cervical cancer

Manitoba expands HPV vaccination program to include boys

Source: www.rapidnewsnetwork.com
Author: Cody Griffin
 
Human-papillomavirus-HPV-va

While most HPV infections go away over time with no treatment, a few can go on to cause cancer.

Health Minister Sharon Blady said the province’s vaccine program will be expanded next year to include Grade 6 and Grade 9 boys as part of Manitoba’s cancer strategy.

The province will also be doing a catch-up period in grade 9. About 59 percent of the physicians recommended HPV vaccination more often for adolescents who they perceived to be at higher risk for getting an HPV infection, as opposed to recommending it routinely for all adolescents.

“Human papillomavirus can cause abnormal cell changes that can lead to cervical cancer, as well as cancer of the vagina, vulva, penis, anus, mouth and throat”, said Dr. Sri Navaratnam, president and CEO, CancerCare Manitoba.

A study in Texas found that a more rigorous, information driven outreach program increased the number of children receiving the vaccine, and other recent studies have reinforced the efficacy of the vaccine to prevent cancer and not promote promiscuity among teenagers.

Any girl or boy who misses the vaccine in Grade 6 will be eligible to get it in later years free of charge under the province’s “once eligible, always eligible”, program. But now we know it causes cancer in men as well.

Gilkey and colleagues found that 27 percent of physicians across the country reported that they do not strongly endorse HPV vaccination, and 26 percent and 39 percent reported that they do not provide timely recommendations for vaccinating girls and boys, respectively.

“The vaccine’s definitely most effective when you’re younger because you have A better immune response to vaccines and when you haven’t been exposed to the virus yet”, he said.

Routledge also said parents will need to give consent for their kids to receive the shot.

Saskatchewan Health Minister Dustin Duncan says offering the HPV vaccine for free to boys is something the province is looking at. “Vaccinating boys with the HPV vaccine will help prevent transmission of the virus and help reduce the incidence and mortality of all HPV-related cancers”. Nova Scotia has announced it plans to do the same.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

October, 2015|Oral Cancer News|

Multisite HPV16/18 Vaccine Efficacy Against Cervical, Anal, and Oral HPV Infection

Source: www.oxfordjournal.com
Authors: Daniel Bleacher, Aimee Kreimer, Mark Schiffman, Rolando Herrero, Ana Cecilia Rodriguez, Douglas Lowy, Carolina Porras, John Schiller, Wim Quint, Silvia Jiminez, Mahboobeh Safaeian, Linda Struijk, John Scchussler, Allan Hildesheim, Paula Gonzalez

 

Background: Previous Costa Rica Vaccine Trial (CVT) reports separately demonstrated vaccine efficacy against HPV16 and HPV18 (HPV16/18) infections at the cervical, anal, and oral regions; however, the combined overall multisite efficacy (protection at all three sites) and vaccine efficacy among women infected with HPV16 or HPV18 prior to vaccination are less known.

Methods: Women age 18 to 25 years from the CVT were randomly assigned to the HPV16/18 vaccine (Cervarix) or a hepatitis A vaccine. Cervical, oral, and anal specimens were collected at the four-year follow-up visit from 4186 women. Multisite and single-site vaccine efficacies (VEs) and 95% confidence intervals (CIs) were computed for one-time detection of point prevalent HPV16/18 in the cervical, anal, and oral regions four years after vaccination. All statistical tests were two-sided.

Results: The multisite woman-level vaccine efficacy was highest among “naïve” women (HPV16/18 seronegative and cervical HPV high-risk DNA negative at vaccination) (vaccine efficacy = 83.5%, 95% CI = 72.1% to 90.8%). Multisite woman-level vaccine efficacy was also demonstrated among women with evidence of a pre-enrollment HPV16 or HPV18 infection (seropositive for HPV16 and/or HPV18 but cervical HPV16/18 DNA negative at vaccination) (vaccine efficacy = 57.8%, 95% CI = 34.4% to 73.4%), but not in those with cervical HPV16 and/or HPV18 DNA at vaccination (anal/oral HPV16/18 VE = 25.3%, 95% CI = -40.4% to 61.1%). Concordant HPV16/18 infections at two or three sites were also less common in HPV16/18-infected women in the HPV vaccine vs control arm (7.4% vs 30.4%, P < .001).

Conclusions: This study found high multisite vaccine efficacy among “naïve” women and also suggests the vaccine may provide protection against HPV16/18 infections at one or more anatomic sites among some women infected with these types prior to HPV16/18 vaccination.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

October, 2015|Oral Cancer News|

Vaccine clears some precancerous cervical lesions in clinical trial

Source: www.sciencedaily.com
Author: Mark L Bagarazzi, MD et al.
 

Scientists have used a genetically engineered vaccine to successfully eradicate high-grade precancerous cervical lesions in nearly one-half of women who received the vaccine in a clinical trial. The goal, say the scientists, was to find nonsurgical ways to treat precancerous lesions caused by HPV.

