251
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Current strategies for prevention of oral manifestations of human immunodeficiency virus. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:29-38. [PMID: 26679357 DOI: 10.1016/j.oooo.2015.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/08/2015] [Accepted: 09/02/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Strategies to prevent new-onset and recurrent oral manifestations of human immunodeficiency virus (HIV), including fungal, viral, neoplastic, and idiopathic mucosal diseases and destructive periodontal conditions, are poorly understood. STUDY DESIGN A structured review of the English language literature in PubMed through March 2015 was conducted to identify current prevention strategies for initial and recurrent oral manifestations of HIV. RESULTS Pharmacologic approaches, including combination antiretroviral therapy or other targeted therapies for prevention of oropharyngeal candidiasis, orolabial herpes, oral hairy leukoplakia, oral Kaposi sarcoma, linear gingival erythema and necrotizing ulcerative periodontitis were found. Nonpharmacologic approaches for prevention of oropharyngeal candidiasis, orolabial herpes, oral hairy leukoplakia, and necrotizing ulcerative periodontitis are presented. CONCLUSIONS Current strategies for the prevention of oral manifestations of HIV include pharmacologic and nonpharmacologic therapies. Immune reconstitution inflammatory syndrome, future vaccine therapy for pathogens causing oral mucosal disease, and the possible role of oral inflammatory disease prevention in controlling HIV disease progression are discussed.
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Targeted Therapy in Oropharyngeal Squamous Cell Carcinoma: The Implications of HPV for Therapy. ACTA ACUST UNITED AC 2015; 3:89-117. [PMID: 27182480 PMCID: PMC4837939 DOI: 10.1007/s40487-015-0008-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 12/13/2022]
Abstract
Oropharyngeal cancers caused by human papillomaviruses (HPV) have a different epidemiology, prognosis, genetic mutational landscape, response to treatment, and outcome when compared to HPV-negative cancers. In this review, a summary of our current understanding of HPV in head and neck cancer and the important advances that have shown HPV to be an etiological agent are discussed. HPV-positive and HPV-negative tumors are compared discussing clinicopathological factors, prognosis, outcome following treatment, and the molecular and genetic differences. Currently, the standard of care for oropharyngeal cancer is both surgery and post-operative radiotherapy with or without cisplatin or concurrent chemo-radiotherapy. The latter is used more often, especially in cancers of tonsil and base of tongue. However, there is increased interest in trying to de-intensify treatment and in the development of new treatments to target the underlying different molecular pathways of HPV-positive cancers. The current clinical trials involving surgery, chemotherapy, and radiation therapy are discussed. The new targeted treatments are also summarized. Although there is currently is no evidence from prospective studies to support a change in the treatment algorithm, the treatment options for patients with HPV-positive disease are likely to change in the future.
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253
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Maresso KC, Tsai KY, Brown PH, Szabo E, Lippman S, Hawk ET. Molecular cancer prevention: Current status and future directions. CA Cancer J Clin 2015; 65:345-83. [PMID: 26284997 PMCID: PMC4820069 DOI: 10.3322/caac.21287] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 12/20/2022] Open
Abstract
The heterogeneity and complexity of advanced cancers strongly support the rationale for an enhanced focus on molecular prevention as a priority strategy to reduce the burden of cancer. Molecular prevention encompasses traditional chemopreventive agents as well as vaccinations and therapeutic approaches to cancer-predisposing conditions. Despite challenges to the field, we now have refined insights into cancer etiology and early pathogenesis; successful risk assessment and new risk models; agents with broad preventive efficacy (eg, aspirin) in common chronic diseases, including cancer; and a successful track record of more than 10 agents approved by the US Food and Drug Administration for the treatment of precancerous lesions or cancer risk reduction. The development of molecular preventive agents does not differ significantly from the development of therapies for advanced cancers, yet it has unique challenges and special considerations given that it most often involves healthy or asymptomatic individuals. Agents, biomarkers, cohorts, overall design, and endpoints are key determinants of molecular preventive trials, as with therapeutic trials, although distinctions exist for each within the preventive setting. Progress in the development and evolution of molecular preventive agents has been steadier in some organ systems, such as breast and skin, than in others. In order for molecular prevention to be fully realized as an effective strategy, several challenges to the field must be addressed. Here, the authors provide a brief overview of the context for and special considerations of molecular prevention along with a discussion of the results from major randomized controlled trials.
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Affiliation(s)
- Karen Colbert Maresso
- Program Manager, Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kenneth Y Tsai
- Assistant Professor, Department of Dermatology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Powel H Brown
- Chair, Department of Clinical Cancer Prevention, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eva Szabo
- Chair, Lung and Upper Aerodigestive Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Scott Lippman
- Director, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Ernest T Hawk
- Vice President and Division Head, Boone Pickens Distinguished Chair for Early Prevention of Cancer, Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
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254
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Abstract
Oral cavity squamous cell carcinoma (OC-SCC) is the most common malignancy of the head and neck (excluding nonmelanoma skin cancer). Recent trends have shown a dramatic rise in the incidence of oropharyngeal squamous cell carcinoma (OP-SCC), with a marked increase in lesions related to human papillomavirus infection. This update presents the latest evidence regarding OC-SCC and OP-SCC. In particular, the authors compare and contrast tumors at these two sites with respect to epidemiology, etiopathogenesis, clinicopathologic presentation, clinical assessment, imaging, management, and prognosis. It is important for clinicians to be aware of differences between OC-SCC and OP-SCC so that appropriate patient education and multidisciplinary care can be provided to optimize outcomes.
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Affiliation(s)
- Angela C Chi
- Professor, Division of Oral Pathology, Medical University of South Carolina, Charleston, SC
| | - Terry A Day
- Professor, Wendy and Keith Wellin Endowed Chair for Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Brad W Neville
- Distinguished University Professor, Division of Oral Pathology, Medical University of South Carolina, Charleston, SC
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Osazuwa-Peters N, López J, Rice S, Tutlam N, Tokarz S, Varvares MA. No change in physician discussions with patients about the human papillomavirus vaccine between 2007 and 2013. J Cancer Policy 2015. [DOI: 10.1016/j.jcpo.2015.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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256
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Murray S, Ha MN, Thompson K, Hart RD, Rajaraman M, Snow SL. A different entity: a population based study of characteristics and recurrence patterns in oropharyngeal squamous cell carcinomas. J Otolaryngol Head Neck Surg 2015; 44:30. [PMID: 26310237 PMCID: PMC4551366 DOI: 10.1186/s40463-015-0082-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/09/2015] [Indexed: 02/02/2023] Open
Abstract
Background Cases of squamous cell carcinoma (SCC) of the oropharynx were compared with other head and neck cancer (HNC) anatomic subsites in patients treated at the provincial referral centre for HNC, the Nova Scotia Cancer Centre (NSCC). Methods A retrospective chart review was performed on HNC patients assessed at the NSCC between 2010 and 2011. Patient demographics, disease characteristics, treatment details and outcomes, including recurrence rates and survival were collected. Data was collected on new and recurrent cases of HNC. This data was compared between the two types of HNC using chi-square tests for dichotomous categorical variables or Fishers exact test where appropriate. Wald test was used to compare categorical variables with 3 categories. Continuous variables were compared using the non-parametric Wilcoxon test. Results 318 charts were included in the analysis. 122 (38 %) were oropharyngeal squamous cell carcinomas (OPSCCs). In terms of disease characteristics, OPSCCs were more likely to be poorly differentiated/undifferentiated (n = 267, 49(40 %) vs 42(21 %), p < 0.001), non-keratinizing (n = 169, 25(20 %) vs 17(9 %), p < 0.001), greater than 2 cm (n = 253, 72(59 %) vs 78(40 %), p = 0.0061), stage 4 (n = 313, 55(45 %) vs 64(33 %), p = 0.0315) and have had locoregional nodal spread (n = 315, 103(84 %) vs 55(28 %), p < 0.001). In the subset of 57 patients that had p16 testing, OPSCCs were more likely to be p16(+) (37(30 %) vs 1(1 %), p < .001). There were no significant differences in terms of Charlson probability of 10 year survival, smoking or alcohol consumption although OPSCC patients were significantly less likely to have COPD as a co-morbidity (n = 318, 19(16 %) vs 53(27 %), p = 0.0175). Finally, OPSCCs had less chance for relapse than non-OPSCCs in both univariate (2.119 times less, p=0.0034) and multivariate (1.899 times less, p=0.0505) analyses along with a 1.822 times less overall mortality in a multivariae analysis (p=0.0408). Conclusions This analysis suggests that Nova Scotian OPSCCs should be considered distinct from other HNC lesions, most notably in terms of disease characteristics and prognosis. Specifically, despite a higher association with disease factors traditionally considered to be linked to poor prognosis, outcomes were actually superior in terms of relapse and overall mortality.
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Affiliation(s)
- Scott Murray
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada.
| | - Michael N Ha
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada.
| | - Kara Thompson
- Dalhousie University, Research Methods Unit, Halifax, Nova Scotia, Canada.
| | - Robert D Hart
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada. .,Department of Surgery, Division of Otolaryngology, Capital District Health Authority, Halifax, Nova Scotia, Canada.
| | - Murali Rajaraman
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada. .,Department of Radiation Oncology, Capital District Health Authority, Halifax, Nova Scotia, Canada.
| | - Stephanie L Snow
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada. .,Department of Internal Medicine, Division of Medical Oncology, Capital District Health Authority, Halifax, Nova Scotia, Canada.
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257
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Scully C, Samaranayake LP. Emerging and changing viral diseases in the new millennium. Oral Dis 2015; 22:171-9. [PMID: 26179810 PMCID: PMC7167660 DOI: 10.1111/odi.12356] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 12/14/2022]
Abstract
Most viral infections encountered in resource‐rich countries are relatively trivial and transient with perhaps fever, malaise, myalgia, rash (exanthema) and sometimes mucosal manifestations (enanthema), including oral in some. However, the apparent benignity may be illusory as some viral infections have unexpected consequences – such as the oncogenicity of some herpesviruses and human papillomaviruses. Infections are transmitted from various human or animal vectors, especially by close proximity, and the increasing movements of peoples across the globe, mean that infections hitherto confined largely to the tropics now appear worldwide. Global warming also increases the range of movement of vectors such as mosquitoes. Thus recent decades have seen a most dramatic change with the emergence globally also of new viral infections – notably human immunodeficiency viruses (HIV) – and the appearance of some other dangerous and sometimes lethal infections formerly seen mainly in, and reported from, resource‐poor areas especially in parts of Asia, Latin America and Africa. This study offers a brief update of the most salient new aspects of the important viral infections, especially those with known orofacial manifestations or other implications for oral health care.
