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Large Study Shows Reduced Oral HPV Infections With Vaccine

Author: Kate Johnson
Date: May 18, 2017
Source: http://www.medscape.com/viewarticle/880184#vp_1

Human papillomavirus (HPV) vaccination is associated with an 88% reduction in rates of oral HPV infection according to one of the first studies to investigate this association.

The findings, reported in a premeeting presscast for the American Society of Clinical Oncology (ASCO) 2017 Annual Meeting, suggest that HPV vaccination may play an important role in the prevention of oropharyngeal cancer.

“Our data indicate that HPV vaccines have tremendous potential to prevent oral infections,” said senior study author Maura L. Gillison, MD, PhD, who conducted the research at Ohio State University and is now a professor of medicine at the University of Texas MD Anderson Cancer Center in Houston.

But she emphasized that although more than 90% of oropharangeal cancers are caused by HPV-16 ― one of the types for which HPV vaccines are currently available ― the vaccine is only indicated for the prevention of cervical and anogenital infections and associated cancers.

“There haven’t been any clinical trials evaluating whether the currently approved HPV vaccines can prevent oral infections that lead to cancer, so that is not currently an indication,” she explained.

In the absence of randomized trials, Dr Gillison and colleagues carried out a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) survey collected from 2627 young adults aged 18 to 33 years during the period 2011-2014.

This study was conducted by the National Center for Health Statistics and was designed to assess the health and wellness of the US population. Since 2009, Dr Gillison and colleagues have collaborated with NHANES to study oral HPV infections and have analyzed oral rinse samples collected by mobile health facilities.

Comparing individuals who had received the HPV vaccine (29.2% of women and 6.9% of men; P < .001) to those who had not, the analysis found the prevalence of oral HPV infections covered by the vaccine (HPV-16, -18, -6, and -11) was significantly lower in the vaccinated group (0.11% vs 1.61%; P = .008).

The most significant reduction was seen in men. None of those who had been vaccinated had an HPV infection of the types for which vaccinations were available, compared to 2.1% of unvaccinated men (P = .007).

“We were particularly interested in infections among men because the burden of HPV caused by head and neck cancer is largely borne by men, and the rates are rising most dramatically among men,” she said. The prevalence of HPV-positive oropharyngeal cancer is increasing faster than that of any other cancer among young, white, American men, she added.

“Using thse data, we estimated in an unvaccinated population about a million young adults would have oral HPV infection by one of these types, and if vaccines were universally accepted, we could have prevented perhaps over 900,000 of those,” she said.

HPV vaccines are recommended by a number of organizations, including the Centers for Disease Control and Prevention, the National Comprehensive Cancer Network, and ASCO, as well as a coalition of the top US cancer centers.

They were approved by the US Food and Drug Administration in 2006 for female patients aged 9 to 26 years; in 2011, they were approved for male patients aged 9 to 21 years (for men who have sex with men, they were approved to the age of 26 years).

However, in the 2011-2014 survey, only 18.3% of this population reported being vaccinated (6.9% of men and 29.2% of women).

Given this low uptake, the researchers estimated that “only 17% of potentially preventable infections have been prevented, 25% in women and a modest 7% in men,” said Dr Gillison.

Despite this, there is “considerable optimism,” she added.

“Recent data indicate that in individuals under the age of 18, 60% of girls have received more than one vaccine and 40% of boys – so vaccine uptake is higher now,” she added.

Dr Gillison warned against concluding on the basis of this study that there is a causal relationship between vaccination and prevention, because this was not a prospective trial. “Nevertheless, we can conclude that HPV vaccination may have additional benefits beyond prevention of anogenital cancers,” she said.

“The HPV vaccine has the potential to be one of the most significant cancer prevention tools ever developed, and it’s already reducing the world’s burden of cervical cancers,” said ASCO President-elect Bruce E. Johnson, MD, from the Dana-Farber Cancer Institute​ in Boston, Massachusetts.

“The hope is that vaccination will also curb rising rates of HPV-related oral and genital cancers, which are hard to treat. This study confirms that the HPV vaccine can prevent oral HPV infections, but we know it only works if it’s used.”

Approached for comment, Carole Fakhry, MD, from Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, said the results are promising, but further work is necessary.

