people are infected with HPV at one time or another, it is the “common cold” of sexually transmitted infections (STIs). - HPV related cancers can develop decades after you first contract an HPV infection, they do not indicate you have been unfaithful to your partner. - HPV vaccination is cancer prevention.

Q. What can be done to increase awareness of HPV in cancers/diseases other than cervical cancer? When I first learned of the emerging HPV related oropharyngeal epidemic ten years ago I thought that all we needed to do was talk about it. And when I say “we”, I mean the media and the public. But I was wrong. I know of celebrities who’ve contracted HPV related oropharyngeal cancers who don’t specify the type of cancer they have because of the stigma of sexually transmitted infections (STIs). Just look at the actor Michael Douglas. We know that knowledge and education are the best ways to reduce feelings of stigma, shame and anxiety, so those of us who know the facts need to keep talking and educate those who are willing to listen.

Q. What possible interventions would help increase vaccination rates? Boys and girls aged 12-13 should be offered two doses of the HPV vaccine via a school-based program at no cost as part of a national government funded program. We also need to better understand vaccine opponents and find new ways to present scientific consensus to an audience sceptical of medical experts.

Q. Any final thoughts? Anything we haven’t covered that you would like to mention? Well I thought I might take this opportunity to lead by example and talk openly about HPV. I tell my patients that I’m a sitting duck for an HPV related oropharyngeal related cancer. I’m aged in my mid fifties and I’ve been married for more than twenty five years but I had a number of sexual partners before I met my wife. So if I notice a lump in my neck, difficulty or pain on swallowing, or unexplained earache I can assure you that I will be getting myself checked out ASAP.


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