HPV

Despite only a 50% HPV vaccination rate in adolescents, cervical precancer incidence rates drop

Source: www.targetedonc.com
Author: Tony Berberabe, MPH

Although a vaccine for the human papillomavirus (HPV) is widely available, an average of 34,800 HPV-associated cancers attributable to the virus, including cervical, vaginal, vulva, penile, anal, and oropharynx were reported in the United States from 2012 through 2016, according to data published in Morbidity and Mortality Weekly Report.1 The estimated number of cancers attributable to HPV types targeted by the 9-valent HPV vaccine (9vHPV) is also rising. These recent increases are due in part to an aging and growing population and increases in oropharyngeal, anal, and vulvar cancers, lead author Virginia Senkomago, PhD, MPH, an epidemiologist and senior service fellow at the Centers for Disease Control and Prevention in Atlanta, Georgia, said in an email.

Although HPV vaccination is an important component of cancer prevention, only about 50% of adolescents have received the vaccine. Of cancer cases attributable to the HPV types targeted by the vaccine, 19,000 (59%) occurred in female patients and 13,100 (41%) occurred in male patients.

But there is some good news.

Senkomago said HPV infections and cervical precancers have dropped significantly since the vaccine was introduced. Infections with HPV types have dropped 86% among teenage girls. Among vaccinated women aged 20 to 24 years, the percentage of cervical precancers caused by the HPV types most often linked to cervical cancer dropped by 40%. The vaccination is recommended through age 26 for all individuals, especially for those who were not vaccinated when they were younger. The vaccine is not recommended for individuals older than 26 years, but some adults between 27 and 45 years may decide to get the HPV vaccine based on a discussion with their clinician. HPV vaccination provides less benefit to adults in this age range, as more have already been exposed to HPV, said Senkomago.

Further, it is anticipated that compliance should increase because the original 3 doses every 2 months now seems to be getting replaced by 2 doses with similar efficacy rates.

Previous annual estimates of cancers attributable to the types targeted by 9vHPV were 28,500 (2008-2012),2 30,000 (2010-2014),3 and 31,200 (2011-2015).4

“HPV is a distinct subset of head and neck cancers. It now exceeds cervical cancer as a major health burden in the [United States] because, in part, there’s no effective screening strategy,” said Robert L. Ferris, MD, PhD, director of the University of Pittsburgh Medical Center’s Hillman Cancer Center in Pittsburgh, Pennsylvania, and co–physician editor in chief of Targeted Therapies in Oncology. A number of challenges exist in the treatment of patients with HPV-positive head and neck cancer, Ferris said. These include lack of a screening tool and relatively low adherence to vaccination. The disease also has a long latency period,5 adding to the difficulty in treatment.

“These patients don’t have traditional risk factors,” Ferris continued. “They may just present to their doctor with a lump in the neck area with very few symptoms. They usually have no history of tobacco use or exposure history, so they can be overlooked for weeks and months before a needle biopsy is ordered. Needle biopsy can be diagnostic.”

Of the 32,100 HPV cancer types, those with the highest incidence were oropharyngeal and the lowest was vaginal (FIGURE 1), the report said.1

“We are striving to vaccinate as many people as possible. Right now our goals are identifying groups with the lower rates, such as people who live in rural areas, and working to remove unique barriers to vaccination they may face,” Senkomago said.

Senkomago added that the most surprising finding was that oropharyngeal cancer was the most common cancer attributable to HPV types targeted by 9vHPV in most states, except in Texas, where cervical cancer was most common, and in Alaska, New Mexico, New York, and Washington DC, where estimates of oropharyngeal and cervical cancers attributable to the 9vHPV-targeted types were the same (FIGURE 2).1

In particular, Senkomago said, these findings can inform community oncologists of the burden of HPV-associated cancers, especially in light of the increase of cases of oropharyngeal, anal, and vulvar cancers. Increasing awareness of the burden of the 7 HPV-associated cancers, individually and as a group, is a powerful prevention tool. Oncologists can advocate for strategies such as screening and HPV vaccination. In addition, community oncologists can work together with cancer survivors to engage communities to vaccinate and get screened as appropriate, she said.

Ferris cautioned against changing treatment algorithms too soon, especially before prospective clinical trials result are fully analyzed. “We need specific clinical trials before we can reduce the intensity of therapy because we don’t want to impair the very good survival, which can be 80% to 90%, in these patients and put that at risk,” he said. “We don’t want to jeopardize that strong survival rate. Those prospective clinical trials are ongoing, and those results should be reported out intensively in 2020, 2021, and beyond.”

