301
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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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302
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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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303
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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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304
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Bauman J, Wirth L. Human Papillomavirus and Oropharyngeal Squamous Cell Carcinoma of the Head and Neck: A Growing Epidemic. ADOLESCENT MEDICINE: STATE OF THE ART REVIEWS 2014; 25:489-501. [PMID: 27132327 PMCID: PMC5957483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Human papillomavirus (HPV) is now considered a major causative agent in oropharyngeal squamous cell carcinoma (OP-SCC). The incidence of HPV+ OP-SCC is increasing dramatically, is higher in men, and is now more common than cervical cancer in the United States. HPV+ OPSCCs usually present as locally advanced, stage IV cancers, requiring intensive treatment with surgery, chemotherapy, and/or radiation that can cause tremendous morbidity. HPV vaccination is predicted to prevent HPV+ OP-SCC because over 90% are caused by vaccine-type HPV. However, current vaccination rates are not yet high enough to be effective at preventing HPV-associated malignancies at a population level.
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Affiliation(s)
- Jessica Bauman
- Corresponding author Jessica Bauman, MD, Phone: 617-724-4000 Fax: 617-643-0798
| | - Lori Wirth
- Medical Director of the Center for Head and Neck Cancers, Massachusetts General Hospital, Boston, MA; Assistant Professor, Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Boston, MA
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305
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Gaudet M, Hamm J, Aquino-Parsons C. Incidence of ano-genital and head and neck malignancies in women with a previous diagnosis of cervical intraepithelial neoplasia. Gynecol Oncol 2014; 134:523-6. [PMID: 25042671 DOI: 10.1016/j.ygyno.2014.07.088] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 07/10/2014] [Accepted: 07/13/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The objective of this study was to determine if women with a history of Cervical Intraepithelial Neoplasia grades 2 and 3 (CIN2 and CIN3) are at increased long-term risk for developing non-cervix HPV-related malignancies. MATERIAL AND METHODS Women diagnosed with CIN2 or CIN3 between 1980 and 2005 were identified from the British Columbia (BC) Cancer Agency Cervical Cancer Screening Program's database. These patients' records were then cross-referenced with the BC Cancer Registry for diagnosis of vulvar, vaginal, anal or head and neck (HN) cancers during the period subsequent to their diagnosis of CIN. Standardized incidence ratios (SIR) were generated according to expected rates of each cancer. RESULTS 54,320 women with a diagnosis of CIN2 or CIN3 were identified between 1985 and 2005. The crude incidence rate for non-cervix HPV-related cancers was 35.4 per 100,000 person-years (8.6 for vagina, 17.6 for vulva, 3.7 for anal canal and 5.5 for HN). The SIR was 1.9 (95% CI 1.3-2.7) for all non-cervix cancers, 6.7 (95% CI: 3.0-12.8) for vagina, 2.9 (95% CI: 1.7-4.6) for vulva, 1.8 (95% CI: 0.4-4.7) for anal canal, and 0.6 (95% CI: 0.2-1.4) for HN. There were statistically significant increases in anal cancers for years 5-9 and in HN cancers for years 0.5-5. CONCLUSION BC women with a history of CIN2 or CIN3 are at relatively high risk of developing non-cervical HPV-related malignancies. The findings of this study suggest that interventions such as vaccination against high-risk HPV or long-term screening for these other cancers should be evaluated.
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Affiliation(s)
- Marc Gaudet
- BC Cancer Agency Vancouver Centre, Vancouver BC, Canada; Radiation Oncology, CSSS de Gatineau, Gatineau QC, Canada.