“Every standard therapeutic option for women with these lesions destroys part of the cervix, which is particularly relevant for women of childbearing age, who may then be at risk for preterm birth due to a weakened cervix,” says Cornelia Trimble, M.D., professor of gynecology and obstetrics, oncology, and pathology at the Johns Hopkins University School of Medicine, and first author of the new report, which appears online Sept. 17 in The Lancet. “A vaccine able to cure precancerous lesions could eventually be one way women can avoid surgery that is invasive and can also harm their fertility.”

High-grade cervical lesions, termed CIN2/3, occur most often in women 40 or younger, according to Trimble, a member of Johns Hopkins’ Kelly Gynecologic Oncology Service and Kimmel Cancer Center. Because the lesions can progress to cancer, they are usually removed by surgery, freezing or laser. The procedures are successful in removing the precancerous areas in approximately 80 percent of women, says Trimble. Less troublesome lesions, called low-grade dysplasia, are usually monitored by physicians rather than immediately removed because they pose less of a risk for cancer and usually regress on their own.

For the study, the scientists used a vaccine, originally developed by University of Pennsylvania scientist David Weiner, Ph.D., which is engineered to teach immune system cells to recognize precancerous and cancerous cells. Those cells are coated with proteins linked to an infection with two strains of HPV — 16 and 18 — that cause cervical cancer. The vaccine, given by injection into the arm, is made by Inovio Pharmaceuticals Inc., which funded the clinical trial, and whose employees co-authored the report with Trimble.

Between 2011 and 2013, the scientists recruited 167 women, ages 18 to 55, with newly diagnosed, high-grade precancerous cervical lesions. The women were randomly assigned to receive either three doses of the vaccine or saline injections over a 12-week period at 36 hospitals and private gynecology practices in the U.S. and six other countries.

After each of the injections, the scientists gave the women a small electric pulse at the site of the injection. Cells near the electric pulse open their pores, says Trimble, increasing the likelihood that the vaccine will be taken up by immune system cells.

Of 114 women who received at least one vaccine dose, 55 (48.2 percent) had a regression of their precancerous lesion, meaning their lesions disappeared or converted to low-grade lesions, compared with 12 of 40 (30 percent) who received saline injections. Of the 114, 107 received all three vaccine doses, and 53 of them (49.5 percent) had regression of their lesions. Of the 40 in the saline group, 36 got all three injections, and 11 of them (30.6 percent) had regression of their lesions. Thirteen women dropped out of the study after enrollment.

Two patients discontinued the study because of pain at the injection site. Skin redness was more common in the vaccine group compared with saline.

Among women who completed all three injections, scientists could find no trace of HPV in the cervixes of 56 of the 107 women who received the vaccine, compared with only nine of 35 saline recipients.

“In many of these women, the vaccine not only made their lesions disappear, but it also cleared the virus from their cervix,” says Trimble. “In most unvaccinated patients whose lesions went away, the virus was still present, and many still had low-grade lesions.”

Trimble says clearance of the virus is a “significant bonus” from receiving the vaccine because persistent HPV infection is a major risk factor for recurrence of cervical lesions.

After 12 weeks, doctors surgically removed lesions that did not regress and took biopsies of each study participant’s cervix. In the surgically removed lesions, scientists found miniscule cancers in two of the women who received the vaccine. Trimble says these microinvasive cancers are rarely diagnosed by a biopsy but are found in surgical specimens.

n the biopsy samples, the scientists found that patients whose lesions completely regressed after treatment had more immune cells, called T cells, present in the tissue. “It’s important that T cells capable of recognizing HPV stay in the cervix and fight off any recurrence of the infection,” says Trimble.

“This is a great first step,” says Trimble. “We showed that the vaccine may enable an immune response in a person whose immune system was initially not adequately engaged or was hampered in some way so as to let the lesion occur.”

Trimble says that precancerous lesions are unlikely to progress to cancer during the vaccine treatment period, and monitoring of high-grade lesions is done routinely for pregnant women. “It typically takes about 10 or more years for precancerous cells to become cancer, so there is a window of opportunity to intervene with nonsurgical approaches to reverse the process of viral-associated cancers,” says Trimble.

Trimble says she and her colleagues are now working to identify biomarkers from cervical tissue that can predict which lesions are more likely to persist and eventually progress to cancer. The research team will be monitoring this initial group of study participants to see whether they have fewer recurrences than unvaccinated patients. Trimble is also studying other types of vaccines to prevent the progression of high-grade cervical lesions to cancer.

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Trimble received an unrestricted grant from Inovio Pharmaceuticals Inc., but she has no other financial or consulting arrangements with the company.