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Affiliation(s)
- C Scully
- WHO Collaborating Centre for Oral Health-General Health, London.,UCL, London, UK
| | - L P Samaranayake
- Oral Microbiomics and Infection, School of Dentistry, University of Queensland, Brisbane, Qld, Australia
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258
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Abstract
When HPV vaccines were registered in 2006/2007, it was unclear whether these new and type-specific prophylactic vaccines would be accepted by the community for cancer prevention. With an optimal vaccination age of early adolescence, three vaccine doses required, HPV a sexually transmitted infection, and secondary prevention already available in the form of cervical screening, considerable potential challenges were faced. At the time of licensing, vaccine efficacy in males and duration of immunity were not yet unknown. Almost a decade later, with over 230 million doses of the vaccines distributed worldwide and national HPV vaccination programs in place in many countries, it is timely to reflect on current knowledge about the vaccines and some of the lessons learned during implementation.
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Affiliation(s)
- Julia ML Brotherton
- National HPV Vaccination Program Register, VCS Registries, PO Box 310, East Melbourne, Victoria 8002, Australia
- Honorary Principal Fellow, School of Population & Global Health, University of Melbourne, Victoria 3010, Australia
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259
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Khariwala SS, Moore MG, Malloy KM, Gosselin B, Smith RV. The "HPV Discussion": Effective Use of Data to Deliver Recommendations to Patients Impacted by HPV. Otolaryngol Head Neck Surg 2015. [PMID: 26220060 DOI: 10.1177/0194599815597200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The dramatic rise in oropharyngeal squamous cell carcinoma associated with the human papilloma virus (HPV) has brought significant change to the interaction between patients and head and neck oncologists. HPV-induced cancers are generally the result of elements from the patient's sexual history, and otolaryngologists are generally less experienced than primary care physicians in addressing patient questions relating to sexual history and practices. This article addresses questions commonly posed by patients relating to HPV-induced head and neck cancers, issues related to HPV vaccination, and surveillance of HPV-related lesions. Supporting data are provided such that physicians may be better equipped to sufficiently address patient queries on this topic. DATA SOURCES Available peer-reviewed literature and clinical practice guidelines. REVIEW METHODS Assessment and discussion of specific topics by authors selected from the Head and Neck Surgery Education Committee of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. RESULTS An educational "miniseminar" resulted in a notable increase in attendee knowledge and comfort regarding oropharyngeal squamous cell carcinoma counseling for patients in the setting of HPV-positive disease. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The dramatic increase in HPV-associated head and neck cancers has resulted in a changed paradigm of the physician-patient interaction. Care providers in today's environment must be prepared to counsel patients regarding sexually transmitted diseases and high-risk sexual behaviors. Examination of the existing data provides the foundation with which to construct a framework in which physicians can effectively communicate information and recommendations as they pertain to HPV-related carcinoma.
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Affiliation(s)
- Samir S Khariwala
- Department Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael G Moore
- Department Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Kelly M Malloy
- Department Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benoit Gosselin
- Department Otolaryngology-Head and Neck Surgery, Dartmouth Medical Center, Manchester, New Hampshire, USA
| | - Richard V Smith
- Department Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
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260
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Venuti A, Curzio G, Mariani L, Paolini F. Immunotherapy of HPV-associated cancer: DNA/plant-derived vaccines and new orthotopic mouse models. Cancer Immunol Immunother 2015; 64:1329-38. [PMID: 26138695 PMCID: PMC4554738 DOI: 10.1007/s00262-015-1734-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/06/2015] [Indexed: 12/19/2022]
Abstract
Under the optimistic assumption of high-prophylactic HPV vaccine coverage, a significant reduction of cancer incidence can only be expected after decades. Thus, immune therapeutic strategies are needed for persistently infected individuals who do not benefit from the prophylactic vaccines. However, the therapeutic strategies inducing immunity to the E6 and/or E7 oncoprotein of HPV16 are more effective for curing HPV-expressing tumours in animal models than for treating human cancers. New strategies/technologies have been developed to improve these therapeutic vaccines. Our studies focussed on preparing therapeutic vaccines with low-cost technologies by DNA preparation fused to either plant-virus or plant-toxin genes, such as saporin, and by plant-produced antigens. In particular, plant-derived antigens possess an intrinsic adjuvant activity that makes these preparations especially attractive for future development. Additionally, discrepancy in vaccine effectiveness between animals and humans may be due to non-orthotopic localization of animal models. Orthotopic transplantation leads to tumours giving a more accurate representation of the parent tumour. Since HPV can cause cancer in two main localizations, anogenital and oropharynx area, we developed two orthotopic tumour mouse models in these two sites. Both models are bioluminescent in order to follow up the tumour growth by imaging and are induced by cell injection without the need to intervene surgically. These models were utilized for immunotherapies with genetic or plant-derived therapeutic vaccines. In particular, the head/neck orthotopic model appears to be very promising for studies combining chemo-radio-immune therapy that seems to be very effective in patients.
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Affiliation(s)
- Aldo Venuti
- HPV-UNIT, Laboratory of Virology, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144, Rome, Italy,
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261
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Young D, Xiao CC, Murphy B, Moore M, Fakhry C, Day TA. Increase in head and neck cancer in younger patients due to human papillomavirus (HPV). Oral Oncol 2015; 51:727-30. [PMID: 26066977 DOI: 10.1016/j.oraloncology.2015.03.015] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023]
Abstract
The face of head and neck cancer has changed dramatically over the past 30 years. There has been a steady decline in the number of tobacco and alcohol related squamous cell carcinomas over the past 30 years, but and increasing incidence of human papillomavirus (HPV) related cancers. Some estimates suggest that 70-90% of new oropharyngeal cancers have evidence of HPV. These patients have different demographic patterns, in that they are more likely to be younger, white adults in their 40s and 50s who are never smokers or have reduced tobacco exposure. Studies have shown that a higher number of lifetime oral sex partners (>5) and a higher number of lifetime vaginal sex partners (>25) have been associated with increased risk of HPV positive head and neck cancer. People can also reduce their risk of HPV linked head and neck cancer by receiving the HPV vaccine series prior to becoming sexually active. Recent evidence suggests HPV related head and neck cancers present with different symptoms than those caused by tobacco. The most popular test for HPV status is the p16 immunohistochemical stain because it is cheap, simple, and studies have shown it to have comparable sensitivity and specificity to the previous standards. It is widely recommended that all cancers of the oropharynx be tested for the presence of HPV, and some recommend it for all head and neck cancers. Overall 2-year and 5-year survival for HPV positive head and neck cancer is significantly greater than for HPV negative cancers, likely due to HPV positive cancers being more responsive to treatment.
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Affiliation(s)
- David Young
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, United States
| | - Christopher C Xiao
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, United States
| | - Benjamin Murphy
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, United States
| | - Michael Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 1120 W. Michigan Street Suite 200, Indianapolis, IN, United States
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, 601 North Caroline Street, Baltimore, MD, United States
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, United States.
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262
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Pils S, Joura EA. From the monovalent to the nine-valent HPV vaccine. Clin Microbiol Infect 2015; 21:827-33. [PMID: 25980355 DOI: 10.1016/j.cmi.2015.05.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/29/2015] [Accepted: 05/02/2015] [Indexed: 11/28/2022]
Abstract
An investigational monovalent human papillomavirus (HPV) 16 virus-like particle vaccine has been shown to prevent persistent infection and cervical disease related to HPV 16 and was proof of concept (2002). Designed to prevent the bulk of invasive cervical cancer, quadrivalent (HPV 6/11/16/18) and bivalent (HPV 16/18) vaccines have been available since 2006 and 2007, respectively. They are highly effective in preventing HPV 16/18-related cervical precancer; the quadrivalent version also prevents genital warts related to HPV 6/11. It has been shown that the precursors of vulvar, vaginal and anal cancer related to the vaccine types are effectively prevented. This led to a paradigm shift from a female-only cervical cancer vaccine to a vaccine for the prevention of HPV-related disease and cancer for both sexes. Vaccination before the start of sexual activity is most effective, and consequently most programs target 9- to 12-year-olds. Additionally, recent studies have proven the noninferior immunoresponse of a two-dose schedule in these age cohorts. Gender-neutral vaccination has become more common; it improves coverage and also provides protection to all males. Recently a nine-valent HPV vaccine (HPV 6/11/16/18/31/33/45/52/58) was licensed; it provides high and consistent protection against infections and diseases related to these types, with ∼90% of cervical and other HPV-related cancers and precancers potentially being avoided. Coverage is key. Efforts must be made to provide HPV vaccination in low-resource countries that lack screening programs. In countries with cervical cancer screening, HPV vaccination will greatly affect screening algorithms.
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Affiliation(s)
- S Pils
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - E A Joura
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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263
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Bogaards JA, Wallinga J, Brakenhoff RH, Meijer CJLM, Berkhof J. Direct benefit of vaccinating boys along with girls against oncogenic human papillomavirus: bayesian evidence synthesis. BMJ 2015; 350:h2016. [PMID: 25985328 PMCID: PMC4428278 DOI: 10.1136/bmj.h2016] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the reduction in the vaccine preventable burden of cancer in men if boys are vaccinated along with girls against oncogenic human papillomavirus (HPV). DESIGN Bayesian evidence synthesis approach used to evaluate the impact of vaccination against HPV types 16 and 18 on the burden of anal, penile, and oropharyngeal carcinomas among heterosexual men and men who have sex with men. The reduced transmission of vaccine-type HPV from vaccination of girls was assumed to lower the risk of HPV associated cancer in all men but not to affect the excess risk of HPV associated cancers among men who have sex with men. SETTING General population in the Netherlands. INTERVENTION Inclusion of boys aged 12 into HPV vaccination programmes. MAIN OUTCOME MEASURES Quality adjusted life years (QALYs) and numbers needed to vaccinate. RESULTS Before HPV vaccination, 14.9 (95% credible interval 12.2 to 18.1) QALYs per thousand men were lost to vaccine preventable cancers associated with HPV in the Netherlands. This burden would be reduced by 37% (28% to 48%) if the vaccine uptake among girls remains at the current level of 60%. To prevent one additional case of cancer among men, 795 boys (660 to 987) would need to be vaccinated; with tumour specific numbers for anal, penile, and oropharyngeal cancer of 2162, 3486, and 1975, respectively. The burden of HPV related cancer in men would be reduced by 66% (53% to 805) if vaccine uptake among girls increases to 90%. In that case, 1735 boys (1240 to 2900) would need to be vaccinated to prevent an additional case; with tumour specific numbers for anal, penile, and oropharyngeal cancer of 2593, 29107, and 6484, respectively. CONCLUSIONS Men will benefit indirectly from vaccination of girls but remain at risk of cancers associated with HPV. The incremental benefit of vaccinating boys when vaccine uptake among girls is high is driven by the prevention of anal carcinomas, which underscores the relevance of HPV prevention efforts for men who have sex with men.
