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HPV vaccination confers high degree of protection against oral infections, despite underuse
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The HPV vaccine reduced oral HPV–related infection prevalence among young adults in the United States, according to cross-sectional study results scheduled for presentation at the ASCO Annual Meeting.
However, low vaccine uptake — particularly among men — resulted in a modest population-level effectiveness.
“HPV is the fastest rising cancer among young white men in the United States; over 90% [of cases] are caused by one type of HPV — HPV16,” Maura L. Gillison, MD, PhD, professor of medicine at The University of Texas MD Anderson Cancer Center, said during a press conference. “There haven’t been any clinical trials evaluating whether the currently approved HPV vaccines have an impact on oral HPV infections among young adults in America.”
Gillison and colleagues examined the impact of prophylactic HPV vaccination on oral HPV infections in 2,627 men and women aged 18 to 33 years using 2011 to 2014 data from the National Health and Nutrition Examination Survey. The researchers focused on four HPV types — 16, 18, 6 and 11 — included in HPV vaccines prior to 2016.
In total, 18.3% of participants received at least one HPV vaccine dose prior to the age of 26 years. The vaccination rate appeared much lower among men than women (6.9% vs. 29.2%; P < .001).
Vaccinated participants demonstrated a reduced population-weighted prevalence of oral HPV16/18/6/11 infections compared with unvaccinated individuals (0.11% vs. 1.61%; P = .008), which corresponded to an estimated 88.2% (95% CI, 5.7-98.5) reduction in prevalence.
However, vaccinated and unvaccinated participants showed a similar prevalence of oral infection within 33 HPV types not covered by the vaccine (3.98% vs. 4.74%).
Still, these data suggest a modest impact of HPV vaccination on the prevalence of vaccine-covered, oral HPV infections in the general population due to low uptake. Prevalence reduced by 17% overall, or by 25% in women and 6.9% in men.
“While we were encouraged there was a notable impact of the vaccine on oral HPV infections among vaccinated individuals, that benefit was modest overall and lower than we would hope in men due to low vaccine uptake,” Gillison said in a press release.
Gillison noted HPV vaccination is indicated for the prevention of cervical, vulvar, vaginal and anal cancers in women, and anal cancers in men; however, whether the vaccine could eventually reduce incidence of oral cancers related to oral HPV infections remains unknown.
“The HPV vaccine is one of the most important advances in cancer prevention in the last several decades,” she said during the press conference. “Parents who choose to have their children vaccinated against HPV should realize the vaccine may provide additional benefits, such as prevention of oral HPV infections linked to oral cancers.” – by Kristie L. Kahl and Melinda Stevens
Reference:
Gillison ML, et al. Abstract 6003. Scheduled for presentation at: ASCO Annual Meeting; June 2-6, 2017; Chicago.
Disclosure: Gillison reports consultant/advisory roles with Amtene, AstraZeneca, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Lilly and Merck, as well as research funding paid to her institution from AstraZeneca, Bristol-Myers Squibb, Kyowa Hakko Kirin and Merck.
Perspective
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Bruce E. Johnson, MD, FASCO
The HPV vaccine has the potential to be one of the most significant cancer prevention tools ever developed, and it’s already reducing the world’s burden of cervical cancers. The hope is that vaccination will also curb rising rates of HPV–related oral and genital cancers, which are hard to treat. This study confirms that the HPV vaccine can prevent oral HPV infections, but we know it only works if it’s used.
Perspective
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David Kutler, MD
The HPV vaccine is a very important development for preventing cervical cancer, oral cavity cancer, anal cancer and other HPV–associated cancers. The rate of HPV–associated tonsil cancers and tongue cancers is increasing. It’s like an epidemic.
Vaccination has been shown to be pretty effective. However, the problem is, it hasn’t caught on in the United States. It is not being used as much as it should be.
It is pretty well known to administer the HPV vaccine to young women and children, but it used far less about young men. Despite the vaccine’s efficacy, it’s not useful when you don’t administer it.
As a society, we must begin to understand we should be vaccinating. There should be some promotion of the vaccine and its usefulness for preventing cancer. We give polio vaccines and measles and mumps vaccines, but HPV has not caught on. If it doesn’t catch on, it won’t help reduce the rate of HPV infection.
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