| | - Jeremy Hamm
- Centre for Population Oncology and Outcomes, BC Cancer Research Centre, Vancouver BC, Canada
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306
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Hildesheim A, Wacholder S, Catteau G, Struyf F, Dubin G, Herrero R. Efficacy of the HPV-16/18 vaccine: final according to protocol results from the blinded phase of the randomized Costa Rica HPV-16/18 vaccine trial. Vaccine 2014; 32:5087-97. [PMID: 25018097 DOI: 10.1016/j.vaccine.2014.06.038] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/16/2014] [Accepted: 06/06/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND A community-based randomized trial was conducted in Costa Rica to evaluate the HPV-16/18 AS04-adjuvanted vaccine (NCT00128661). The primary objective was to evaluate efficacy of the vaccine to prevent cervical intraepithelial neoplasia 2 or more severe disease (CIN2+) associated with incident HPV-16/18 cervical infections. Secondary objectives were to evaluate efficacy against CIN2+ associated with incident cervical infection by any oncogenic HPVs and to evaluate duration of protection against incident cervical infection with HPV-16/18. Vaccine safety and immunogenicity over the 4-year follow-up were also evaluated. METHODS We randomized (3727 HPV arm; 3739 control arm), vaccinated (HPV-16/18 or Hepatitis A) and followed (median 53.8 months) 7466 healthy women aged 18-25 years. 5312 women (2635 HPV arm; 2677 control arm) were included in the according to protocol analysis for efficacy. The full cohort was evaluated for safety. Immunogenicity was considered on a subset of 354 (HPV-16) and 379 (HPV-18) women. HPV type was assessed by PCR on cervical specimens. Immunogenicity was assessed using ELISA and inhibition enzyme immunoassays. Disease outcomes were histologically confirmed. Vaccine efficacy and 95% confidence intervals (95%CI) were computed. RESULTS Vaccine efficacy was 89.8% (95% CI: 39.5-99.5; N=11 events total) against HPV-16/18 associated CIN2+, 59.9% (95% CI: 20.7-80.8; N=39 events total) against CIN2+ associated with non-HPV-16/18 oncogenic HPVs and 61.4% (95% CI: 29.5-79.8; N=51 events total) against CIN2+ irrespective of HPV type. The vaccine had an acceptable safety profile and induced robust and long-lasting antibody responses. CONCLUSIONS Our findings confirm the high efficacy and immunogenicity of the HPV-16/18 vaccine against incident HPV infections and cervical disease associated with HPV-16/18 and other oncogenic HPV types. These results will serve as a benchmark to which we can compare future findings from the ongoing extended follow-up of participants in the Costa Rica trial. TRIAL REGISTRATION Registered with clinicaltrials.gov: NCT00128661.
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Affiliation(s)
- Allan Hildesheim
- National Cancer Institute (NCI), Division of Cancer Epidemiology and Genetics, 9609 Medical Center Drive, Bethesda, MD 20892, United States.
| | - Sholom Wacholder
- National Cancer Institute (NCI), Division of Cancer Epidemiology and Genetics, 9609 Medical Center Drive, Bethesda, MD 20892, United States.
| | - Gregory Catteau
- GlaxoSmithKline Vaccines, Avenue Fleming 20, B-1300 Wavre, Belgium.
| | - Frank Struyf
- GlaxoSmithKline Vaccines, Avenue Fleming 20, B-1300 Wavre, Belgium.
| | - Gary Dubin
- GlaxoSmithKline SA, 2301 Renaissance 22 Boulevard, RN0220, King of Prussia, PA 19406, United States.
| | - Rolando Herrero
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Solarium Bldg., Liberia, Costa Rica.
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307
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Seitz H, Müller M. Current perspectives on HPV vaccination: a focus on targeting the L2 protein. Future Virol 2014. [DOI: 10.2217/fvl.14.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT: Thirty years ago, human papillomavirus types 16 and 18 were isolated from cervical carcinomas, and it has been almost 10 years since the introduction of the first prophylactic virus-like particle (VLP) vaccine. The VLP vaccines have already impacted the reduction of pre-malignant lesions and genital warts, and it is expected that vaccination efforts will successfully lower the incidence of cervical cancer before the end of the decade. Here we summarize the historical developments leading to the prophylactic HPV vaccines and discuss current advances of next-generation vaccines that aim to overcome certain limitations of the VLP vaccines, including their intrinsic narrow range of protection, stability and production/distribution costs.