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Affiliation(s)
- Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands
| | - Ruud H Brakenhoff
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands
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264
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Carcinomes oropharyngés HPV induits. ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2522-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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265
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Herrero R, González P, Markowitz LE. Present status of human papillomavirus vaccine development and implementation. Lancet Oncol 2015; 16:e206-16. [PMID: 25943065 DOI: 10.1016/s1470-2045(14)70481-4] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Oncogenic human papillomavirus (HPV) infection is the cause of nearly all cervical cancers and a proportion of other anogenital and oropharyngeal cancers. A bivalent vaccine containing HPV 16 and 18 and a quadrivalent vaccine containing HPV 6, 11, 16, and 18 antigens are in use in vaccination programmes around the world. In clinical trials, three vaccine doses provided 90-100% protection against cervical infection and pre-cancer related to HPV 16 and 18 in women aged 15-26 years who were not infected at vaccination. Partial cross-protection against other HPV types has been reported but its duration is unknown. The vaccines were also efficacious at the prevention of HPV 16 and 18 infections at other anatomical sites in both sexes. Immunobridging studies allowed licensing of the vaccines for use starting at age 9 years for both sexes. Two-dose schedules elicit high antibody concentrations, leading to the recommendation of two-dose schedules for girls aged 9-14 years. Pre-licensure and post-licensure studies have provided data supporting vaccine safety. In 2014, a nonavalent vaccine containing HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58 antigens was licensed by the US Food and Drug Administration. HPV vaccination was first introduced in high-income countries owing to vaccine cost, logistic challenges, and competing health priorities. Since 2011, vaccine prices have lowered, allowing the introduction of the vaccine in some middle-income countries. Funding of the vaccine by the GAVI Alliance in 2012 led to demonstration projects in some low-income countries. By 2014, more than 57 countries had included the HPV vaccine in their national health programmes. Data from several countries have shown the effect of vaccination on HPV infection and associated disease, and provided evidence of herd immunity. Expansion of programmes to countries with the highest burden of disease is beginning, but further efforts are needed to realise the potential of HPV vaccines.
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Affiliation(s)
- Rolando Herrero
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France.
| | - Paula González
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France; Proyecto Epidemiológico Guanacaste, Liberia, Guanacaste, Costa Rica
| | - Lauri E Markowitz
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA, USA
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Saraiya M, Unger ER, Thompson TD, Lynch CF, Hernandez BY, Lyu CW, Steinau M, Watson M, Wilkinson EJ, Hopenhayn C, Copeland G, Cozen W, Peters ES, Huang Y, Saber MS, Altekruse S, Goodman MT. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst 2015; 107:djv086. [PMID: 25925419 DOI: 10.1093/jnci/djv086] [Citation(s) in RCA: 497] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 03/03/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study sought to determine the prevaccine type-specific prevalence of human papillomavirus (HPV)-associated cancers in the United States to evaluate the potential impact of the HPV types in the current and newly approved 9-valent HPV vaccines. METHODS The Centers for Disease Control and Prevention partnered with seven US population-based cancer registries to obtain archival tissue for cancers diagnosed from 1993 to 2005. HPV testing was performed on 2670 case patients that were fairly representative of all participating cancer registry cases by age and sex. Demographic and clinical data were evaluated by anatomic site and HPV status. Current US cancer registry data and the detection of HPV types were used to estimate the number of cancers potentially preventable through vaccination. RESULTS HPV DNA was detected in 90.6% of cervical, 91.1% of anal, 75.0% of vaginal, 70.1% of oropharyngeal, 68.8% of vulvar, 63.3% of penile, 32.0% of oral cavity, and 20.9% of laryngeal cancers, as well as in 98.8% of cervical cancer in situ (CCIS). A vaccine targeting HPV 16/18 potentially prevents the majority of invasive cervical (66.2%), anal (79.4%), oropharyngeal (60.2%), and vaginal (55.1%) cancers, as well as many penile (47.9%), vulvar (48.6%) cancers: 24 858 cases annually. The 9-valent vaccine also targeting HPV 31/33/45/52/58 may prevent an additional 4.2% to 18.3% of cancers: 3944 cases annually. For most cancers, younger age at diagnosis was associated with higher HPV 16/18 prevalence. With the exception of oropharyngeal cancers and CCIS, HPV 16/18 prevalence was similar across racial/ethnic groups. CONCLUSIONS In the United States, current vaccines will reduce most HPV-associated cancers; a smaller additional reduction would be contributed by the new 9-valent vaccine.
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Affiliation(s)
- Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
| | - Elizabeth R Unger
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Charles F Lynch
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Brenda Y Hernandez
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Christopher W Lyu
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Martin Steinau
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Meg Watson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Edward J Wilkinson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Claudia Hopenhayn
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Glenn Copeland
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Wendy Cozen
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Edward S Peters
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Youjie Huang
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Maria Sibug Saber
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Sean Altekruse
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
| | - Marc T Goodman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA)
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267
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Gonzalez P, Hildesheim A, Herrero R, Katki H, Wacholder S, Porras C, Safaeian M, Jimenez S, Darragh TM, Cortes B, Befano B, Schiffman M, Carvajal L, Palefsky J, Schiller J, Ocampo R, Schussler J, Lowy D, Guillen D, Stoler MH, Quint W, Morales J, Avila C, Rodriguez AC, Kreimer AR. Rationale and design of a long term follow-up study of women who did and did not receive HPV 16/18 vaccination in Guanacaste, Costa Rica. Vaccine 2015; 33:2141-51. [PMID: 25796338 PMCID: PMC4390538 DOI: 10.1016/j.vaccine.2015.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
The Costa Rica Vaccine Trial (CVT) was a randomized clinical trial conducted between 2004 and 2010, which randomized 7466 women aged 18 to 25 to receive the bivalent HPV-16/18 vaccine or control Hepatitis-A vaccine. Participants were followed for 4 years with cross-over vaccination at the study end. In 2010 the long term follow-up (LTFU) study was initiated to evaluate the 10-year impact of HPV-16/18 vaccination, determinants of the immune response, and HPV natural history in a vaccinated population. Herein, the rationale, design and methods of the LTFU study are described, which actively follows CVT participants in the HPV-arm 6 additional years at biennial intervals (3 additional study visits for 10 years of total follow-up), or more often if clinically indicated. According to the initial commitment, women in the Hepatitis-A arm were offered HPV vaccination at cross-over; they were followed 2 additional years and exited from the study. 92% of eligible CVT women accepted participation in LTFU. To provide underlying rates of HPV acquisition and cervical disease among unvaccinated women to compare with the HPV-arm during LTFU, a new unvaccinated control group (UCG) of women who are beyond the age generally recommended for routine vaccination was enrolled, and will be followed by cervical cancer screening over 6 years. To form the UCG, 5000 women were selected from a local census, of whom 2836 women (61% of eligible women) agreed to participate. Over 90% of participants complied with an interview, blood and cervical specimen collection. Evaluation of comparability between the original (Hepatitis-A arm of CVT) and new (UCG) control groups showed that women's characteristics, as well as their predicted future risk for cervical HPV acquisition, were similar, thus validating use of the UCG. LTFU is poised to comprehensively address many important questions related to long-term effects of prophylactic HPV vaccines.
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Affiliation(s)
- Paula Gonzalez
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Guanacaste, Costa Rica; International Agency for Research on Cancer, Lyon, France.
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Hormuzd Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Sholom Wacholder
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Carolina Porras
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Guanacaste, Costa Rica
| | - Mahboobeh Safaeian
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Silvia Jimenez
- International Agency for Research on Cancer, Lyon, France
| | - Teresa M Darragh
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Bernal Cortes
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Guanacaste, Costa Rica
| | - Brian Befano
- Information Management Services (IMS), Calverton, MD, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Loreto Carvajal
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Guanacaste, Costa Rica
| | - Joel Palefsky
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - John Schiller
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Rebeca Ocampo
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Guanacaste, Costa Rica
| | - John Schussler
- Information Management Services (IMS), Calverton, MD, USA
| | - Douglas Lowy
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Diego Guillen
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Guanacaste, Costa Rica
| | - Mark H Stoler
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Jorge Morales
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Guanacaste, Costa Rica
| | - Carlos Avila
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Guanacaste, Costa Rica
| | | | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Zeitlin R, Nguyen HP, Rafferty D, Tyring S. Advancements in the Management of HPV-Associated Head and Neck Squamous Cell Carcinoma. J Clin Med 2015; 4:822-31. [PMID: 26239449 PMCID: PMC4470200 DOI: 10.3390/jcm4050822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 02/04/2023] Open
Abstract
Head and neck carcinomas have long been linked to alcohol and tobacco abuse; however, within the last two decades, the human papillomavirus (HPV) has emerged as a third etiology and is specifically associated with head and neck squamous cell carcinomas (HNSCC). In this anatomical region, the oncogenic HPV-16 mediates transformation and immortalization of epithelium, most commonly in the oropharynx. Nevertheless, the recent identification of novel HPV mechanisms thought to be specific to oropharyngeal carcinogenesis has coincided with observations that HPV-associated HNSCC has differing clinical behavior-in terms of natural history, therapeutic response, and prognosis-than HPV-negative head and neck tumors. Taken together with the growing incidence of HPV transmission in younger populations, these discoveries have sparked a rapid expansion in both laboratory and clinical studies on the infection and disease. Herein, we review the clinical characteristics of HPV-associated HNSCC, with particular emphasis on recent advancements in our understanding of the management of this infectious malignancy.
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Affiliation(s)
- Ross Zeitlin
- University of Florida College of Medicine, 1600 SW Archer Rd., Gainesville, FL 32603, USA.
| | | | - David Rafferty
- Paul L. Foster School of Medicine, 5001 El Paso Dr., El Paso, TX 79905, USA.
| | - Stephen Tyring
- Department of Dermatology, University of Texas Medical School at Houston, 6655 Travis Street, Houston, TX 77030, USA.