In addition to Trimble, scientists who contributed to the research include Lance Edwards from Suffolk Obstetrics and Gynecology in Port Jefferson, New York; R. Lamar Parker from Lyndhurst Gynecologic Associates in Winston-Salem, North Carolina; Lynette Denny from the University of Cape Town’s Groote Schuur Hospital in South Africa; David B. Weiner from the University of Pennsylvania; and Matthew P. Morrow, Kimberly A. Kraynyak, Xuefei Shen, Michael Dallas, Jian Yan, Mary Giffear, Ami Shah Brown, Kathleen Marcozzi-Pierce, Divya Shah, Anna M. Slager, Albert J. Sylvester, Amir Khan, Kate E. Broderick, Robert J. Juba, Timothy A. Herring, Jean Boyer, Jessica Lee, Niranjan Y. Sardesai, David B. Weiner and Mark L Bagarazzi from Inovio Pharmaceuticals Inc.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

September, 2015|Oral Cancer News|

AstraZenica, Inovio strike deal to find HPV cancer vaccine

Source: www.philly.com
Author: David Sell
 

Local drugmakers – big and small – struck a deal to try to develop a vaccine to prevent a form of cervical, head and neck cancer.

 MedImmune, which is the biologics and research division with AstraZeneca, said Monday it will collaborate with Inovio Pharmaceuticals to develop an early stage cancer vaccine designed to treat human pappilomavirus.

 AstraZeneca will pay Inovio $27.5 million upfront. If the compound reaches development and commercial milestones, Inovio could get up to $700 million, along with “double-digit tiered royalties” on product sales. However, sales are a long way off because the compound is only in phase I and phase II of what is normally a three-phase clinical trial process.

 AstraZeneca is moving its headquarters from London to Cambridge in the United Kingdom, and has operations in Wilmington and Fort Washington. The MedImmune division is headquartered in Gaithersburg, Md.

 Inovio is based in Blue Bell and its basic scientific premise is to use DNA to develop vaccines. unlike most current vaccines.

 The companies have worked together before. The compound at the heart of the latest deal is called INO-3112. The early clinical trials are examining cervical and head and neck camcers and the compound tries to generate “killer T-cell responses that are able to destroy HPV 16- and 18- driven tumors. These HPV types are responsible for more than 70 per cent of cervical pre-cancers and cancers, ” according to the statement.

The full statement from AstraZeneca is here.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

August, 2015|Oral Cancer News|

Professor Harald zur Hausen: Nobel scientist calls for HPV vaccination for boys

Source: www.independent.co.uk
Author: Charlie Cooper & Gloria Nakajubi
 

The UK should vaccinate all boys against the cancer-causing human papilloma virus (HPV), the Nobel Prize-winning scientist who discovered the link between HPV and cancer has said.

Professor Harald zur Hausen, the German virologist whose theory that HPV could be a cause of cervical cancers led to global efforts to vaccinate girls against the virus, said that boys should also be protected.

There is now a wealth of evidence that HPV also causes cancers in men, including anal, penile and throat cancer. Professor zur Hausen added that there was now a chance to “eradicate” HPV viruses altogether if the world developed global vaccination programmes for all children.

Since 2008 the UK has offered free vaccinations against HPV to girls aged 12 to 13 – a programme that had an almost 87 per cent uptake from 2013 to 2014 and has led to falls in the number of pre-cancerous abnormalities of the cervix, according to research carried out among vaccinated girls in Scotland.

Capture

Vaccine authorities in the UK, traditionally an international leader in the field of immunisation, are yet to make a judgement on a publicly funded vaccination programme for boys, which would follow in the wake of those already in place in Australia, Austria, Israel and parts of Canada.

HPV is the name for a common group of viruses that can affect the moist membranes of the cervix, anus, mouth and throat. It is usually spread through sexual contact.

Most sexually active people will contract it in their lifetime but usually it causes no ill-effects. However, in some cases it causes changes to cells, which can become cancerous. It is the cause of almost all cases of cervical cancer, a discovery made by Professor zur Hausen in the 1970s, for which he won the Nobel Prize in physiology or medicine in 2008.

Speaking to HPV Action, in an interview to be published by the campaign group this week, Professor zur Hausen said that vaccinating boys was of “the utmost importance”, not only because boys can also contract HPV-related cancers of the throat, anus and penis, but because protecting boys is key to ending transmission of the virus altogether.

“The vaccination programme for girls [in the UK] is marvellous – it reaches a very high proportion,” he said. “In my opinion, the vaccination of boys is also of the utmost importance because virus transmission is due to male partners and men are affected by oropharyngeal [cancers of the throat], anal and penile cancers as well as genital warts.”

Last year the UK’s vaccination authority, the Joint Committee on Vaccination and Immunisation (JCVI), recommended that the UK introduce a vaccination programme for gay men, to be delivered via sexual health clinics. The rationale behind the recommendation is that heterosexual men will be protected from HPV infection because most women will have been immunised, but that men who have sex with men will miss out on “herd immunity”.

However, campaigners and some experts say this reasoning is flawed, as many gay men will have been sexually active before their first visit to a sexual health clinic, and would most likely have already contracted or transmitted the virus.

The JCVI is due to consider the cost-effectiveness of vaccination for boys but campaigners do not anticipate any decision until 2017.

However, the NHS in London is currently planning what would be the first pilot of routine HPV vaccination for boys, with a likely start date of February 2016. The “field test” will work across four sites to establish whether school-age young males would “embrace the uptake of HPV vaccination as part of a community programme”, NHS England’s London office said.

Rolling out the vaccine to boys would require a public-information campaign because it has previously been presented to parents and children as a girls-only jab to prevent cervical cancer.