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Affiliation(s)
- Hanna Seitz
- National Institutes of Health, NCI/CCR/LCO, 37 Convent Drive, Bethesda, MD 20892, USA
| | - Martin Müller
- Deutsches Krebsforschungszentrum, F035, Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
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308
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Dunne EF, Markowitz LE, Taylor LD, Unger ER, Wheeler CM. Human papilloma virions in the laboratory. J Clin Virol 2014; 61:196-8. [PMID: 25088765 DOI: 10.1016/j.jcv.2014.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/27/2014] [Accepted: 06/14/2014] [Indexed: 01/10/2023]
Abstract
Carcinogenic human papillomaviruses (HPV) can cause cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers. Non-carcinogenic HPVs can cause anogenital warts and recurrent respiratory papillomatosis. Currently, few research laboratories propagate, isolate or generate papilloma virions. However, there have been questions about potential exposure and risk in this setting. In this brief note, we discuss the use of wild type and laboratory-generated virions in research laboratories, potential routes of laboratory exposure, and considerations for HPV vaccination of laboratory personnel.
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Affiliation(s)
- Eileen F Dunne
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauri E Markowitz
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - La'shan D Taylor
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service Fellow (EIS), Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
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309
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Woods RSR, O’Regan EM, Kennedy S, Martin C, O’Leary JJ, Timon C. Role of human papillomavirus in oropharyngeal squamous cell carcinoma: A review. World J Clin Cases 2014; 2:172-193. [PMID: 24945004 PMCID: PMC4061306 DOI: 10.12998/wjcc.v2.i6.172] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/21/2014] [Accepted: 05/19/2014] [Indexed: 02/05/2023] Open
Abstract
Human papillomavirus (HPV) has been implicated in the pathogenesis of a subset of oropharyngeal squamous cell carcinoma. As a result, traditional paradigms in relation to the management of head and neck squamous cell carcinoma have been changing. Research into HPV-related oropharyngeal squamous cell carcinoma is rapidly expanding, however many molecular pathological and clinical aspects of the role of HPV remain uncertain and are the subject of ongoing investigation. A detailed search of the literature pertaining to HPV-related oropharyngeal squamous cell carcinoma was performed and information on the topic was gathered. In this article, we present an extensive review of the current literature on the role of HPV in oropharyngeal squamous cell carcinoma, particularly in relation to epidemiology, risk factors, carcinogenesis, biomarkers and clinical implications. HPV has been established as a causative agent in oropharyngeal squamous cell carcinoma and biologically active HPV can act as a prognosticator with better overall survival than HPV-negative tumours. A distinct group of younger patients with limited tobacco and alcohol exposure have emerged as characteristic of this HPV-related subset of squamous cell carcinoma of the head and neck. However, the exact molecular mechanisms of carcinogenesis are not completely understood and further studies are needed to assist development of optimal prevention and treatment modalities.
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310
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DALIANIS TINA. Human papillomavirus and oropharyngeal cancer, the epidemics, and significance of additional clinical biomarkers for prediction of response to therapy (Review). Int J Oncol 2014; 44:1799-805. [PMID: 24676623 PMCID: PMC4063535 DOI: 10.3892/ijo.2014.2355] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/05/2014] [Indexed: 12/19/2022] Open
Abstract
In 2007, the International Agency for Research against Cancer (IARC) recognized human papillomavirus (HPV), especially HPV16, besides smoking and alcohol, as a risk factor for oropharyngeal squamous cell carcinoma (OPSCC), where tonsillar and base of tongue cancer dominate. Moreover, during the past decade, in many Western countries, a sharp rise in the incidence of OPSCC, more specifically of HPV-positive OPSCC has been observed. Notably, patients with HPV-positive OPSCC, where the majority are men, particularly never-smokers have a better clinical outcome than patients with HPV-negative OPSCC and other head neck cancer (roughly 80 vs. 40% disease-free survival with conventional radiotherapy and surgery). This suggests that many patients with HPV-positive OPSCC may not require the more aggressive intensified chemo-radiotherapy given to head neck cancer patients today, and could with somewhat tapered treatment maintain excellent survival, avoiding some of the severe side effects along with intensified treatment. However, before de-intensified treatment is administered additional biomarkers are necessary in combination with HPV-positive status in order to predict and select patients that will respond favorably to therapy. In conclusion, noteworthy issues within this field with an increasing cohort of patients with HPV-positive OPSCC are better-tailored therapy and prevention. Patients with HPV-positive OPSCC, with biomarkers for good response to therapy e.g., low MHC class I, or CD44 expression or high numbers of CD8+ tumor infiltrating lymphocytes, could be included in randomized trials with less severe therapy. Furthermore, possibilities to screen for HPV-positive OPSCC and to vaccinate boys against HPV infection should be further investigated.