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269
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Giuliano AR, Kreimer AR, de Sanjose S. The Beginning of the End: Vaccine Prevention of HPV-Driven Cancers. J Natl Cancer Inst 2015; 107:djv128. [DOI: 10.1093/jnci/djv128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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270
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Chaturvedi AK, Graubard BI, Broutian T, Pickard RKL, Tong ZY, Xiao W, Kahle L, Gillison ML. NHANES 2009-2012 Findings: Association of Sexual Behaviors with Higher Prevalence of Oral Oncogenic Human Papillomavirus Infections in U.S. Men. Cancer Res 2015; 75:2468-77. [PMID: 25873485 DOI: 10.1158/0008-5472.can-14-2843] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/17/2015] [Indexed: 11/16/2022]
Abstract
The incidence of human papillomavirus (HPV)-positive oropharyngeal cancers is higher and increasing more rapidly among men than women in the United States for unknown reasons. We compared the epidemiology of oral oncogenic HPV infection between men and women ages 14 to 69 years (N = 9,480) within the U.S. National Health and Nutritional Examination Surveys (NHANES) 2009-2012. HPV presence was detected in oral DNA by PCR. Analyses were stratified by gender and used NHANES sample weights. Oral oncogenic HPV prevalence was higher among men than women (6.6% vs. 1.5%, P < 0.001), corresponding to 7.07 million men versus 1.54 million women with prevalent infection at any point in time during 2009-2012. Prevalence increased significantly with age, current smoking, and lifetime number of sexual partners for both genders (adjusted Ptrend < 0.02). However, men had more partners than women (mean = 18 vs. 7, P < 0.001). Although oncogenic HPV prevalence was similar for men and women with 0 to 1 lifetime partners, the male-female difference in prevalence significantly increased with number of lifetime partners (adjusted prevalence differences for none, 1, 2-5, 6-10, 11-20, and 20+ partners = 1.0%, 0.5%, 3.0%, 5.7%, 4.6%, and 9.3%, respectively). Importantly, the per-sexual partner increase in prevalence was significantly stronger among men than among women (adjusted synergy index = 3.3; 95% confidence interval, 1.1-9.7), and this increase plateaued at 25 lifetime partners among men versus 10 partners among women. Our data suggest that the higher burden of oral oncogenic HPV infections and HPV-positive oropharyngeal cancers among men than women arises in part from higher number of lifetime sexual partners and stronger associations with sexual behaviors among men.
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Affiliation(s)
- Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, Maryland
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, Maryland
| | | | | | | | | | - Lisa Kahle
- Information Management Services, Calverton, Maryland
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271
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Graham DM, Isaranuwatchai W, Habbous S, de Oliveira C, Liu G, Siu LL, Hoch JS. A cost-effectiveness analysis of human papillomavirus vaccination of boys for the prevention of oropharyngeal cancer. Cancer 2015; 121:1785-92. [PMID: 25867018 DOI: 10.1002/cncr.29111] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/18/2014] [Accepted: 09/05/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many western countries have established female human papillomavirus (HPV) vaccination programs for the prevention of cervical cancer. The quadrivalent HPV vaccine (HPV4) has proven efficacy against additional HPV-related disease in both sexes, but the cost effectiveness of male HPV vaccination remains controversial. To assess the cost effectiveness of male HPV vaccination in Canada with respect to oropharyngeal cancer (OPC), the authors performed a preliminary cost-effectiveness analysis. METHODS After an extensive literature review regarding HPV-related OPC in Canadian males, health care costs and clinical effectiveness estimates were obtained. A Markov model was used to compare the potential costs and effectiveness of HPV4 versus no vaccination among boys aged 12 years. A theoretical cohort based on a Canadian population of 192,940 boys aged 12 years in 2012 was assumed to apply the model. A 3-month cycle length was used with a "lifetime" time horizon. The outcome of the analysis was the incremental cost per quality-adjusted life-year (QALY). Sensitivity analyses were conducted on variables, including the vaccine uptake rate and vaccine efficacy. RESULTS Assuming 99% vaccine efficacy and 70% uptake, HPV4 produced 0.05 more QALYs and saved $145 Canadian dollars (CAD) per individual compared with no vaccine (QALYs and costs were discounted at 5% per year). Assuming 50% vaccine efficacy and 50% uptake, HPV4 produced 0.023 more QALYs and saved $42 CAD. The results indicated that HPV4 in males may potentially save between $8 and $28 million CAD for the theoretical cohort of 192,940 over its lifetime. CONCLUSIONS On the basis of this model, HPV vaccination for boys aged 12 years may be a cost-effective strategy for the prevention of OPC in Canada.
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Affiliation(s)
- Donna M Graham
- Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | | | - Steven Habbous
- Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Department of Social and Epidemiological Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Lillian L Siu
- Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Jeffrey S Hoch
- Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada
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272
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Louie KS, Mehanna H, Sasieni P. Trends in head and neck cancers in England from 1995 to 2011 and projections up to 2025. Oral Oncol 2015; 51:341-8. [PMID: 25619734 DOI: 10.1016/j.oraloncology.2015.01.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/17/2014] [Accepted: 01/02/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND The magnitude of the growing burden of oropharyngeal cancers (OPC), a sub-set of head and neck cancers (HNC), is unknown in England. METHODS Data were extracted from population-based cancer registries in England. The burden of HNC overall and by anatomic site was described from 1995 to 2011. Projections of future rates up to 2025 were estimated using flexible age-period-cohort modelling. RESULTS HNC increased by 59% between 1995 and 2011 in England. Projections indicate that the number of HNC cases will increase by 55% from 2011, totalling 11,748 new cases in 2025, ranking HNC as the sixth most common cancer. Of the anatomic sites, OPC is projected to account for 35% of HNC with the largest rate increase (annual percentage change, +7.3% for men and +6.2% for women between 2011 and 2025), predominantly affecting males <60years. This projected burden is equivalent to a 239% increase in number of OPC cases. Incidence of the oral cavity, salivary glands and palate are projected to rise at lower rates, whereas rates of the nasopharynx, hypopharynx and larynx remain relatively stable or decreasing. CONCLUSION The substantial recent and predicted future significant increase in OPC highlights the need for prioritising the provision of cancer services for the considerable burden of OPC patients and survivors and cancer control strategies.
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Affiliation(s)
- Karly S Louie
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, College of Medicine and Dentistry, University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham B15 2TT, UK
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
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273
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Ramqvist T, Grün N, Dalianis T. Human papillomavirus and tonsillar and base of tongue cancer. Viruses 2015; 7:1332-43. [PMID: 25803099 PMCID: PMC4379573 DOI: 10.3390/v7031332] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/13/2015] [Accepted: 03/17/2015] [Indexed: 12/11/2022] Open
Abstract
In 2007, human papillomavirus (HPV) type 16 was recognized as a risk factor by the International Agency for Research on Cancer, for oropharyngeal squamous cell carcinoma (OSCC), where tonsillar and base of tongue cancer (TSCC and BOTSCC) dominate. Furthermore, patients with HPV-positive TSCC and BOTSCC, had a much better clinical outcome than those with corresponding HPV-negative cancer and other head and neck cancer. More specifically, survival was around 80% for HPV-positive TSCC and BOTSCC vs. 40% five-year disease free survival, for the corresponding HPV-negative tumors with conventional radiotherapy and surgery, while this could not be observed for HPV-positive OSCC at other sites. In addition, the past 20-40 years in many Western Countries, the incidence of HPV-positive TSCC and BOTSCC has risen, and >70% are men. This has resulted in a relative increase of patients with HPV-positive TSCC and BOTSCC that may not need the intensified chemo-radiotherapy (with many more severe debilitating side effects) often given today to patients with head and neck cancer. However, before tapering therapy, one needs to enable selection of patients for such treatment, by identifying clinical and molecular markers that together with HPV-positive status will better predict patient prognosis and response to therapy. To conclude, there is a new increasing group of patients with HPV-positive TSCC and BOTSCC with good clinical outcome, where options for better-tailored therapy are needed. For prevention, it would be of benefit to vaccinate both girls and boys against HPV16 infection. For potential future screening the ways to do so need optimizing.
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Affiliation(s)
- Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska R8:01, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Nathalie Grün
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska R8:01, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska R8:01, Karolinska University Hospital, 171 76 Stockholm, Sweden.
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274
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Kram YA, Schmidt TH, Saghezchi S, Russell MD. Attitudes toward Human Papilloma Virus Vaccination and Head and Neck Cancer Prevention in a Diverse, Urban Population. Otolaryngol Head Neck Surg 2015; 153:538-43. [PMID: 25779468 DOI: 10.1177/0194599815574821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/05/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE (1) To understand if awareness of the human papilloma virus (HPV) vaccination's potential to prevent head and neck cancer improves acceptability of the vaccine in a large urban population and (2) to identify characteristics of those in whom such discussions would have the greatest impact. STUDY DESIGN In-person, anonymous survey. SETTING Academic public hospital between March 2014 and June 2014. SUBJECTS Patients aged 12 to 24 years and their parents or guardians awaiting scheduled outpatient pediatric appointments. METHODS Demographics and modified Carolina HPV Immunization Attitudes and Beliefs Scales data were cross-analyzed, followed by univariate binomial logistic regression to identify predictors for major outcomes of interest. RESULTS More than 78% of those surveyed indicated they would be more receptive to the HPV vaccine if given strong evidence that it prevented head and neck cancer. Respondents were more likely to increase receptivity to HPV vaccination if they held the belief that they did not have enough information about the vaccine or indicated they preferred to wait because the vaccine was too new. CONCLUSION Increasing public awareness of head and neck cancer prevention with HPV vaccination could increase HPV vaccination acceptance.
