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Dear Dr. Roach: Thank you for your recent column about the benefits of HPV vaccine for males. I would like to add that, from a public-health perspective, there is little controversy about the idea that the HPV vaccine prevents cancers in all the parts of the body that can be infected by high-risk types of HPV — not only the cervix, vagina and vulva in women and the anus in both men and women, but also the oropharynx (a region of the throat) in both sexes, especially men.

The reason we can’t say that there is absolute proof of HPV vaccine preventing HPV-related oropharyngeal cancer is that there is no early sign of this type of cancer that researchers could look for when testing the vaccine’s effects. They would have to wait for the cancer itself to develop, which can take decades. But there is no biological reason why HPV vaccine would not prevent HPV-related oropharyngeal cancer. (Smoking is another cause of oropharyngeal cancer, but HPV vaccine can’t do anything about that.) HPV-related oropharyngeal cancer is becoming very common — soon to surpass cervical cancer — and it’s important for your readers to know that HPV vaccine almost certainly will reduce young people’s chances of ever getting this type of cancer.

I also want to mention that all the evidence points to HPV vaccine being very long-lasting. Unlike other vaccines that are known to wane over time, there is nothing in the past nine years’ worth of data on HPV vaccine to suggest that booster doses will be necessary. This is all the more reason to give the vaccine at the recommended age of 11-12 years, well before a person is likely to be exposed to the virus. There is nothing to be gained by waiting until the person is older.

Kristen R. Ehresmann, RN, director of Infectious Disease Epidemiology, Prevention and Control at the Minnesota Department of Health

Dear Ms. Ehresmann: I thank Ms. Ehresmann for providing additional information on the HPV vaccine. I believe that the benefits of the vaccine just for reduction in cervical cancer make it worthwhile, considering the safety of the vaccine. I agree with you that it is likely there will be additional benefit in reducing the risk of other HPV-associated disease, such as head and neck cancer. I also appreciate the information that the newest data show the immunity is very long-lasting.

Dear Dr. Roach: I have been taking EDTA for about 10 years for the chelation effect. My question is whether you think it would be more effective if taken on an empty stomach, or after meals?

D.

Dear D.: Plaque, the material inside arteries that blocks blood flow, is made out of cholesterol and calcium. The major theory behind chelation is that the calcium can be removed from the plaque by introducing a molecule into the bloodstream (EDTA) that binds to calcium, and removes it from the artery, improving blood flow. However, this mechanism hasn’t been proven.

Oral EDTA has never, to my knowledge, been evaluated, let alone been proven effective, for heart disease, and may cause more harm than good. I do not recommend oral EDTA treatment to prevent or treat heart disease, neither before meals nor on an empty stomach.

However, a 2013 trial with intravenous EDTA showed about a 3.5 percent reduction in cardiac events, mostly in the need for surgery or angioplasty. The study was severely criticized, and the benefit was limited to people with diabetes. Ultimately, the authors noted that “These results provide evidence to guide further research but are not sufficient to support the routine use of chelation therapy for treatment of patients who have had a myocardial infarction.” I agree. IV chelation therapy is not an appropriate standard therapy, but it may deserve more study.

Email questions to ToYourGoodHealth@med.cornell.edu.

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