Scientists say changes in sexual behaviour – with more couples having oral and anal sex – may be the cause of increased cases of anal and throat cancers in both men and women in recent decades.

Margaret Stanley, emeritus professor at the University of Cambridge and a leading expert on HPV, said that cases could continue to rise. “It’s very much under-thirties [having more anal and oral sex] so you can predict there will be a rise in both those cancers. It’s a time bomb,” she said. “Wider exposure to different sexual practices – in other words porn on the internet – is also changing sexual behaviour in teenagers.”

HPV is also the cause of genital warts, the second-most common sexually transmitted infection in the UK. There are nearly 90,000 cases annually, costing the NHS around £55m. Campaigners hope that figure will be taken into account when the JCVI weighs up the cost-effectiveness of a vaccination programme.

Despite safety concerns being raised about the vaccine’s alleged side effects in some parts of the world, including Japan, no causal links have been established between the vaccine and reported long-term health problems. It is approved by the World Health Organisation, as well as European and UK vaccine-safety authorities. Professor zur Hausen added that it was “one of the safest vaccines we have”.

8-Injection-GetRolling out the vaccine to boys would require a public-information campaign because it has previously been presented to parents and children as a girls-only jab to prevent cervical cancer (Getty)

 

A Department of Health spokesperson said: “The HPV-prevention programme is key in helping us prevent cervical cancer. We have successfully given more than a million doses in the UK since 2008.

“Our independent vaccination experts are assessing whether it should be extended to prevent cancers in adolescent boys, men who have sex with men, or both.”

Time for an update?

Parents are currently advised and asked for consent for their daughters to have the HPV vaccination through a form and information leaflet sent out via schools.

The vaccine’s preventative effects against cervical cancer and the protection it offers against genital warts are explained. The protection against other cancers is not mentioned.

Parents and children are told that the vaccine, which is now given in just two doses instead of three, protects against 70 per cent of cervical cancers and that girls will still require cervical screening tests when they are older. Newer versions of the vaccine may protect against more cases in the future.

Parents are told that the vaccine may cause “soreness, swelling and redness in the arm” that will wear off in a couple of days. The leaflet states that “more serious side effects are extremely rare” and reassures parents that it meets European and UK safety standards. However, parents have the option to deny permission for their daughters to have the jab – and are told it would be “helpful” if they gave reasons for refusal.

The leaflet is directly targeted at girls and their parents and focuses on cervical cancer. If the Government were to extend the HPV-vaccination programme to boys, they would have to reconsider how the vaccine was presented to parents and children. The current programme has had impressive uptake, possibly in part because the key reason for taking the vaccine – to prevent cervical cancer – is straightforward and well understood. It may be that in a new HPV vaccination programme, the jab could be presented more broadly as protection against “a range of cancers”.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Single Dose of HPV-16/18 Vaccine Looks to Be Sufficient

Source: www.medscape.com
Author: Jenni Laidman
 

A single dose of a vaccine against human papillomavirus (HPV) may prevent cervical cancer as effectively as the standard three-dose regimen, researchers concluded after analyzing the combined results of two large vaccine trials. The HPV vaccine in these studies was Cervarix (GlaxoSmithKline), which is effective against HPV strains 16/18.

If randomized controlled trials ultimately support the result of this post hoc analysis, it could broaden protection against cervical cancer in areas of the world where vaccination programs are hardest to administer and where cervical cancer is disproportionately burdensome, the study authors say.

“Even if you ignore the expense, the feasibility of implementing and getting back to individuals for a second and third dose is quite challenging, especially in places where there is no infrastructure,” coauthor Cosette Wheeler, PhD, Regents Professor, Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center in Albuquerque, told Medscape Medical News.

The studies are published online June 10 in the Lancet Oncology.

The possibility of a single-dose HPV vaccine is “a huge public health win,” coauthor Aimée R. Kreimer, PhD, Investigator, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, told Medscape Medical News. “Even if one dose protects only against HPV types included in the vaccine formulation, if we vaccinated most girls, we would have the chance to reduce cervical cancer by around 75%.”

That’s the exciting part, Dr Wheeler added. “If we’re able to achieve success with one dose, or frankly even with two doses, that makes the possibility for worldwide prevention much greater.”

HPV type 16 is the leading cause of cervical cancer, responsible for about 50% of all cases, and HPV 18 is the second-largest cause, at 20%.The authors note that this research was carried out with Cervarix, and it is unclear whether the results would also apply to the other HPV vaccine that is available, Gardasil (Merck & Co.), which is active against several more HPV strains and is the product that is commonly used in the United States. Whether results of this trial have any bearing on Gardasil will depend on what’s driving the strong immune response to Cervarix, the authors suggest. Cervarix carries a proprietary adjuvant, which may be responsible for the immune response.

Surprise Over Efficacy Findings

The idea of the current post hoc analysis arose from results in the large randomized controlled Costa Rica Vaccine Trial, in which about 20% of participants received fewer than three doses of HPV-16/18 vaccine. “We were surprised to observe that efficacy was the same regardless of the number of doses received,” Dr Kreimer told Medscape Medical News.