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Affiliation(s)
- Yoseph A Kram
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Timothy H Schmidt
- University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Sohail Saghezchi
- University of California, San Francisco School of Medicine, San Francisco, California, USA Department of Oral & Maxillofacial Surgery, University of California, San Francisco, California, USA
| | - Marika D Russell
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
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275
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Rusan M, Li YY, Hammerman PS. Genomic landscape of human papillomavirus-associated cancers. Clin Cancer Res 2015; 21:2009-19. [PMID: 25779941 DOI: 10.1158/1078-0432.ccr-14-1101] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/28/2015] [Indexed: 11/16/2022]
Abstract
Recent next-generation sequencing studies have generated a comprehensive overview of the genomic landscape of human papillomavirus (HPV)-associated cancers. This review summarizes these findings to provide insight into the tumor biology of these cancers and potential therapeutic opportunities for HPV-driven malignancies. In addition to the tumorigenic properties of the HPV oncoproteins, integration of HPV DNA into the host genome is suggested to be a driver of the neoplastic process. Integration may confer a growth and survival advantage via enhanced expression of viral oncoproteins, alteration of critical cellular genes, and changes in global promoter methylation and transcription. Alteration of cellular genes may lead to loss of function of tumor suppressor genes, enhanced oncogene expression, loss of function of DNA repair genes, or other vital cellular functions. Recurrent integrations in RAD51B, NR4A2, and TP63, leading to aberrant forms of these proteins, are observed in both HPV-positive head and neck squamous cell carcinoma (HNSCC) and cervical carcinoma. Additional genomic alterations, independent of integration events, include recurrent PIK3CA mutations (and aberrations in other members of the PI3K pathway), alterations in receptor tyrosine kinases (primarily FGFR2 and FGFR3 in HPV-positive HNSCC, and ERBB2 in cervical squamous cell carcinoma), and genes in pathways related to squamous cell differentiation and immune responses. A number of the alterations identified are potentially targetable, which may lead to advances in the treatment of HPV-associated cancers.
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Affiliation(s)
- Maria Rusan
- Department of Clinical Medicine, Aarhus University, Denmark. Department of Otorhinolaryngology, Aarhus University, Denmark. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Yvonne Y Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Peter S Hammerman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts.
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276
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Osazuwa-Peters N, Wang DD, Namin A, John VM, O'Neill M, Patel PV, Varvares MA. Sexual behavior, HPV knowledge, and association with head and neck cancer among a high-risk group. Oral Oncol 2015; 51:452-6. [PMID: 25683135 DOI: 10.1016/j.oraloncology.2015.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 01/20/2015] [Accepted: 01/25/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To understand knowledge of HPV, its association with head and neck cancer (HNC), and source of knowledge in a high-risk population. MATERIALS AND METHODS A cross-sectional survey was conducted among attendees at a Drag Racing event in East St. Louis in 2013. RESULTS Only 29.9% knew that HPV definitely increases the risk of developing HNC, 42.4% thought HPV was same as HIV, and only 25.1% received HPV information from a healthcare practitioner. Participants that thought number of sexual partners did not increase risk of developing HPV were more likely to have low knowledge scores (r=.74, p<.001). There were significant associations between HNC knowledge, number of sexual partners, age at initial coitus, and risk perception; and those who did not think having more sexual partner increases the chance of developing HPV infection were 33times more likely to have lower knowledge of the association between HPV and HNC (OR=33.27; 95% CI: 16.34, 67.74). CONCLUSIONS Knowledge of HPV and its association with head and neck cancer has significant gaps in this population, with a large number of the population accessing HPV information from sources other than a healthcare provider.
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Affiliation(s)
- Nosayaba Osazuwa-Peters
- Saint Louis University Cancer Center, 3655 Vista Avenue, Saint Louis, MO 63110, United States; Saint Louis University, School of Medicine, Department of Otolaryngology-Head and Neck Surgery, 3635 Vista Avenue, Saint Louis, MO 63110, United States.
| | - Dawei David Wang
- Saint Louis University, School of Medicine, 1402 S Grand Blvd., Saint Louis, MO 63104, United States
| | - Arya Namin
- Saint Louis University, School of Medicine, 1402 S Grand Blvd., Saint Louis, MO 63104, United States
| | - Vivek Mathew John
- Saint Louis University, School of Medicine, 1402 S Grand Blvd., Saint Louis, MO 63104, United States
| | - Michael O'Neill
- Saint Louis University, School of Medicine, 1402 S Grand Blvd., Saint Louis, MO 63104, United States
| | - Pranav V Patel
- Saint Louis University, School of Medicine, 1402 S Grand Blvd., Saint Louis, MO 63104, United States
| | - Mark A Varvares
- Saint Louis University Cancer Center, 3655 Vista Avenue, Saint Louis, MO 63110, United States; Saint Louis University, School of Medicine, Department of Otolaryngology-Head and Neck Surgery, 3635 Vista Avenue, Saint Louis, MO 63110, United States
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277
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Chai RC, Lambie D, Verma M, Punyadeera C. Current trends in the etiology and diagnosis of HPV-related head and neck cancers. Cancer Med 2015; 4:596-607. [PMID: 25644715 PMCID: PMC4402074 DOI: 10.1002/cam4.424] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/18/2014] [Accepted: 12/18/2014] [Indexed: 12/15/2022] Open
Abstract
Human papilloma virus (HPV) infection is a major risk factor for a distinct subset of head and neck squamous cell carcinoma (HNSCC). The current review summarizes the epidemiology of HNSCC and the disease burden, the infectious cycle of HPV, the roles of viral oncoproteins, E6 and E7, and the downstream cellular events that lead to malignant transformation. Current techniques for the clinical diagnosis of HPV-associated HNSCC will also be discussed, that is, the detection of HPV DNA, RNA, and the HPV surrogate marker, p16 in tumor tissues, as well as HPV-specific antibodies in serum. Such methods do not allow for the early detection of HPV-associated HNSCC and most cases are at an advanced stage upon diagnosis. Novel noninvasive approaches using oral fluid, a clinically relevant biological fluid, allow for the detection of HPV and cellular alterations in infected cells, which may aid in the early detection and HPV-typing of HNSCC tumors. Noninvasive diagnostic methods will enable early detection and intervention, leading to a significant reduction in mortality and morbidity associated with HNSCC.
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Affiliation(s)
- Ryan C Chai
- The University of Queensland Diamantina Institute, The University of Queensland, The Translational Research Institute, Woolloongabba, Queensland, 4102, Australia
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278
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Beachler DC, Viscidi R, Sugar EA, Minkoff H, Strickler HD, Cranston RD, Wiley DJ, Jacobson LP, Weber KM, Margolick JB, Reddy S, Gillison ML, D’Souza G. A longitudinal study of human papillomavirus 16 L1, e6, and e7 seropositivity and oral human papillomavirus 16 infection. Sex Transm Dis 2015; 42:93-7. [PMID: 25585068 PMCID: PMC4295625 DOI: 10.1097/olq.0000000000000236] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Individuals with human papillomavirus (HPV) infections can develop IgG antibodies to HPV proteins including the L1 capsid and E6 and E7 oncoproteins. Evidence on whether L1 antibodies reduce the risk of cervical HPV infection is mixed, but this has not been explored for oral HPV infections. Antibodies to HPV16's E6 oncoprotein have been detected in some oropharyngeal cancer cases years before cancer diagnosis, but it is unknown if these antibodies are associated with oral HPV16 DNA. METHODS Enzyme-linked immunosorbent assays tested for serum antibodies to HPV16's L1 capsid in 463 HIV-infected and 293 HIV-uninfected adults, and for antibodies to recombinantly expressed E6 and E7 oncoproteins to HPV16 in 195 HIV-infected and 69 HIV-uninfected cancer-free participants at baseline. Oral rinse samples were collected semiannually for up to 3 years and tested for HPV DNA using PGMY 09/11 primers. Adjusted Poisson, logistic, and Wei-Lin-Weissfeld regression models were used. RESULTS Human papillomavirus 16 L1 seroreactivity did not reduce the subsequent risk of incident oral HPV16 infection in unadjusted (hazard ratio, 1.4; 95% confidence interval, 0.59-3.3) or adjusted (adjusted hazard ratio = 1.1; 95% confidence interval, 0.41-3.0) analysis. Antibodies to HPV16 E6 and E7 oncoproteins were detected in 7.6% and 3.4% of participants, respectively, but they were not associated with baseline oral HPV16 DNA prevalence or oral HPV16 persistence (each P > 0.40). CONCLUSIONS Naturally acquired HPV16 L1 antibodies did not reduce the risk of subsequent oral HPV16 infection. Human papillomavirus 16 E6 and E7 seropositivity was not a marker for oral HPV16 infection in this population without HPV-related cancer.
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Affiliation(s)
- Daniel C. Beachler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Raphael Viscidi
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Elizabeth A. Sugar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn NY, US
| | - Howard D. Strickler
- Departments of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, US
| | - Ross D. Cranston
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, US
| | - Dorothy J. Wiley
- School of Nursing, University of California-Los Angeles, Los Angeles, CA, US
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Kathleen M. Weber
- Hektoen Institute of Medicine, The CORE Center at John H. Stroger Jr. Hospital of Cook County, Chicago, IL, US
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Susheel Reddy
- Department of Infectious Disease, Northwestern University, Chicago, IL, US
| | - Maura L. Gillison
- Viral Oncology Program, Ohio State University Comprehensive Cancer Center, Columbus, OH, US
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
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279
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Wang JW, Hung CF, Huh WK, Trimble CL, Roden RBS. Immunoprevention of human papillomavirus-associated malignancies. Cancer Prev Res (Phila) 2015; 8:95-104. [PMID: 25488410 PMCID: PMC4315720 DOI: 10.1158/1940-6207.capr-14-0311] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Persistent infection by one of 15 high-risk human papillomavirus (hrHPV) types is a necessary but not sufficient cause of 5% of all human cancers. This provides a remarkable opportunity for cancer prevention via immunization. Since Harald zur Hausen's pioneering identification of hrHPV types 16 and 18, found in approximately 50% and 20% of cervical cancers, respectively, two prophylactic HPV vaccines containing virus-like particles (VLP) of each genotype have been widely licensed. These vaccines are beginning to affect infection and HPV-associated neoplasia rates after immunization campaigns in adolescents. Here, we review recent progress and opportunities to better prevent HPV-associated cancers, including broadening immune protection to cover all hrHPV types, reducing the cost of HPV vaccines especially for developing countries that have the highest rates of cervical cancer, and immune-based treatment of established HPV infections. Screening based upon George Papanicolaou's cervical cytology testing, and more recently detection of hrHPV DNA/RNA, followed by ablative treatment of high-grade cervical intraepithelial neoplasia (CIN2/3) have substantially reduced cervical cancer rates, and we examine their interplay with immune-based modalities for the prevention and eventual elimination of cervical cancer and other HPV-related malignancies.
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Affiliation(s)
- Joshua W Wang
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland
| | - Chein-Fu Hung
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland
| | - Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cornelia L Trimble
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland. Department of Oncology, The Johns Hopkins University, Baltimore, Maryland. Department of Gynecology and Obstetrics, The Johns Hopkins University, Baltimore, Maryland
| | - Richard B S Roden
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland. Department of Oncology, The Johns Hopkins University, Baltimore, Maryland. Department of Gynecology and Obstetrics, The Johns Hopkins University, Baltimore, Maryland.