Although the report focused on only the 9vHPV vaccine, a quadrivalent vaccine is also available. Investigators are evaluating whether any shift in the subtypes of HPV that cause cervical or head and neck cancer has been detected with the implementation of the quadrivalent vaccine. Senkomago said scientists continue to evaluate HPV types before and after vaccine introduction in population-based studies. To date, they have not found any evidence that type replacement is occurring.6

References:
1. Senkomago V, Henley J, Thomas CC, Mix JM, Markowitz LE, Saraiya M. Human papillomavirus—attributable cancers—United States, 2012-2016. MMWR Morb Mortal Wkly Rep. 2019;68(33):724-728. doi: 10.15585/mmwr.mm6833a3.
2. Viens LJ, Henley SJ, Watson M, et al. Human papillomavirus–associated cancers — United States, 2008–2012. MMWR Morb Mortal Wkly Rep. 2016;65(26):661-666. doi: 10.15585/mmwr.mm6526a1
3. Cancers associated with human papillomavirus, United States—2010–2014. Centers for Disease Control and Prevention website. cdc.gov/cancer/uscs/about/data-briefs/no1-hpv-assoc-cancers-UnitedStates-2010-2014.htm. Accessed September 12, 2019.
4. Cancers associated with human papillomavirus, United States—2011–2015. Centers for Disease Control and Prevention website. cdc.gov/cancer/uscs/about/data-briefs/no4-hpv-assoc-cancers-UnitedStates-2011-2015.htm. Accessed September 12, 2019.
5. Human papillomavirus (HPV). Centers for Disease Control and Prevention website. cdc.gov/hpv/parents/cancer.html. Accessed September 10, 2019.
6. Mesher D, Soldan K, Lehtinen M, et al. Population-level effects of human papillomavirus vaccination programs on infections with nonvaccine genotypes. Emerg Infect Dis. 2016;22(10):1732-1740. doi: 10.3201/eid2210.160675.

November, 2019|Oral Cancer News|

Oral sex blamed for rise of mouth cancer in UK

Source: www.medicaldaily.com
Author: Darwin Malicdem

The number of people diagnosed with mouth cancer has significantly increased by 135 percent over the past 20 years in the United Kingdom. Experts believe the increase comes amid the growing number of Brits engaging in oral sex.

Nonprofit Oral Health Foundation (OHF) issued a report showing oral cancer rates “have more than doubled in a generation” across the U.K. In 2018 alone, seven people died every day from the disease in Great Britain and Northern Ireland.

“While most cancers are on the decrease, cases of mouth cancer continue to rise at an alarming rate,” Nigel Carter, chief executive of the OHF, told the Daily Mail. “It changes how somebody speaks, it makes eating and drinking more difficult, and often changes a person’s physical appearance.”

The foundation said the sexually transmitted human papillomavirus (HPV) caused 73 percent of the oropharyngeal mouth cancers. But drinking alcohol also contributed to the higher rates of the disease in the U.K.

OHF said 33 percent of mouth cancer diagnoses over the past decades were linked to consumption of alcoholic beverages. Smoking was associated with 17 percent of the cases.

The foundation launched Mouth Cancer Action Month in early November that aims to spread awareness of mouth cancer and its signs and symptoms.

“We want everyone to be more mouth aware during this year’s campaign,” Carter said in a press release. “This means being able to identify the signs and symptoms of mouth cancer, understand what is more likely to put us at greater risk, and importantly, know where to go if you spot anything out of the ordinary.”

He added early diagnosis has been effective to prevent deaths in the past years. Philip Lewis, of the Mouth Cancer Foundation, also highlighted that public awareness programs and self examination would help address the health issue.

In the U.S., the number of mouth cancer is also increasing. The Oral Cancer Foundation reported that nearly 54,000 Americans are being diagnosed with the disease every year.

Mouth cancer kills one person per hour in the country, leading to 13,500 deaths every year.

November, 2019|Oral Cancer News|

Health department official on HPV vaccine: “What are we waiting for?”

Source: www.mynews13.com
Author: Rebecca Turco

Despite studies from the CDC showing the effectiveness of the HPV vaccine at preventing certain types of cancer, some parents are still hesitant to get their children vaccinated.

  • 92% of almost 35,000 cancers could be prevented by vaccine
  • Doctor: Some parents may think vaccine promotes sexual behavior
  • County Health Departments offer HPV vaccine for free

Dr. Raul Pino, the interim administrator of the Orange County Health Department, wants to change that.

Among the estimated 34,800 cancers probably caused by the human papilloma virus between 2012 and 2016, an estimated 92% could be prevented by the vaccine, according to the Centers for Disease Control and Prevention.