That led to the post hoc analysis of the immunization results from the Costa Rica Vaccine Trial combined with results from the only other large phase 3, double-blind, randomized trial of HPV-16/18, for a total of more than 14,000 participants, ages 15 to 25 years, including about 7000 control subjects. The second trial, called PATRICIA (Papilloma Trial Against Cancer in Young Adults), took place in 14 countries. The analysis found that 4 years after vaccination, women who received the required three vaccine doses and women who received fewer than three doses — usually due to pregnancy or a colposcopy referral — were equally protected against HPV-16/18. Further, the analysis showed a potential benefit of cross-protection against closely related HPV strains 31/35/45 among women whose two doses were 6 months apart — a benefit previously seen only with three doses.

Four-year vaccine efficacy against HPV-16/18 in the combined analysis was 77% for the 13,296 (6634 case, 6662 control) women in the three-dose group, 76% for the 549 (273 case, 276 control) women in the two-dose group, and 85.7% for the 238 (138 case, 100 control) women in the single-dose group. Efficacy against the closely related HPV-31/33/35 was 59.7% for three doses, 37.7% for two doses, and 36.6% for one dose. When data for the two doses were analyzed according to dosing regimen, the cross-protective efficacy was 10.1% for those who received their second dose 1 month after the first and 68.1% for those who received the second dose at 6 months.

Antibody concentrations for two doses given 6 months apart were very close to concentrations for three doses, the research showed. One-dose vaccination titers at 6 to 48 months were lower than those for two or three doses, “but the titers were stable and several times higher than those identified for natural immunity,” the researchers write. “We can now infer that these lower, vaccine-induced antibody titers provide as strong HPV prevention as the titers from two or three doses, at least in the short term.”

Just how long these vaccines will provide protection still needs to be determined. “We know with three doses we can see the protection going out toward 10 years, and we hope that maybe the protection is lifelong,” commented Dr Wheeler. “That does not mean that we know we will never need a booster. And that doesn’t mean if we give less than three doses that we know about the longevity or durability of that protection. So that’s another piece of the puzzle.”

Although these results cannot be applied to Gardasil, Dr Wheeler notes that studies looking at Gardisil antibody titers after two doses look promising.

In an accompanying comment, Julia M.L. Brotherton, Medical Director, National HPV Vaccination Program Register, VCS Registries, East Melbourne, Victoria, Australia, commented: “These data suggest that one dose of bivalent HPV vaccine might be adequate to protect against HPV-16 and HPV-18 persistent infections and, therefore, probably disease. HPV-16 and HPV-18 cause more than 70% of cervical cancers and the vast majority of HPV-related cancers at other anatomic sites. If this finding is confirmed, it opens up a great opportunity to extend the reach of protection using HPV vaccines to more people than we would have previously thought possible.”

Four authors of the study are GSK employees and own shares and stock options in the company. Other researchers had financial or advisory relationships GSK, Roche Molecular Systems, Merck, and Sanofi Pasteur MSD. Dr Brotherton notes that she has been an investigator for investigator-initiated HPV epidemiology research grants partially funded by bioCSL/Merck, but this did not involve financial compensation.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

The Beginning of the End: Vaccine Prevention of HPV-Driven Cancers

Source: JNCI – Journal of the National Cancer Institute

Anna R. Giuliano, Aimée R. Kreimer and Silvia de Sanjose
+ Author Affiliations

Affiliations of authors: Center for Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (ARG); Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (ARK); Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Spain (SdS); CIBER Epidemiologia y Salut Pública, Barcelona, Spain (SdS). Correspondence to: Anna R. Giuliano, PhD, Professor and Director, Center for Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, MRC-CAN CONT, 12902 Magnolia Drive, Tampa, FL 33612 (e-mail: anna.giuliano@moffitt.org).
In this issue of the Journal, Saraiya and coauthors present an important analysis of human papillomavirus (HPV) detection in tumors retrieved from select US sites prior to HPV vaccine implementation (2006) (1). Not only are these data necessary to evaluate future vaccine effectiveness in reducing cancers caused by HPV infection, but they will also aid in the growing assessment of the worldwide burden of tumors attributable to HPV infection. These data raise the question: How many cases of cancer can be prevented by HPV vaccination in the United States?

Twenty years ago, in 1995, the World Health Organization recognized for the first time that HPV 16 is the cause of cervical cancer. In 2005, 10 years after this report, there was sufficient accumulated evidence to state that HPV 16 is also the cause of multiple cancers in men and women, and that HPV 16 is only one of 13–15 HPV types deemed “high-risk” types that cause cervical cancer (2,3). Growing evidence that HPV causes cancers, combined with the technology to develop efficacious vaccines against DNA viruses (4), simultaneously led to vaccine development. This was followed by demonstration of vaccine efficacy in women and men (5–8) and, ultimately, licensure of multiple vaccines that protect against HPV infection acquisition and prevention of the lesions these viruses cause (9–11). The recent licensure in the United States of Gardasil 9 presents an opportunity to further expand vaccine protection to prevent 90% of all cervical cancers worldwide (12,13).