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280
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Affiliation(s)
- R.A. Kennedy
- Oral / Head and Neck Pathology; Guy's Hospital; London SE1 7EH UK
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281
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Bowles DW, McDermott JD, Jimeno A. Novel treatments for head and neck squamous cell carcinoma: preclinical identification and clinical investigation. Future Oncol 2015; 10:1065-80. [PMID: 24941990 DOI: 10.2217/fon.14.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a common cancer worldwide. Classically, it is a disease related to tobacco and alcohol use; an increasing number of patients are being diagnosed with HNSCC caused by infection with the human papillomavirus. New deep-sequencing techniques have confirmed the importance of p53 and EGF receptor in HNSCC development, and have identified pathways of critical importance, such as PI3K/mTOR and NOTCH. Increasing knowledge of key molecular features has lead to new therapeutic avenues for HNSCC. Novel therapies under investigation in HNSCC include antibody and small molecule inhibitors of EGF receptor and its family members, PI3K inhibitors, antiangiogenic agents, immunotherapies and agents interacting with early developmental pathways such as Hedgehog.
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Affiliation(s)
- Daniel W Bowles
- Division of Medical Oncology, University of Colorado School of Medicine, CO, USA
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282
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Pierce Campbell CM, Kreimer AR, Lin HY, Fulp W, O'Keefe MT, Ingles DJ, Abrahamsen M, Villa LL, Lazcano-Ponce E, Giuliano AR. Long-term persistence of oral human papillomavirus type 16: the HPV Infection in Men (HIM) study. Cancer Prev Res (Phila) 2015; 8:190-6. [PMID: 25575501 DOI: 10.1158/1940-6207.capr-14-0296] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Persistent infection with oral HPV16 is believed to drive the development of most oropharyngeal cancers. However, patterns of oral HPV16 persistence remain understudied, particularly among HIV-negative individuals. Oral HPV16 persistence was evaluated among 1,626 participants of the HPV Infection in Men (HIM) Study. Twenty-three oral HPV16-positive men who provided an oral gargle sample on ≥2 study visits were included in the analysis. Archived oral samples from all follow-up visits were tested for HPV16 using Linear Array and INNO-LiPA detection methods. Persistence was evaluated using consecutive HPV16-positive visits held approximately 6 months apart and using the Kaplan-Meier method. Oral HPV16-positive men were aged 18 to 64 years [median, 36 years; interquartile range (IQR), 25-42] and were followed for a median of 44.4 months (IQR, 29.9-49.5). Of 13 incident infections, 4 (30.8%) persisted ≥12 months, 1 (10.0%) persisted ≥24 months, and none persisted ≥36 months [median infection duration, 7.3 months; 95% confidence interval (CI), 6.4-NA)]. Of 10 prevalent infections, 9 (90.0%) persisted ≥12 months, 8 (80.0%) persisted ≥24 months, 4 (57.1%) persisted ≥36 months, and 2 (40.0%) persisted ≥48 months (median infection duration, NA). Twelve-month persistence of incident infections increased significantly with age (Ptrend = 0.028). Prevalent oral HPV16 infections in men persisted longer than newly acquired infections, and persistence appeared to increase with age. These findings may explain the high prevalence of oral HPV observed at older ages. Understanding oral HPV16 persistence will aid in the identification of men at high-risk of developing HPV-related oropharyngeal cancer.
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Affiliation(s)
- Christine M Pierce Campbell
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hui-Yi Lin
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - William Fulp
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michael T O'Keefe
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Donna J Ingles
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Martha Abrahamsen
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Luisa L Villa
- Molecular Biology Laboratory, Center of Translational Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil. Department of Radiology and Oncology, School of Medicine, University of São Paulo, São Paulo, Brazil. HPV Institute, School of Medicine, Santa Casa de São Paulo, São Paulo, Brazil
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Anna R Giuliano
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida.
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283
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Bonanni P, Bechini A, Donato R, Capei R, Sacco C, Levi M, Boccalini S. Human papilloma virus vaccination: impact and recommendations across the world. THERAPEUTIC ADVANCES IN VACCINES 2015; 3:3-12. [PMID: 25553242 PMCID: PMC4266686 DOI: 10.1177/2051013614557476] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Human papilloma virus (HPV) vaccination has been implemented in several countries for about the past 7 years, mainly in the adolescent female population, with varying coverage results. Although the impact of immunization on cervical and other HPV-related cancers will be evident in the next decades, a marked decrease of prevalent HPV infections, precancerous lesions and genital warts is already dramatic in the vaccinated cohorts, and also in their sexual partners, thus providing clear evidence of the effectiveness of HPV vaccination, including a herd-protection effect. Today, recommendations and implementation of universal HPV vaccination for adolescent girls are a public-health priority in all countries of the world. Countries with limited resources are presently involved in demonstration projects and, in some cases, have launched national programmes with the help of international agencies and alliances. Extension of immunization offer to young women and to adolescent male subjects has become an important additional opportunity for several countries, with a special focus needed on homosexual men with HIV infection who are at particularly increased risk of HPV-related diseases. Public-health authorities are confronted with the need to enlarge HPV-vaccination offer to all target groups, especially pre-adolescent girls, so that they can be saved from dreadful cancers by reaching high immunization coverage.
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Affiliation(s)
- Paolo Bonanni
- Department of Health Sciences, University of Florence, Viale G.B. Morgagni 48, 50134 Florence, Italy
| | - Angela Bechini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Rosa Donato
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Raffaella Capei
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristiana Sacco
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Miriam Levi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Florence, Italy
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284
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Rettig E, Kiess AP, Fakhry C. The role of sexual behavior in head and neck cancer: implications for prevention and therapy. Expert Rev Anticancer Ther 2015; 15:35-49. [PMID: 25193346 PMCID: PMC4385715 DOI: 10.1586/14737140.2015.957189] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
HPV-positive oropharyngeal squamous cell carcinoma (HPV-OSCC) is associated with oral sexual behaviors. The sharp rise in incidence of HPV-OSCC in the USA has been attributed to changes in sexual norms over the past five decades, with lower age at sexual debut and higher numbers of sexual partners per individual. In addition, variations in HPV-OSCC prevalence by race, age cohort and gender may be attributable to differences in oral sexual behaviors among these groups. Oral HPV infection is the putative precursor to HPV-OSCC. Risk factors for oral HPV incidence, prevalence, clearance and persistence are crucial to understanding how, and in whom, oral HPV infection progresses to malignancy. Future investigation should focus on elucidating the natural history of oral HPV infection persistence and malignant transformation, developing effective screening tools and exploring opportunities for prevention such as vaccination and public health education.
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Affiliation(s)
- Eleni Rettig
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, 601 N. Caroline St, Baltimore, MD 21287, USA
| | - Ana Ponce Kiess
- Department of Radiation Oncology, Johns Hopkins Medicine, 401 N. Broadway, Baltimore, MD 21231, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, 601 N. Caroline St, Baltimore, MD 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
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285
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Hung MC, Lai WW, Chen HHW, Su WC, Wang JD. Comparison of expected health impacts for major cancers: integration of incidence rate and loss of quality-adjusted life expectancy. Cancer Epidemiol 2014; 39:126-32. [PMID: 25553846 DOI: 10.1016/j.canep.2014.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 11/14/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The study aims to quantify the expected impacts of different cancers through multiplying the incidence rate by loss-of-QALE (quality-adjusted life expectancy), with QALY (quality-adjusted life year) as the common unit, to aid prevention policy decisions. METHODS 464,722 patients with pathologically verified cancer registered in the Taiwan Cancer Registry during 1998-2009 were used to estimate lifetime survival through Kaplan-Meier estimation combined with a semi-parametric method. A convenience sample for measuring the utility value with EQ-5D was conducted with 11,453 cancer patients, with the results then multiplied by the survival functions to estimate QALE. The loss-of-QALE was calculated by subtracting the QALE of each cancer cohort from the life expectancy of the corresponding age- and gender-matched reference population. The cumulative incidence rates from age 20 to 79 (CIR₂₀₋₇₉) were calculated to estimate the lifetime risk of cancer for each organ-system. RESULTS Liver and lung cancer were found the highest expected lifetime health impacts in males and females, or expected lifetime losses of 0.97 and 0.41 QALYs that could be averted, respectively. While the priority changes for prevention based on expected health impacts were slightly different for females based on standardized mortality rates, those of males involve a broader spectrum, including oral, colorectal, esophageal and stomach cancer. CONCLUSION The integration of incidence rate with loss-of-QALE could be used to represent the expected losses that could be averted by prevention, which may be useful in prioritizing strategies for cancer control.
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Affiliation(s)
- Mei-Chuan Hung
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan 704, Taiwan
| | - Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Helen H W Chen
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Wu-Chou Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Jung-Der Wang
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan 704, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan.
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286
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Lang Kuhs KA, Gonzalez P, Rodriguez AC, van Doorn LJ, Schiffman M, Struijk L, Chen S, Quint W, Lowy DR, Porras C, DelVecchio C, Jimenez S, Safaeian M, Schiller JT, Wacholder S, Herrero R, Hildesheim A, Kreimer AR. Reduced prevalence of vulvar HPV16/18 infection among women who received the HPV16/18 bivalent vaccine: a nested analysis within the Costa Rica Vaccine Trial. J Infect Dis 2014; 210:1890-9. [PMID: 24958910 PMCID: PMC4271025 DOI: 10.1093/infdis/jiu357] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/18/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Vaccine efficacy (VE) against vulvar human papillomavirus (HPV) infection has not been reported and data regarding its epidemiology are sparse. METHODS Women (n = 5404) age 22-29 present at the 4-year study visit of the Costa Rica Vaccine Trial provided vulvar and cervical samples. A subset (n = 1044) was tested for HPV DNA (SPF10/LiPA25 version 1). VE against 1-time detection of vulvar HPV16/18 among HPV vaccinated versus unvaccinated women was calculated and compared to the cervix. Prevalence of and risk factors for HPV were evaluated in the control arm (n = 536). RESULTS Vulvar HPV16/18 VE (54.1%; 95% confidence interval [CI], 4.9%-79.1%) was comparable to cervix (45.8%; 95% CI, 6.4%-69.4%). Vulvar and cervical HPV16 prevalence within the control arm was 3.0% and 4.7%, respectively. Independent risk factors for vulvar HPV were similar to cervix and included: age (adjusted odds ratio [aOR] 0.5 [95% CI, .3-.9] ≥28 vs 22-23]); marital status (aOR 2.3 [95% CI, 1.5-3.5] single vs married/living-as-married); and number of sexual partners (aOR 3.6 [95% CI, 1.9-7.0] ≥6 vs 1). CONCLUSIONS In this intention-to-treat analysis, VE against vulvar and cervical HPV16/18 were comparable 4 years following vaccination. Risk factors for HPV were similar by anatomic site. CLINICAL TRIALS REGISTRATION NCT00128661.