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Affiliation(s)
- TINA DALIANIS
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, 171 76 Stockholm,
Sweden
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311
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Videla S, Darwich L, Cañadas M, Clotet B, Sirera G. Incidence and clinical management of oral human papillomavirus infection in men: a series of key short messages. Expert Rev Anti Infect Ther 2014; 12:947-57. [PMID: 24865412 DOI: 10.1586/14787210.2014.922872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oral human papillomavirus (HPV) infections are less prevalent than genital and anal infections. However, the incidence of oropharyngeal squamous cell carcinomas has increased significantly over the last 2 decades in several countries. At least 90% of these cancers are associated with oncogenic type HPV16. Oral HPV infections are notably more frequent in men than in women, and the incidence of HPV-positive oropharyngeal squamous cell carcinomas has increased, predominantly among mid-adult men. Nevertheless, little is known about the progression of oral HPV infection to cancer, and it remains unclear which medical interventions should be applied to modify the natural history of the disease. This narrative review aimed at non-experts in HPV infection provides an update on oral HPV infection and its clinical management in men. Furthermore, using the cervix as a reference anatomical site, the lessons learned from investigations on cervical HPV infection are also addressed.
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Affiliation(s)
- Sebastián Videla
- Lluita Contra La SIDA Foundation, Hospital Universitari Germans Trias i Pujol, 08916 Badalona (Barcelona), Spain
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312
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Simard EP, Torre LA, Jemal A. International trends in head and neck cancer incidence rates: Differences by country, sex and anatomic site. Oral Oncol 2014; 50:387-403. [DOI: 10.1016/j.oraloncology.2014.01.016] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/16/2014] [Accepted: 01/26/2014] [Indexed: 01/23/2023]
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313
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Pytynia KB, Dahlstrom KR, Sturgis EM. Epidemiology of HPV-associated oropharyngeal cancer. Oral Oncol 2014; 50:380-6. [PMID: 24461628 PMCID: PMC4444216 DOI: 10.1016/j.oraloncology.2013.12.019] [Citation(s) in RCA: 341] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 11/12/2013] [Accepted: 12/17/2013] [Indexed: 02/06/2023]
Abstract
Squamous cell carcinoma of the oropharynx is increasing in incidence in epidemic proportion. This site specific increase in incidence is due to an increase in human papillomavirus (HPV)-related squamous cell carcinoma, while the incidence of tobacco related squamous cell carcinoma is decreasing. In particular, the incidence of HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is increased among middle aged white men, and sexual behavior is a risk factor. HPV-related oropharyngeal squamous cell carcinoma represents a growing etiologically distinct subset of head and neck cancers with unique epidemiological, clinical, and molecular characteristics that differ from those of HPV-unassociated cancers. In this review, we discuss the epidemiology of HPV-related OPSCC, the prevalence of oral/oropharyngeal HPV infection, and efforts aimed at reducing the incidence of HPV-related OPSCC.
