Source: Examiner.com
Author: Charles Simmins


An editorial in the British Medical Journal on March 25 links the increasing incidence of oropharyngeal squamous cell carcinoma to infections by human papillomavirus (HPV) that patients caught through oral sex. HPV infection is known to be related to cancers of the cervix, as well as vulvar, vaginal, and male anal cancers.

The United States has seen a 22% increase in this oral cancer from 1999 to 2006 and the United Kingdom a 51% increase from 1989 to 2006. The editorial reports that biopsies of these cancers in the United States are showing a 50% to 100% increase in HPV findings over a decade.

The authors point to recent studies that show the risks of developing oropharyngeal carcinoma are increased in those patients with six or more lifetime sexual partners, four or more lifetime oral sex partners and, for men, an earlier age at first sexual intercourse. The implications of these findings suggest reconsideration of some basic healthcare issues.

In an e-mail exchange with William Bonnez, M.D., Associate Professor of Medicine at the University of Rochester, he pointed out that no screening tools exist for HPV related cancers other than the Pap smear for cervical cancer. The authors of the editorial report that HPV oropharyngeal squamous cell carcinoma appears to have a more favorable prognosis than the non-HPV variety, and that those affected are usually younger. They point out that this means the patients will be dealing with the illness and its effects for a longer period of time.

Dr. Bonnez is a co-inventor of the HPV vaccine, now available under the brand names Gardasil(Merck Inc.) and Cervarix (GSK Inc.). These are his remarks concerning the use of the vaccine:

We already know that these vaccines are extremely effective at preventing the precursor alterations caused by HPV-16 and -18 that lead to cervical cancer. Moreover, Gardasil has been effective preventing the precursors of vulvar, vaginal, and male anal cancers.

Although we do not have yet the clinical studies demonstrating that HPV vaccination would be effective preventing oropharyngeal cancer related to HPV (95% of which are caused by HPV-16 or 18), it is very sensible to expect success here as well. Scrutiny is on-going, but to date no unusual serious adverse effects have been attributed to HPV vaccination. Therefore, costs remain the primary obstacle to vaccinating males against HPV. Gardasil, which in addition to HPV-16 and -18 offers protection against types 6 and 11, the cause of most genital warts, has received a male indication by the US Food and Drug Administration in October 2009.

The authors of the editorial suggest that use of the HPV vaccine be re-evaluated in young men, given the rise in these HPV related cancers. Dr. Bonnez told me:

Cost-effectiveness analyses, reevaluated in light of the rapidly changing epidemiology of oropharyngeal cancer may eventually make the case for routine HPV immunization of young male adolescents.

Many public health agencies have recommended the vaccine as routine for young women before their first sexual experience. The opponents point to the cost of the vaccine, and the fact that most HPV infections resolve themselves without any complication. At this point in time, very few authorities would suggest routine vaccination of young men.

Dr. Bonnez is correct to point out that the changing epidemiology of oropharyngeal cancer means that the routine use of HPV vaccine should be re-evaluated as necessary when the medical studies are completed regarding HPV and oropharyngeal cancer. The costs of diagnosis and treatment for HPV related oral cancers may suggest a health benefit in vaccinating both sexes.

The Centers for Disease Control offers this information: Genital HPV Infection – CDC Fact Sheet. The National Cancer Institute offers this: Human Papillomaviruses and Cancer: Questions and Answers.

Note: Dr. Bonnez declares owning intellectual property on the HPV vaccines and receiving a portion of the vaccine royalties paid to the University of Rochester.