“There have been no prospective studies to date that evaluate the impact of the vaccine on oral HPV infection,” Dr Fakhry told Medscape Medical News. “It is reassuring to see that the vaccine helps reduce oral HPV infections ― that was previously largely unknown ― [but] we can’t extrapolate from anogenital HPV [data].”

May, 2017|Oral Cancer News|

Decreases in adolescent tobacco use leveling off

Source: HemOncToday.com

Declines in rates of adolescent tobacco use have stagnated in the past few years, prompting the CDC to call for better prevention efforts, according to a recent report.

“Smoking continues to be the leading preventable cause of death and disability in the United States; and among adult established smokers in the United States, more than 80% began smoking before age 18 years,” CDC researchers wrote.
To evaluate behaviors and attitudes toward tobacco use during the critical period of adolescence, the researchers used National Youth Tobacco Survey (NYTS) data collected from 2000 to 2009.
The NYTS, which presents school-based survey responses from a cross-sectional, nationally representative sample of middle school and high school students, gleans information on youth tobacco use; smoking cessation; tobacco-related knowledge and attitudes; access to tobacco; media and advertising and secondhand smoke exposure. The study has been conducted every 2 years since 2000.
From the 205 participating schools, 22,679 students responded. They were polled about any use of, current use of and experimentation with certain tobacco products, including cigarettes, cigars, smokeless tobacco, pipes, bidis and kreteks. Survey questions also investigated students’ willingness to initiate tobacco use.
Results indicated that 8.2% of middle school students and 23.9% of high school students reported current tobacco use in 2009, the researchers said, with 5.2% of middle school and 17.2% of high school students reporting current cigarette use. The researchers also noted that 21.2% of middle school and 24% of high school students were willing to start smoking cigarettes.
Data from 2009 also suggested that, among middle school students, 3.9% currently used cigars; 2.6%, smokeless tobacco; 2.3%, pipes; 1.6%, bidis; and 1.2%, kreteks. A similar distribution of use of these products was noted among high school students, with 10.9% currently using cigars; 6.7%, smokeless tobacco; 3.9%, pipes; 2.4%, kreteks; and 2.4%, bidis.
From 2000 to 2009, decreases occurred among middle school students for current tobacco use, 15.1% to 8.2%; current cigarette use, 11% to 5.2%; and cigarette smoking experimentation, 29.8% to 15%. Overall rates for susceptibility to smoking, however, did not decline. Analysis also indicated that rates of decreases demonstrated no change during this time.
Among high school students, current tobacco use decreased from 34.5% to 23.9% from 2000 to 2009, according to the researchers, with current cigarette use also declining from 28% to 17.2% and rates of experimentation falling from 39.4% to 30.1%. Again, rates of decline did not change.
Prevalence of susceptibility to smoking remained steady for middle school and high school students throughout the study period.
Between 2006 and 2009, however, the willingness to start using tobacco products and current use of cigarettes, cigars, smokeless tobacco, pipes, bidis and kreteks did not change among middle school or high school students. For middle school students, the researchers only noted declines in two subpopulations, with rates of current cigarette use falling from 6.4% to 4.7% among girls and decreasing from 6.5% to 4.3% among white students.
Similarly, from 2006 to 2009, prevalence among high school students only declined in girls for current tobacco use, decreasing from 21.3% to 18.2%, and current cigarette use, with rates falling from 18.4% to 14.8%. Prevalence for current bidi use also declined among white students (2.6% to 1.7%).
“The findings in this report indicate that, from 2000 to 2009, prevalences of current tobacco and cigarette use and experimentation with smoking cigarettes declined for middle school and high school students, but no overall declines were noted for the 2006-2009 period,” the researchers wrote. “The general lack of significant change during the shorter period indicates that the current rate of decline in tobacco use is relatively slow.”
Researchers noted that prevention programs are effective, but they do not receive adequate financial support. “Comprehensive tobacco control programs should be fully funded and implemented, as recommended by the CDC,” they wrote.
The researchers also said better control of cigarette advertisements and more graphic warnings on cigarette packs may help deter adolescents from smoking by altering the general public’s attitudes toward tobacco use.
“Changes in social norms might help reduce youth susceptibility to try cigarettes and other tobacco products and accelerate the decline in tobacco use among youths,” the researchers wrote.

August, 2010|Oral Cancer News|