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Affiliation(s)
| | - Paula Gonzalez
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Costa Rica
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Linda Struijk
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Sabrina Chen
- Information Management Services, Calverton, Maryland
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | | | - Carolina Porras
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Costa Rica
| | | | - Silvia Jimenez
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Costa Rica
| | | | | | | | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
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288
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Steinau M, Saraiya M, Goodman MT, Peters ES, Watson M, Cleveland JL, Lynch CF, Wilkinson EJ, Hernandez BY, Copeland G, Saber MS, Hopenhayn C, Huang Y, Cozen W, Lyu C, Unger ER. Human papillomavirus prevalence in oropharyngeal cancer before vaccine introduction, United States. Emerg Infect Dis 2014; 20:822-8. [PMID: 24751181 PMCID: PMC4012803 DOI: 10.3201/eid2005.131311] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We conducted a study to determine prevalence of HPV types in oropharyngeal cancers in the United States and establish a prevaccine baseline for monitoring the impact of vaccination. HPV DNA was extracted from tumor tissue samples from patients in whom cancer was diagnosed during 1995–2005. The samples were obtained from cancer registries and Residual Tissue Repository Program sites in the United States. HPV was detected and typed by using PCR reverse line blot assays. Among 557 invasive oropharyngeal squamous cell carcinomas, 72% were positive for HPV and 62% for vaccine types HPV16 or 18. Prevalence of HPV-16/18 was lower in women (53%) than in men (66%), and lower in non-Hispanic Black patients (31%) than in other racial/ethnic groups (68%–80%). Results indicate that vaccines could prevent most oropharyngeal cancers in the United States, but their effect may vary by demographic variables.
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289
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Safaeian M, Rodriguez AC. Invited commentary: multiple human papillomavirus infections and type replacement-anticipating the future after human papillomavirus vaccination. Am J Epidemiol 2014; 180:1076-81. [PMID: 25355444 DOI: 10.1093/aje/kwu265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Prophylactic human papillomavirus (HPV) vaccination with 3 doses of either of 2 commercially available vaccines is highly efficacious in preventing infections with the most carcinogenic types of HPV (HPV 16 and HPV 18) at the cervix and other anatomical sites at which HPV-related cancers develop. Concern has been raised that eradicating the most virulent HPV types, 16 and 18, could result in 1 or more of the types that are not targeted by the vaccine occupying the ecological niche created by the elimination of these types, referred to as type replacement. In this issue of the Journal, Yang et al. (Am J Epidemiol. 2014;180(11):1066-1075) report on concurrent infections with multiple HPV types in unvaccinated women who underwent cervical screening in New Mexico (December 2007-April 2009) to identify possible interactions between HPV types, which if present could suggest the possibility of type replacement. Consistent with previous reports, they show minimal type-specific interactions among women with normal cytology, which they consider an indication that type replacement of HPV 16/18 is unlikely to be an issue in the general population postvaccination. Type replacement may be of less concern with the introduction of multivalent vaccines that include most of the carcinogenic HPV types; continued surveillance postvaccination should improve our understanding of the impact of HPV vaccination on type distribution and screening performance.
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290
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Söderlund-Strand A, Uhnoo I, Dillner J. Change in population prevalences of human papillomavirus after initiation of vaccination: the high-throughput HPV monitoring study. Cancer Epidemiol Biomarkers Prev 2014; 23:2757-64. [PMID: 25380734 DOI: 10.1158/1055-9965.epi-14-0687] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Organized human papillomavirus (HPV) vaccination was introduced in Sweden in 2012. On-demand vaccination was in effect from 2006 to 2011. We followed the HPV prevalences in Southern Sweden from 2008 to 2013. METHODS Consecutive, anonymized samples from the Chlamydia trachomatis screening were analyzed for HPV DNA for two low-risk types and 14 high-risk types using PCR with genotyping using mass spectrometry. We analyzed 44,146 samples in 2008, 5,224 in 2012, and 5,815 in 2013. RESULTS Registry-determined HPV vaccination coverages of the population in Southern Sweden increased mainly among 13- to 22-year-old women. Most analyzed samples contained genital swabs from women and the HPV6 prevalence in these samples decreased from 7.0% in 2008 to 4.2% in 2013 [-40.0%; P < 0.0005 (χ(2) test)]. HPV16 decreased from 14.9% to 8.7% (-41.6%; P < 0.0005) and HPV18 decreased from 7.9% to 4.3% (-45.6%; P < 0.0005) among 13- to 22-year-old women. There were only small changes in vaccination coverage among 23- to 40-year-old women. In this age group, HPV18 decreased marginally (-19.6%; P = 0.04) and there were no significant changes for HPV6 or HPV16. Two nonvaccine HPV types (HPV52 and HPV56) were increased among 13- to 22-year-old women, both in 2012 and 2013. CONCLUSIONS A major reduction of HPV6, 16, and 18 prevalences is seen in the age groups with a concomitant increase in HPV vaccination coverage. The minor changes seen for nonvaccine types will require further investigation. IMPACT Monitoring of type-specific HPV prevalences may detect early effects of HPV vaccination.
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Affiliation(s)
| | - Ingrid Uhnoo
- Department of Monitoring and Evaluation, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden.
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291
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Grün N, Ährlund-Richter A, Franzén J, Mirzaie L, Marions L, Ramqvist T, Dalianis T. Oral human papillomavirus (HPV) prevalence in youth and cervical HPV prevalence in women attending a youth clinic in Sweden, a follow up-study 2013-2014 after gradual introduction of public HPV vaccination. Infect Dis (Lond) 2014; 47:57-61. [PMID: 25378085 DOI: 10.3109/00365548.2014.964764] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During 2009-2011, we reported that the oral and cervical prevalence of human papillomavirus (HPV) was high by international standards at 9.3% and 74%, respectively, in youth aged 15-23 years attending a youth clinic in Stockholm. After gradual introduction of public HPV vaccination during 2007-2012, between 2013 and 2014, when 73% of the women were HPV-vaccinated, but not necessarily before their sexual debut, oral HPV prevalence had dropped to 1.4% as compared with 9.3% in 2009-2011 (p < 0.00001). Cervical HPV prevalence was high and common cervical high-risk types were HPV51, 56, 59, 73, 16, 39, 52, and 53. However, it was shown that HPV16, 31, and 70 were significantly less common among HPV-vaccinated women than among those who had not received the vaccine.
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Affiliation(s)
- Nathalie Grün
- From the Department of Oncology-Pathology, Karolinska Institutet , Stockholm , Sweden
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Incidence of human papillomavirus positive tonsillar and base of tongue carcinoma: a stabilisation of an epidemic of viral induced carcinoma? Eur J Cancer 2014; 51:55-61. [PMID: 25466506 DOI: 10.1016/j.ejca.2014.10.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 01/10/2023]
Abstract
AIM To investigate whether the rise during the past decades in the incidence of tonsillar and base of tongue squamous cell carcinoma (TSCC and BOTSCC) and the proportion of human papillomavirus (HPV) positive cancer has continued in Stockholm. PATIENTS AND METHODS Pre-treatment biopsies (n=252) available from 280 patients diagnosed with TSCC and BOTSCC during 2008-2012 in the County of Stockholm were tested for HPV DNA by a multiplex bead-based assay. Incidence records were acquired from the Swedish Cancer Registry. The data obtained were evaluated together with previous figures from 1970 to 2007. RESULTS HPV DNA was present in 186/252 (74%) of TSCC and BOTSCC biopsies obtained during 2008-2012 in Stockholm. In this region the age-standardised incidence, including the prevalence of HPV-positive and HPV-negative TSCC stabilised 2007-2012 compared to 2000-2006, while for BOTSCC throughout 1998-2012 the same parameters increased moderately (p<0.05, for all). In parallel, from 2000 to 2006 through 2007-2012 in Sweden, the age-standardised incidence of both TSCC and BOTSCC continued to rise (p=0.012 and p=0.001 respectively). CONCLUSION During 2000-2012 the age-standardised incidence and the proportion of HPV-positive TSCC have stabilised at a high level, while the proportion of HPV-negative cancer has remained at a low level in Stockholm, whereas for BOTSCC all parameters are increasing moderately. In contrast, in Sweden the incidence of both TSCC and BOTSCC is still increasing. We hypothesise that the HPV epidemic could be stabilising, first for TSCC, but so far not for BOTSCC, in e.g. some urban areas, while previous trends for both tumours persist at other geographic locations.
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Abstract
Oral and oropharyngeal cancer (OPC) is a complex and often relentless malignancy prone to local invasion and dissemination. Despite advances in understanding of the disease and improved therapeutic interventions, it continues to be diagnosed at an advanced stage and the survival rate remains poor. The financial cost of treating OPC may be the highest of all cancers in the United States and survivors often experience major detriments to quality of life. Major risk factors for OPC are tobacco, alcohol, areca nut, and human papillomavirus infection. This article updates medical practitioners on the causes, presentation, diagnosis, and management of OPC.