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Affiliation(s)
- Kristen B Pytynia
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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314
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Palmer E, Newcombe RG, Green AC, Kelly C, Noel Gill O, Hall G, Fiander AN, Pirotte E, Hibbitts SJ, Homer J, Powell NG. Human papillomavirus infection is rare in nonmalignant tonsil tissue in the UK: implications for tonsil cancer precursor lesions. Int J Cancer 2014; 135:2437-43. [PMID: 24723209 DOI: 10.1002/ijc.28886] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/11/2014] [Indexed: 01/23/2023]
Abstract
The incidence of human papillomavirus (HPV)-associated tonsil cancer is increasing but the prevalence of HPV, and of premalignant precursors, in tonsil tissue is unknown. We aimed to assess prevalence of HPV infection in nonmalignant tonsillar crypt epithelia and to histopathologically characterise positive samples. Formalin-fixed paraffin-embedded (FFPE) tonsil tissue specimens were obtained from an age- and sex-stratified random sample of patients aged 0-69 years whose paired tonsils were archived following elective tonsillectomy at hospitals throughout England and Southern Scotland from 2004 to 2008. Homogenised fresh-frozen tonsil tissue was also obtained from archive for two random subsets of males aged 25-34 and over 44. HPV status was assessed in all samples for 20 mucosal HPV types by GP5+/6+ polymerase chain reaction (PCR) enzyme immunoassay and by HPV16 type-specific PCR targeting the E6 gene. In the homogenised material, HPV status was also assessed for 44 HPV types by SPF10-PCR enzyme immunoassay. Of 4,095 randomly sampled FFPE specimens, amplifiable DNA was extracted from 3,377 (82.5%) and from 511 of 524 (97.5%) homogenised tonsils. HPV DNA was identified in 0 of 3,377 (0%, 95% CI 0-0.089%) fixed samples and 0 of 511 (0%, 95% CI 0-0.58%) homogenised samples. This suggests HPV infection may be rare in tonsil reticulated crypt epithelia. Furthermore, we found no evidence of HPV-associated premalignant neoplasia. These data suggest that if HPV-associated premalignant lesions do occur, they are likely to be rare and may have a high risk of progression to carcinoma.
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Affiliation(s)
- Elizabeth Palmer
- HPV Research Group, Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
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315
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Antonsson A, Cornford M, Perry S, Davis M, Dunne MP, Whiteman DC. Prevalence and risk factors for oral HPV infection in young Australians. PLoS One 2014; 9:e91761. [PMID: 24637512 PMCID: PMC3956721 DOI: 10.1371/journal.pone.0091761] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/13/2014] [Indexed: 01/22/2023] Open
Abstract
The prevalence of human papillomavirus (HPV)–associated head and neck cancers is increasing, but the prevalence of oral HPV infection in the wider community remains unknown. We sought to determine the prevalence of, and identify risk factors for, oral HPV infection in a sample of young, healthy Australians. For this study, we recruited 307 Australian university students (18–35 years). Participants reported anonymously about basic characteristics, sexual behaviour, and alcohol, tobacco and illicit drugs use. We collected oral rinse samples from all participants for HPV testing and typing. Seven of 307 (2.3%) students tested positive for oral HPV infection (3 HPV-18, one each of HPV-16, -67, -69, -90), and six of them were males (p = 0.008). Compared to HPV negative students, those with oral HPV infection were more likely to have received oral sex from more partners in their lifetime (p = 0.0004) and in the last year (p = 0.008). We found no statistically significant associations with alcohol consumption, smoking or numbers of partners for passionate kissing or sexual intercourse. In conclusion, oral HPV infection was associated with male gender and receiving oral sex in our sample of young Australians.
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Affiliation(s)
- Annika Antonsson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- * E-mail:
| | - Michelle Cornford
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Susan Perry
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Marcia Davis
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Michael P. Dunne
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - David C. Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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316
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Elwood JM, Youlden DR, Chelimo C, Ioannides SJ, Baade PD. Comparison of oropharyngeal and oral cavity squamous cell cancer incidence and trends in New Zealand and Queensland, Australia. Cancer Epidemiol 2014; 38:16-21. [DOI: 10.1016/j.canep.2013.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 12/03/2013] [Accepted: 12/09/2013] [Indexed: 11/15/2022]
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317
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Differences in oral sexual behaviors by gender, age, and race explain observed differences in prevalence of oral human papillomavirus infection. PLoS One 2014; 9:e86023. [PMID: 24475067 PMCID: PMC3901667 DOI: 10.1371/journal.pone.0086023] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/04/2013] [Indexed: 12/21/2022] Open