While there has been tremendous progress in the prevention of cervical cancer through screening of adult women in high-resource countries and, recently, prevention of cervical precancer with vaccination (14), less progress has been made in the prevention of HPV-related cancers in men, cancers for which screening interventions are not routinely available. Despite clear evidence that HPV causes cancer at the oropharynx, that HPV-related oropharyngeal cancers (OPC) disproportionately affect men, and that OPC incidence is increasing in the United States, there have been no trials conducted to assess the efficacy of HPV vaccines to prevent these cancers. There is preliminary evidence of prophylactic HPV vaccine efficacy against prevalent oral HPV16/18 infections in women (15); however, it remains unknown what proportion of HPV-related OPC can be prevented with broad dissemination of HPV vaccines to males. Moreover, it remains unclear what proportion of OPC that have HPV DNA present are truly attributable to HPV.

Using HPV DNA-based detection to ascribe causality to tumors at different anatomic sites requires caution. There is strong evidence that HPV infection causes all cervical cancers and that DNA detection correlates well with markers of viral activity; thus, the use of DNA detection alone may be well justified at the cervix. However, for noncervical sites, particularly in the head and neck, HPV DNA-based detection methods overestimate the HPV attributable proportion. Identification of viral DNA in the tumor can occur if there is simply a transitory infection (not causal), as well as in cases where HPV is causally involved in the development of the tumor (transcriptionally active). Thus, identification of viral transcripts of the E6/E7 oncogenes by detection of the related mRNA and downstream markers, such as p16INK4a expression, is an approach utilized to ascertain whether HPV is causally involved in the development of the tumor. As an example, a recent meta-analysis of the attributable fraction of HPV in head and neck squamous cell carcinomas showed that HPV DNA was detected in 46% of OPC, 22% of laryngeal cancers, and 24% of oral cavity cancers. When E6/E7 mRNA and p16INK4a status were assessed in these same tumors, the proportion caused by HPV infection was similar for OPC (40%) but overestimated for laryngeal (9%) and oral cavity cancer (16%). Thus, in the current analysis (1), in which 70% of OPC, 21% of laryngeal cancers, and 32% of oral cavity cancers were HPV DNA–positive, it is possible that the HPV attributable fractions for oral cavity and laryngeal cancers were overestimated by two- to three-fold, respectively. Given the documented increases in the proportion of OPC tumors attributable to HPV over the past several decades, the absolute number of cases due to HPV should not be viewed as static; future estimates of the HPV-related OPC burden may be affected by changes in the underlying causes of these cancers, including smoking prevalence and HPV, especially as vaccination dissemination increases. Similar data on the importance of using measures of viral activity to determine HPV causality for noncervical anogenital tumors (penile, vulvar, vaginal, anal) are currently unavailable but will be critical in determining whether HPV DNA detection is sufficient to determine causality (as at the cervix) or whether markers of viral activity should also be utilized (as at the larynx and oral cavity).

Most cancer registries do not have access to molecular data to classify HPV infection status and therefore rely on anatomic site and histology to estimate HPV-related cancer incidence and case counts. In a best-case scenario, such as reported by Saraiya et al., registries have access to discarded samples that enable molecular analysis of tumors. For the purposes of monitoring HPV vaccine impact, these data allow surveillance of HPV-related tumor burden reduction in the post-HPV vaccination era. However, studies aiming to determine the true attributable proportion of HPV in cancers outside the cervix should assess causality with laboratory measures that capture viral activity.

The proportion of HPV-driven cancers that can be prevented with HPV vaccination differs by world region. The United States, like other high-resource countries with organized cervical cancer screening programs, has a low invasive cervical cancer rate but higher rates of noncervical cancers, particularly OPC in men. In contrast, in countries that have not yet benefited from cervical cancer screening programs or tobacco control policies, cervical cancer incidence is higher and HPV-related OPC incidence lower. In the last decade, OPC incidence increased in many economically developed countries as smoking prevalence decreased (16,17). Data reported in this issue indicate that approximately 60% to 70% of OPCs are caused by HPV infection in the United States (1), contrasting with data reported from less economically developed regions where less than 10% of tumors are HPV-positive (18–20). In a comprehensive review of the global burden of infection-associated cancers, de Martel et al. estimated that HPV infection accounts for 38% to 56% of OPC in Australia, Japan, North America, and Northern and Western Europe, compared with only 13% to 17% of OPC in other parts of the world (21). The proportion of OPC attributed to HPV may be even lower in certain African countries (19).

Regardless of how precisely we define the total number of cases due to HPV, vaccination against HPV has the potential to prevent multiple cancers in men and women, cancers for which we have no evidence-based prevention modalities, except in the case of cervical cancer. The data presented by Saraiya and coauthors estimate the number of cancers in the United States we can expect to prevent in the era of HPV vaccination. However, until we reach the national goal of 80% of men and women fully vaccinated against HPV (22), the prevention of multiple cancers with a relatively simple intervention will remain a dream. Providers are the key to implementing the national vaccine recommendations, ensuring this dream becomes a reality. Strong messages from providers to vaccinate age-eligible men and women can move the United States from among the lowest rates of HPV vaccination to the highest, with reductions in the national cancer burden to follow sooner rather than later.

