HPV vaccinations will slow oropharynx cancer rates but may take 25 years to see impact
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According to projections in JAMA Oncology, it will take over 25 years to slow increasing oropharynx cancer incidence by human papillomavirus vaccinations because the disease will be observed in older population not yet vaccinated.
“HPV vaccination will eventually prevent oropharynx cancers (OPC), but it will take more than 25 additional years to see these impacts in the United States,” lead author, Yuehan Zhang, MS, a PhD candidate in cancer epidemiology at Johns Hopkins Bloomberg School of Public Health, told Healio Gastroenterology. “Overall incidence of oropharynx cancer is projected to continue to increase between 2020 and 2045 because most of these cancers will occur among older individuals who have not yet been vaccinated.”
Zhang and colleagues obtained data from the Surveillance, Epidemiology, and End Results program from 69,562 patients aged 34 years to 83 years diagnosed with oropharynx cancer. Investigators used the National Immunization Survey–Teen (n = 60,124) and National Health Interview Survey (n=16,904 participants) to obtain HPV vaccination data. Using a counterfactual scenario of no HPV vaccination and current levels of HPV vaccination, stratifying by sex, Zhang and colleagues applied age-period-cohort forecasting models to project expected 2018 to 2045 OPC incidence. The projected OPC incidence and number of OPC cases expected to be prevented by HPV vaccination served as the primary outcome.
According to Zhang and colleagues, OPC incidence between 2018 and 2045 is projected to decrease in younger individuals (36-45 years of age: 1.4 to 0.8 per 100 000 population; 46-55 years of age: 8.7 to 7.2 per 100,000 population) under current HPV vaccination rates. However, the incidence will continue to increase among older patients (70-83 years of age: 16.8 to 29 per 100,000 population). They also reported the correlation between HPV vaccination and overall OPC incidence through 2045 will remain modest (no vaccination vs. vaccination: 14.3 vs. 13.8 per 100 000 population in 2045).
While HPV vaccination is projected to decrease OPC incidence in patients aged 36 to 45 years (men: 48.1%; women: 42.5%) and aged 46 to 55 years (men: 9.0%; women: 22.6%) by 2045, rates will not meaningfully decrease among those aged 56 years or older because they are not vaccinated. However, Zhang and colleagues concluded that 6,334 OPC cases will be prevented by HPV vaccination between 2018 and 2045. Of these cases, 88.8% occur in the younger age groups.
Perspective
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Jessica Geiger, MD
The overall incidence of tobacco and alcohol-related head and neck cancers is decreasing, though the specific incidence of oropharynx cancer, cancers involving the tonsils or base of tongue, continues to rise. This is due to HPV-related disease, which accounts for up to 70% of all oropharynx cancer cases. Patients with HPV-related oropharynx cancer tend to be younger, with little to no smoking history and with fewer medical co-morbidities.
First approved in 2006, HPV vaccines are currently indicated for both males and females aged 9 years to 45 years and these vaccines have been shown to successfully prevent oral HPV infections and related cancers, including oropharynx cancer. However, as Zhang and colleagues recently described, we will not see this impact on overall oropharynx cancer incidence as numbers are projected to rise through 2045.
Utilizing national health survey statistics of thousands of patients and applying advanced statistical modeling, investigators predict that while rates of HPV-related oropharynx cancer will decline in the coming years amongst younger men and women, HPV-related oropharynx cancer rates for older persons (aged 56 years or older) will remain largely unchanged due to lack of vaccinations in this population.
Though we will continue to see large numbers of HPV-related oropharynx cancer for decades to come, mainly in older patients, it remains abundantly clear the benefit HPV vaccines have on preventing infection and the subsequent development of HPV-related cancers. Current recommendations advocate vaccinating younger children aged 11 years to 12 years, prior to any sexual activity and therefore any HPV exposure. However, since there exist many strains of HPV, patients may still achieve protection against HPV infections even after prior exposure. As such, completing HPV vaccination still should be strongly considered into adulthood in keeping with indicated approval up to 45 years of age.
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