Abstract
Purpose This study explores whether gender, age and race differences in oral sexual behavior account for the demographic distribution of oral human papillomavirus infection (HPV) and HPV-positive oropharyngeal cancer (HPV-OSCC) Methods This analysis included 2,116 men and 2,140 women from NHANES (2009–10) who answered a behavioral questionnaire and provided an oral-rinse sample for HPV detection. Weighted prevalence estimates and prevalence ratios (PR) were calculated for sexual behaviors and oral HPV infection by gender, age-cohort (20–29, 30–44, 45–59, 60–69), and race, and contrasted with incidence rate ratios (IRR) of OSCC from SEER 2009. Multivariate logistic regression was used to evaluate predictors of oral sexual behavior and oral HPV16 infection. Results Differences in oral sexual behavior were observed by gender, age-cohort and race. Most men (85.4%) and women (83.2%) had ever performed oral sex, but men had more lifetime oral and vaginal sexual partners and higher oral HPV16 prevalence than women (each p<0.001). 60–69 year olds (yo) were less likely than 45–59 or 30–44 (yo) to have performed oral sex (72.7%, 84.8%, and 90.3%, p<0.001), although oral HPV16 prevalence was similar. Prevalence ratios (PR) of ever oral sex in men vs. women (PR = 1.03), and 45–59 vs. 30–44 year-old men (PR = 0.96) were modest relative to ratios for oral HPV16 infection (PRs = 1.3–6.8) and OSCC (IRR = 4.7–8.1). In multivariate analysis, gender, age-cohort, and race were significant predictors of oral sexual behavior. Oral sexual behavior was the primary predictor of oral HPV16 infection; once this behavior was adjusted for, age-cohort and race were no longer associated with oral HPV16. Conclusion There are differences in oral sexual behaviors when considering gender, age-cohort and race which explain observed epidemiologic differences in oral HPV16 infection across these groups.
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Clinical update on cancer: molecular oncology of head and neck cancer. Cell Death Dis 2014; 5:e1018. [PMID: 24457962 PMCID: PMC4040714 DOI: 10.1038/cddis.2013.548] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 02/07/2023]
Abstract
Head and neck cancers encompass a heterogeneous group of tumours that, in general, are biologically aggressive in nature. These cancers remain difficult to treat and treatment can cause severe, long-term side effects. For patients who are not cured by surgery and/or (chemo)radiotherapy, there are few effective treatment options. Targeted therapies and predictive biomarkers are urgently needed in order to improve the management and minimise the treatment toxicity, and to allow selection of patients who are likely to benefit from both nonselective and targeted therapies. This clinical update aims to provide an insight into the current understanding of the molecular pathogenesis of the disease, and explores the novel therapies under development and in clinical trials.
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Vogt SL, Gravitt PE, Martinson NA, Hoffmann J, D'Souza G. Concordant Oral-Genital HPV Infection in South Africa Couples: Evidence for Transmission. Front Oncol 2013; 3:303. [PMID: 24377087 PMCID: PMC3860183 DOI: 10.3389/fonc.2013.00303] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/28/2013] [Indexed: 02/03/2023] Open
Abstract
Objective: Cervical cancer is a leading cause of cancer mortality in South Africa. However, little is known about oral human papillomavirus (HPV) infection in high human immunodeficiency virus (HIV) seroprevalence settings. Method: Thirty-four adult heterosexual couples attending an HIV testing center in Soweto, South Africa were enrolled. Each participant provided an oral rinse sample and genital swab, which were tested for 37 types of HPV DNA, and completed a risk behavior survey. Results: Median age was 31 years and 9% (3/34) of men and 29% (10/34) of women enrolled tested HIV-positive; median CD4 count was 437 cells/mm3. Oral HPV prevalence was similar in women and men (12 vs. 18%, p = 0.48), and was non-significantly higher in HIV-infected vs. HIV-uninfected (23 vs. 13%, p = 0.34) subjects. Most men (82%) and women (84%) reported ever performing oral sex. Median number of lifetime sexual partners was “2–5” while median number of lifetime oral sex partners was 1. Oncogenic HPV subtypes were detected in 4% of oral, 26% of penile, and 74% of vaginal samples, including HPV16 in 1, 12, and 21% of these samples respectively. Genital HPV prevalence was significantly higher than oral HPV prevalence (75 vs. 15%, p ≤ 0.001). Thirty-five percent of couples (12/34) had at least one type-specific concordant vaginal-penile HPV infection but only one of nine couples with oral HPV had concordant oral–oral infection. However, 67% (4/6) of men and 25% (1/4) of women with oral HPV infection had partners with concordant genital HPV infection. Implications and Impact: Oral–oral HPV concordance between couples is low, but oral-genital and genital–genital HPV concordance is higher, including concordance of male oral HPV infection with their partners’ vaginal HPV infection. This data is consistent with possible transmission of vaginal HPV infection to the oral cavity of sexual partners performing oral sex.