HPV Vaccine Linked to Less-Risky Behavior

Source: torontosun.com
Author: Roxanne Nelson, Reuters
 

Contrary to concerns that getting vaccinated against human papilloma virus (HPV) will lead young people to have more or riskier sex, a new study in England finds less risky behaviour among young women who got the HPV vaccine.

“To my knowledge no studies have shown that HPV vaccination increases risky sexual behavior among young women and some of these studies have shown this (less risky behaviour) is also the case outside of the UK,” said Dr. Laura Sadler of the University of Manchester, who led the study.

It’s possible that getting vaccinated led to better education about sexual health, Sadler and her colleagues write in the Journal of Family Planning and Reproductive Health Care.

Sadler and other experts say it’s also possible that young women who are already less likely to take risks are the ones who are more likely to get vaccinated.

HPV is one of the most common sexually transmitted infections and causes the majority of cervical cancers. The virus has also been linked to anal and throat cancers. Two vaccines, Cervarix and Gardasil, are now available that protect against strains of HPV that cause most cervical cancers.

Even though public health officials recommend that girls and young women be vaccinated against HPV, some parents have hesitated, fearing that it could encourage sexual activity or unsafe sex.

For their study, Sadler’s team reviewed the medical records of 363 women born in 1990 or later who attended an English clinic. Almost two-thirds of the young women in the group had received at least one dose of the vaccine. Full vaccination requires three vaccine shots.

The researchers compared the womens’ histories of behaviours that are risky in themselves or tend to be linked to risky sexual behaviour, such as not using condoms, having sex for the first time when they were 15 or younger, having six or more sexual partners and drinking alcohol two or more times a week.

They found five variables related to sexual behaviour that were significantly different between women who had been vaccinated and those who hadn’t.

Women who were not vaccinated were more likely to have had three sex partners in the last six months, to have attended the clinic with symptoms of a sexually transmitted disease, to have had anal intercourse with their last sexual contact and to have tested positive for Chlamydia (a common sexually transmitted infection) at their clinic visit.

Being vaccinated, in contrast, was associated with less-risky behaviours, such as using condoms.

“In this study, the lower prevalence of some risk outcomes among vaccinated women relative to unvaccinated women may be related to underlying differences in preventive care seeking and preventive health behaviors,” said Robert A. Bednarczyk, an assistant professor at the Rollins School of Public Health at Emory University, and who was not involved in the study.

“The women in our study were mainly from the catch-up vaccine program – older teens – and as in the other studies, it shows that among this group, vaccination was taken up by those demonstrating other types of preventive or less risky behaviors,” Sadler told Reuters Health by email.

While the findings are encouraging, and consistent with other research demonstrating that HPV vaccination does not lead to riskier behaviors, the study does not demonstrate that vaccination causes less risky behaviors, said Dr. Jessica Kahn, a professor of pediatrics at Cincinnati Children’s Hospital Medical Center.

“One explanation for the findings is that girls who are vaccinated receive education about sexual health and prevention which decreases riskier behaviors,” Kahn said in an email.

Another explanation is that girls who practice healthier and less risky behaviors are more likely to receive the vaccine, she noted. “Preventive health behaviors tend to cluster, so it makes sense that girls who practice safer behaviors are more likely to be vaccinated.”

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
February, 2015|Oral Cancer News|

Researchers discover genetic fingerprint of HPV virus in some head and neck cancers

Author: Staff
Source: cancerreasearchuk.org

A large US study(link is external) has pinpointed genetic errors that mark out head and neck cancers caused by the human papillomavirus (HPV).

If confirmed in further studies this could be used to develop potential new treatments.

Head and neck cancers include tumours of the throat, mouth, nasal cavity, larynx, salivary gland among other tissues and organs.

Some are linked to tobacco or alcohol use, while others are caused by infection with HPV, more commonly associated with no deposit casino bonuses cervical cancers.

Rates of HPV-linked head and neck cancers are on the increase.

The US study, published in the journal Nature, was carried out as part of The Cancer Genome Atla (TCGA) project.

Using cutting-edge DNA analysis, the team found several similarities between the DNA from head and neck tumour cells and other cancer types – as well as new subtypes of smoking-related head and neck cancer.

The US team studied samples from 279 head and neck squamous cell carcinomas (HNSCC) from untreated patients, around eight in 10 of whom were smokers. Most of the samples were oral cavity cancers and larynx cancers (61 per cent and 26 per cent respectively).

The researchers found that specific alterations in genes called FGFR3 and PIK3CA – which produce important protein molecules that help cells grow – were common in many patients with HPV-related cancers.

These genes are also present in a wider set of faults found in smoking-related tumours.

But faults in the epidermal growth factor receptor (EGFR) gene, which produces another important growth molecule, were rare among HPV-positive cancers, despite being frequently altered in HPV-negative tumours.