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Affiliation(s)
- Michaell A Huber
- Department of Comprehensive Dentistry, University of Texas Health Science Center, School of Dentistry, 7703 Floyd Curl Drive, Mail Code 7919, San Antonio, TX 78229, USA.
| | - Bundhit Tantiwongkosi
- Department of Radiology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX 78229, USA; Department of Otolaryngology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX 78229, USA
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Ndiaye C, Mena M, Alemany L, Arbyn M, Castellsagué X, Laporte L, Bosch FX, de Sanjosé S, Trottier H. HPV DNA, E6/E7 mRNA, and p16INK4a detection in head and neck cancers: a systematic review and meta-analysis. Lancet Oncol 2014; 15:1319-31. [PMID: 25439690 DOI: 10.1016/s1470-2045(14)70471-1] [Citation(s) in RCA: 501] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND We aimed to provide updated information about the global estimates of attributable fraction and type distribution of human papillomavirus (HPV) in head and neck squamous cell carcinomas by doing a systematic review and meta-analysis. METHODS We did a literature search on PubMed to identify studies that used PCR for detection of HPV DNA in head and neck squamous cell carcinomas with information about HPV genotype distribution. We included studies that tested 20 or more biopsies per cancer site and were published between July 15, 1990, and Feb 29, 2012. We collected information about sex, risk factors, HPV detection methods, and biomarkers of potentially HPV-induced carcinogenesis (E6/E7 mRNA and p16(INK4a)). If it was not possible to abstract the required information directly from the paper, we contacted the authors. We did a meta-analysis to produce pooled prevalence estimates including a meta-regression to explore sources of heterogeneity. FINDINGS 148 studies were included, contributing data for 12 163 cases of head and neck squamous cell carcinoma from 44 countries. HPV DNA was detected in 3837 cases. HPV16 accounted for 82·2% (95% CI 77·7-86·4) of all HPV DNA positive cases. By cancer site, pooled HPV DNA prevalence estimates were 45·8% (95% CI 38·9-52·9) for oropharynx, 22·1% (16·4-28·3) for larynx (including hypopharynx), and 24·2% (18·7-30·2) for oral cavity. The percent positivity of p16(INK4a) positive cases in HPV-positive oropharyngeal cancer cases was 86·7% (95% CI 79·2-92·9) and of E6/E7 mRNA positive cases was 86·9% (73·2-96·8). The estimate of HPV attributable fraction in oropharyngeal cancer defined by expression of positive cases of E6/E7 mRNA was 39·8% and of p16(INK4a) was 39·7%. Of subsites, tonsils (53·9%, 95% CI 46·4-61·3) had the highest HPV DNA prevalence. HPV DNA prevalence varied significantly by anatomical site, geographic region, but not by sex or tobacco or alcohol consumption. INTERPRETATION The contribution of HPV prevalence in head and neck squamous cell carcinoma and in particular that of HPV16 in the oropharynx shows the potential benefit of prophylactic vaccines. FUNDING European Commission.
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Affiliation(s)
- Cathy Ndiaye
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada; Sainte-Justine Hospital Research Center, Montreal, QC, Canada
| | - Marisa Mena
- Institut Català d'Oncologia (ICO) - Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Laia Alemany
- Institut Català d'Oncologia (ICO) - Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER Epidemiología y Salud Pública, CIBERESP, Barcelona, Spain
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium; University of Antwerp, Antwerp, Belgium
| | - Xavier Castellsagué
- Institut Català d'Oncologia (ICO) - Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER Epidemiología y Salud Pública, CIBERESP, Barcelona, Spain
| | - Louise Laporte
- Sainte-Justine Hospital Research Center, Montreal, QC, Canada
| | - F Xavier Bosch
- Institut Català d'Oncologia (ICO) - Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia de Sanjosé
- Institut Català d'Oncologia (ICO) - Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER Epidemiología y Salud Pública, CIBERESP, Barcelona, Spain
| | - Helen Trottier
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada; Sainte-Justine Hospital Research Center, Montreal, QC, Canada
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Garnaes E, Kiss K, Andersen L, Therkildsen MH, Franzmann MB, Filtenborg-Barnkob B, Hoegdall E, Krenk L, Josiassen M, Lajer CB, Specht L, Frederiksen K, Friis-Hansen L, Nielsen FC, Kjaer SK, Norrild B, von Buchwald C. A high and increasing HPV prevalence in tonsillar cancers in Eastern Denmark, 2000-2010: The largest registry-based study to date. Int J Cancer 2014; 136:2196-203. [DOI: 10.1002/ijc.29254] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/15/2014] [Accepted: 09/09/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Emilie Garnaes
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Katalin Kiss
- Department of Pathology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Luise Andersen
- Department of Pathology; Roskilde Hospital; Roskilde Denmark
| | | | | | | | | | - Lene Krenk
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Michael Josiassen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Christel B. Lajer
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Lena Specht
- Department of Oncology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Kirsten Frederiksen
- Department of Statistics, Bioinformatics and Registry; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Lennart Friis-Hansen
- Center for Genomic Medicine, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Finn C. Nielsen
- Center for Genomic Medicine, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Susanne K. Kjaer
- Department of Virus, Lifestyle and Genes; Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Bodil Norrild
- Institute of Cellular and Molecular Medicine, Panum Institute, University of Copenhagen; Copenhagen Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
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Isidean SD, Tota JE, Gagnon JA, Franco EL. Human papillomavirus vaccines: key factors in planning cost-effective vaccination programs. Expert Rev Vaccines 2014; 14:119-33. [PMID: 25266065 DOI: 10.1586/14760584.2015.964213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prophylactic HPV vaccines hold tremendous potential for reducing cervical and non-cervical HPV-related disease burden worldwide. To maximize on this potential, policy officials will need to carefully consider available evidence, existing uncertainties and the cost-effectiveness of mass HPV vaccination programs in the context of their respective nations and/or regions. Proper harmonization of primary prevention strategies with secondary prevention efforts will also be important. Decisions following such considerations may ultimately depend on programmatic objectives, infrastructure and available resources. Continued research and surveillance surrounding HPV vaccination will be essential for filling current knowledge gaps, and forcing ongoing reconsiderations of selected immunization strategies.
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Affiliation(s)
- Sandra D Isidean
- Department of Epidemiology, Biostatistics, and Occupational Health, Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montreal, QC H2W1S6, Canada
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297
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Winer RL, Huang CE, Cherne S, Stern JE, Butsch Kovacic MS, Mehta PA, Sauter SL, Galloway DA, Katzenellenbogen RA. Detection of human papillomavirus in the oral cavities of persons with Fanconi anemia. Oral Dis 2014; 21:349-54. [PMID: 25158861 DOI: 10.1111/odi.12286] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/31/2014] [Accepted: 08/18/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We conducted a cross-sectional study to describe the prevalence and correlates of type-specific human papillomavirus (HPV) DNA in the oral cavities of persons with Fanconi anemia. MATERIALS AND METHODS Oral swabs were collected from 67 participants with Fanconi anemia and tested for 27 HPV genotypes using polymerase chain reaction-based methods. RESULTS Participants were a mean of 18.6 (standard deviation, 10.0) years of age (range 4-47 years). The prevalence of oral HPV infection was 7.5%, and the prevalence of high-risk HPV infection was 6.0%. HPV type 16 was not detected in any samples. Prevalence was higher in adults than in children (13.3% vs 2.7% in those ≥18 vs <18 years of age). Among adults, prevalence was higher in males than in females (25.0% vs 9.1%, respectively). CONCLUSIONS Prevalence of oral HPV infection in persons with Fanconi anemia was comparable to estimates from other studies in the general population. However, in contrast to previous studies, we did not identify HPV type 16 (the type found in most HPV-related head and neck cancers) in any participants.
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Affiliation(s)
- R L Winer
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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298
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Quinn GP, Vadaparampil ST, Johns T, Alexander KA, Giuliano AR. Adolescent sexual activity and cancer risk: physicians' duty to inform? Curr Med Res Opin 2014; 30:1827-31. [PMID: 24834953 DOI: 10.1185/03007995.2014.924913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Yearly, 33,000 cancer diagnoses in the US are attributed to human papillomavirus (HPV), with cervical cancer the most common. HPV is transmitted through sexual contact; HPV types 16 and 18 cause the majority of ano-genital cancers in men and women. HPV causes ∼100% of cervical cancers, ∼90% of anal cancers, and ∼50% of vaginal, vulvar, and penile cancers. HPV is also involved in ∼70% of oropharyngeal cancers (OPCs) in the US. The CDC recommends routine administration to all female (bivalent or quadrivalent vaccine) and male (quadrivalent vaccine) patients at 11-12 years of age; the series may be started as early as 9 years of age. Recent evidence suggests physicians do not universally recommend the vaccine to all adolescents. Additionally, parents may refuse the vaccine due to safety concerns as well as religious and moral beliefs related to onset of sexual debut. It has been suggested physicians should consider discussing HPV vaccine as a cancer prevention tool only, with less focus on the fact that transmission is caused by sexual activity. In this commentary we suggest physicians have a duty to warn parents and adolescents that OPCs may be transmitted through oral sex, which is often perceived as not constituting sexual activity.
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Affiliation(s)
- Gwendolyn P Quinn
- Cancer Prevention and Control Division, Moffitt Cancer Center , Tampa, FL , USA
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299
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Rusan M, Klug TE, Henriksen JJ, Bonde JH, Fuursted K, Ovesen T. Prevalence of tonsillar human papillomavirus infections in Denmark. Eur Arch Otorhinolaryngol 2014; 272:2505-12. [PMID: 25112603 DOI: 10.1007/s00405-014-3225-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 07/29/2014] [Indexed: 12/19/2022]
Abstract
The incidence of tonsillar carcinomas associated with Human Papillomavirus (HPV) infection has increased dramatically over the last three decades. In fact, currently in Scandinavia, HPV-associated cases account for over 80 % of tonsillar carcinoma cases. Yet, the epidemiology and natural history of tonsillar HPV infections remains poorly characterized. Our aim was to characterize such infections in the Danish population in tumor-free tonsillar tissue. Unlike previous studies, we considered both palatine tonsils. We examined both tonsils from 80 patients with peritonsillar abscess (n = 25) or chronic tonsillar disease (n = 55). HPV was detected by nested PCR with PGMY 09/11 and GP5+/GP6+L1 consensus primers, and typed by sequencing. Samples were also analyzed using a higher-throughput method, the CLART HPV 2 Clinical Array Assay. The overall prevalence of HPV tonsillar infection was 1.25 % (1/80, 95 % CI 0.03-6.77 %) by nested PCR, and 0 % by CLART HPV2 Clinical Array. The HPV-positive patient was a 16-year-old female with recurrent tonsillitis and tonsillar hypertrophy. The type detected was HPV6. HPV was not detected in the contralateral tonsil of this patient. Compared to cervical HPV infections in Denmark, tonsillar HPV infections are 10- to 15-fold less frequent. In the HPV-positive patient in this study, HPV was detected in only one of the tonsils. This raises the possibility that prior studies may underestimate the prevalence of HPV infections, as they do not consider both palatine tonsils.
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Affiliation(s)
- M Rusan
- Department of Otorhinolaryngology, Aarhus University Hospital, Aarhus, Denmark,
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300
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Evans M, Powell NG. Sexual health in oral oncology: Breaking the news to patients with human papillomavirus-positive oropharyngeal cancer. Head Neck 2014; 36:1529-33. [DOI: 10.1002/hed.23792] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/04/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Ned G. Powell
- HPV Oncology Group; School of Medicine, Cardiff University; United Kingdom
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