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Affiliation(s)
- Samantha L Vogt
- Department of Internal Medicine, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | - Patti E Gravitt
- Department of Epidemiology, Johns Hopkins School of Public Health , Baltimore, MD , USA
| | - Neil A Martinson
- Perinatal HIV Research Unit, University of Witwatersrand , Johannesburg , South Africa ; Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | | | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins School of Public Health , Baltimore, MD , USA
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Scully C. HPV and throat cancer. Br Dent J 2013; 215:444. [DOI: 10.1038/sj.bdj.2013.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Osazuwa-Peters N. Human papillomavirus (HPV), HPV-associated oropharyngeal cancer, and HPV vaccine in the United States--do we need a broader vaccine policy? Vaccine 2013; 31:5500-5. [PMID: 24095883 DOI: 10.1016/j.vaccine.2013.09.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 09/16/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is a sexually transmitted infection (STI) of global importance; it is the most prevalent STI in the United States, with strains causally linked to oropharyngeal and other cancers. Efforts to prevent HPV have been made to varying degrees by policies implemented by different state governments; however, HPV and associated oropharyngeal cancer continue to show increasing incidence rates in the US. DESIGN A narrative review based on search on SciVerse, PubMed/Medline, Google Scholar, and EMBASE databases, as well as literature/documents from the World Health Organization, Centers for Disease Control and Prevention, American Cancer Society, National Conference of State legislatures, and the U.S. Department of Health and Human Services relevant to HPV and HPV vaccine policy in the US. RESULTS Vaccination has proved to be a successful policy in the US, and an extant recommendation aimed at preventing HPV and associated cervical and other anogenital cancers is the routine use of HPV vaccines for males and females. However, HPV vaccines are presently not recommended for preventing oropharyngeal cancer, although they have been shown to be highly effective against the HPV strains that are most commonly found in the oropharynx. And while there is a history of successful vaccine mandate in the US with resulting decrease in occurrence of infectious diseases, implementing HPV vaccine mandate has proved to be very unpopular. CONCLUSIONS With emerging evidence of the efficacy of the use of the HPV vaccine in preventing oral-HPV, more focus should be put on extending HPV vaccine to present oral HPV infection and oropharyngeal cancer. Also, implementing a broader HPV vaccine policy that include mandating HPV vaccines as a school-entry requirement for both sexes may increase vaccine use in the US for the greater good of the public.
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Affiliation(s)
- N Osazuwa-Peters
- Cancer Center, Saint Louis University, St. Louis, MO 63110, USA.
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Epidemiology of oral human papillomavirus infection. Oral Oncol 2013; 50:364-9. [PMID: 24080455 DOI: 10.1016/j.oraloncology.2013.09.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/18/2013] [Accepted: 09/04/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe what is known about the epidemiology of oral human papillomavirus (HPV) infection. METHODS In this article we review current data on HPV prevalence, natural history, mode of acquisition, and risk factors for oral HPV infection. RESULTS & CONCLUSION Over the past several years new studies have informed our understanding of oral HPV infection. These data suggest oral HPV prevalence is higher in men than women and support the sexual transmission of HPV to the mouth by oral sex. Data is emerging suggesting that most oral HPV infections usually clear within a year on and describing risk factors for prevalent and persistent infection. Recent data support likely efficacy of the HPV vaccine for oral HPV, suggesting vaccination may reduce risk of HPV-related oropharyngeal cancer.