Similarities between the DNA of head and neck tumours cells and other cancers – including squamous cell lung cancer, and cervical cancer – were also found, suggesting there may be common paths of cancer development – and potentially treatment.

Calling the study “important”, Professor Nick Coleman – a Cancer Research UK expert in HPV and cancer – went on to say: “It greatly improves our understanding of the biology of head and neck cancer, pinpointing crucial genetic differences between those tumours caused by HPV infection, and others linked with risk factors like smoking.

“HPV-linked head and neck cancers are becoming more common, and this study suggests that the virus may trigger a small number of genetic faults that are causing the disease. This opens up important new avenues of research, with the possibility of developing treatments targeted to these faults to help tackle head and neck cancer in the future.”

Director of the National Human Genome Research Institute in the US, Dr Eric Green, said that the new findings “help establish a genomic map of various head and neck cancers, provide new insights into other similar cancers and may further our understanding of how viruses can impact disease.”

For more information: http://www.nih.gov/news/health/jan2015/nhgri-28.htm

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
January, 2015|Oral Cancer News|

Doctors Trying To Remind Americans That The HPV Vaccine Isn’t All About Sex

Source: thinkprogress.org
Author: Tara Culp-Ressler

 

Dr. Ronald A. DePinho is on a mission.

 
DePinho, who’s been a cancer researcher for decades and currently serves as the president of the University of Texas MD Anderson Cancer Center, wants to reframe the national conversation about the HPV vaccine to drive home a fundamental point.

 
“It’s important to appreciate that this is a cancer vaccine. A cancer vaccine!” DePinho said in an interview with ThinkProgress. “It’s a dream come true that we’ve converted knowledge into something that can actually save lives and avoid getting cancer in the first place. It’s really what we have been hoping for, and now we have it.”
Since the introduction of the HPV vaccine in 2006, the rate of human papillomavirus in teenage girls has plummeted. And the research in this field continues to advance. On Thursday, the Food and Drug Administration approved an updated version of the Gardasil vaccine that protects against nine strains of the cancer-causing virus — more than twice as many as the 2006 version, which covered just four strains.

 
According to DePinho, that’s a really significant advance for cancer care. He doesn’t want it to get lost in the ongoing controversy about HPV vaccination, a round of shots that some parents still worry is unsafe or inappropriate for their kids.
There’s a persistent myth, for instance, that giving teen girls the shots will spur them to become more “promiscuous” because they know they’ll be protected from a sexually transmitted infection. Large scientific studies have debunked the notion that there’s any link between the HPV vaccine and sexual activity, but inoculation rates still lag behind in some of the Southern states that are wary to provide teens with preventative tools to protect their sexual health.
In general, HPV vaccination rates in the U.S. are still much too low, hovering around 30 percent. Public health professionals are aiming to increase those rates dramatically, to at least 80 percent — closer to the percentage of people who get vaccinated against the virus in other developed countries.

 
To accomplish that, the health professionals who have dedicated their lives to treating HPV-related cancers want to move the conversation away from sexuality altogether. Instead of framing Gardasil as vaccine that protects against an STD — which might give some Americans the impression that they don’t need to worry about it — they want to present it as a vaccine that protects against cancer.

 
“It doesn’t seem like it makes sense to see it in terms of a vaccine for a sexually transmitted disease necessarily,” Dr. Erich Sturgis, an expert in head and throat cancer who works as the program director for the MD Anderson Oropharynx Program, said in an interview with ThinkProgress. “Most of us will have an HPV infection at some point in our lifetime and we’ll never know it.”
Nearly all sexually active Americans get HPV at some point in their lives, according to the Centers for Disease Control and Prevention. An estimated 80 percent of people are infected at some point, and most never realize it because the infection resolves itself on its own. But certain strains of the virus go on to cause cervical, vulvar, anal, penile, and oropharyngeal cancers.

 
Without the HPV vaccine, men in particular are put at risk of developing neck and throat cancers. Unlike cervical cancers, which can be detected with regular Pap smears, there’s no way to screen men.

 

Sturgis treats mostly middle aged male patients, and he estimated that about 60 percent of the cancers he deals with are caused by HPV. He said it’s important to increase the rates of vaccination among both girls and boys because it will be another 30 to 40 years before today’s kids hit the point when these type of throat cancers may start displaying themselves.
“To let your kids potentially suffer later in life is just a tragedy. That’s really the message here,” he said.

 
Both cancer doctors are optimistic that once more parents are educated about what’s at stake, they’ll start vaccinating their kids at higher rates. There’s a big information gap — one recent study found that 70 percent of U.S. adults didn’t realize the HPV vaccine has any connection to cancer whatsoever — that they believe can be corrected with more investment from primary care doctors who are on the front lines of recommending the shots.

 
“It’s really about empowering parents and health care professionals, and making them recognize that this is a childcare responsibility and a priority for all of us,” DePinho said. “It begins with interviews like this and just having the media getting this information out there.”

 
“Doctors are probably not as good at messaging to the public as we could be. We need some help,” Sturgis agreed.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
December, 2014|Oral Cancer News|