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Sawyers CL, Abate-Shen C, Anderson KC, Barker A, Baselga J, Berger NA, Foti M, Jemal A, Lawrence TS, Li CI, Mardis ER, Neumann PJ, Pardoll DM, Prendergast GC, Reed JC, Weiner GJ, Weiner GJ. AACR Cancer Progress Report 2013. Clin Cancer Res 2013; 19:S4-98. [DOI: 10.1158/1078-0432.ccr-13-2107] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lang Kuhs KA, Gonzalez P, Struijk L, Castro F, Hildesheim A, van Doorn LJ, Rodriguez AC, Schiffman M, Quint W, Lowy DR, Porras C, Delvecchio C, Katki HA, Jimenez S, Safaeian M, Schiller J, Solomon D, Wacholder S, Herrero R, Kreimer AR. Prevalence of and risk factors for oral human papillomavirus among young women in Costa Rica. J Infect Dis 2013; 208:1643-52. [PMID: 24014882 DOI: 10.1093/infdis/jit369] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Little is known about the epidemiology of oral human papillomavirus (HPV) in Latin America. METHODS Women (N = 5838) aged 22-29 in the control and vaccine arms of an HPV-16/18 vaccine trial in Costa Rica had oral, cervical, and anal specimens collected. Samples were tested for alpha mucosal HPV types (SPF10/LiPA25 version 1); a subset of oral samples (n = 500) was tested for cutaneous HPV types in the genera alpha, beta, gamma, mu, and nu. RESULTS In the control arm (n = 2926), 1.9% of women had an oral alpha mucosal HPV detected, 1.3% had carcinogenic HPV, and 0.4% had HPV-16; similar patterns for non-16/18 HPV types were observed in the vaccine arm. Independent risk factors for any oral alpha mucosal HPV among women in the control arm included marital status (adjusted odds ratio [AOR], 3.2; 95% confidence interval [CI], 1.8-5.7 for single compared to married/living as married), number of sexual partners (AOR, 2.4; 95% CI, 1.0-6.1 for ≥4 partners compared to 0-1 partners), chronic sinusitis (AOR, 3.1; 95% CI, 1.5-6.7), and cervical HPV infection (AOR, 2.6; 95% CI, 1.4-4.6). Detection of beta HPV was common (18.6%) and not associated with sexual activity. CONCLUSIONS Unlike cutaneous HPV types, alpha mucosal HPV types were uncommon in the oral region and were predominately associated with sexual behavior. Clinical Trials Registration. NCT00128661.
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Affiliation(s)
- Krystle A Lang Kuhs
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Riedmann EM. Human vaccines & immunotherapeutics: news. Hum Vaccin Immunother 2013; 9:1827-30. [PMID: 24051387 PMCID: PMC3906344 DOI: 10.4161/hv.26237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 11/19/2022] Open
Abstract
Vaccinating boys against HPV to reduce cancer rates across the sexes: New melanoma vaccine contains natural product from marine sponges: Impact of Hib conjugate vaccines in developing countries: Electronic Health Records to keep track of immunization status: Pregnant women urged to get whooping cough vaccination: New nano-coating developed to preserve vaccines: Alternative approach to creating a universal flu vaccine: New modular vaccine design: MAPS technology.
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Kreimer AR. Prospects for prevention of HPV-driven oropharynx cancer. Oral Oncol 2013; 50:555-9. [PMID: 23876626 DOI: 10.1016/j.oraloncology.2013.06.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/03/2013] [Accepted: 06/14/2013] [Indexed: 01/12/2023]
Abstract
Prevention of HPV-associated cancers can take two forms-one through prevention of infection via prophylactic HPV vaccination, and one through interruption of disease progression through early identification (i.e.: screening) and treatment. Primary prevention via vaccination seems promising, as a proof-of-principal study demonstrated high vaccine efficacy against one-time detection of oral HPV16/18 infection. In addition to the direct benefit of vaccination, indirect protection from reduced genital HPV infection should also reduce oral HPV exposure at the individual level. Yet, for the current unvaccinated cohorts who will bear the burden of non-cervical HPV-associated cancers for the foreseeable future, no secondary prevention opportunities exist, as the field has not yet validated any screening methods for non-cervical HPV associated cancers. Serum HPV16 E6 antibody data suggest that this test might one day be able to detect many of the at-risk patients prior to tumor development. For any biomarker that proves valid and reliable, transitioning into clinical practice will require additional research focused on (1) diagnostics, (2) effective intervention, and (3) observed reductions in cancer mortality.
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Affiliation(s)
- Aimée R Kreimer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States.
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