“We have a vaccine that prevents some type of cancers, and now we’re questioning if we should take the vaccine,” he said. “It will not only prevent penile cancer or vaginal cancer or cervical cancer, but also oral, esophagus and tonsils.

“So what are we waiting for?”

Pino thinks some parents might be hesitant because of the widely spread, but disproven, belief that vaccines are linked to autism. Then, there are other parents who think giving their child the vaccine is promoting sexual behavior. HPV is the most common sexually transmitted infection.

“The reality is, I think what the parents have to present to themselves in this debate, is what is the paramount objective here?” Pino said. “Is the paramount objective to offer protection to the individual, or is the paramount objective to prevent the behavior?”

Officials recommended that children receive the multi-dose HPV vaccine years before becoming sexually active, anywhere from 9 to 12 years old. A little more than half of teens, 51 percent, received all recommended doses of the vaccine last year, according to the CDC.

The HPV vaccine is not a required immunization for students in Florida. County health departments offer the vaccine for free.

October, 2019|Oral Cancer News|

Does HPV vaccine reduce HIV-positive men oral cancer risks?

Source: www.precisionvaccinations.com
Author: Don Ward Hackett, Fact checked by Robert Carlson, MD & Danielle Reiter, RN

Does the HPV vaccine protect against oral infections?

That’s the question a new National Cancer Institutes (NCI) funded clinical trial of the Gardasil 9 vaccine hopes to answer.

This extensive study will determine whether the Gardasil 9 vaccine can prevent persistent oral HPV infections among men who are Human Immunodeficiency Virus (HIV) positive, said the NCI online on October 8, 2019.

Oral HPV infections and HPV-related oral cancers are common in men and among HIV-positive individuals.

Gardasil 9 is the most recent formulation of the Human Papolivirus (HPV) vaccine, which covers 5 additional cancer-causing HPV types. There are over 100 types of HPV.

“We are hoping that if we show the efficacy of the vaccine, that vaccinating both males and females will ultimately reverse” the rising incidence of HPV-related oropharyngeal cancers, said one of the trial’s lead investigators, Anna Giuliano, Ph.D., of Moffitt Cancer Center.

The trial is one of several within the US–Latin American–Caribbean Clinical Trials Network (ULACNet), an NCI-led effort to reduce the burden of HPV-related cancers in HIV-positive individuals.

This new study intends to build relevant insights upon a June 2017 study found that vaccination against HPV may sharply reduce oral HPV infections that are a major risk factor for oropharyngeal cancer, a type of head and neck cancer, says the NCI.

The 2017 study found that the prevalence of oral infection with 4 HPV types, including two high-risk, or cancer-causing, types, was 88 percent lower in those who reported receiving at least 1-dose of an HPV vaccine, than in those who said they were not vaccinated.

The ULACNet international collaborative research network brings together institutions in the United States and counterparts in low- and middle-income countries (LMICs) in the Latin American and the Caribbean (LAC) region.

Funded in Fall 2019 via a U54 Partnership Centers Cooperative Agreement mechanism, ULACNet comprises of 3 Partnership Centers, each collaboratively conducting a multidisciplinary Clinical Trials Program supported via an infrastructure of an Administrative and Coordinating Core, a Data Management and Statistical Core, and a Central Laboratory Core.

ULACNet investigators collaborate with the NCI to design and conduct clinical trials on three key scientific areas across the continuum of prevention interventions for HPV-related cancers in people living with HIV, including:

  • optimizing dosing and delivery and evaluating new indications for HPV prophylactic vaccines
  • evaluating new biomarkers and technologies for improving the accuracy of cervical and anogenital cancer screening and triage
  • evaluating novel non-excisional treatments for HPV-related precancerous lesions

Outcomes of ULACNet clinical trials are expected to influence the development of clinical practice guidelines to improve preventive clinical care and reduce the burden of highly preventable HPV-related cancers in people living with HIV.

The three ULACNet Partnership Centers include the following collaborations between institutions in the United States and partners in Mexico, Puerto Rico, Brazil, Peru, and the Dominican Republic:

  • University of California, San Francisco (UCSF) in San Francisco, CA (PI: Joel Palefsky, MD) in partnership with University of Puerto Rico in San Juan, Puerto Rico (PI: Anna Patricia Ortiz, PhD, MPH) and National Institute of Public Health (INSP) in Cuernavaca, Morelos, Mexico (PI: Jorge Salmeron, MD, DSc)
  • Weill Medical College of Cornell University in New York, NY (PI: Timothy Wilkin, MD, MS) in partnership with Moffitt Cancer Center, in Tampa, FL (PI: Anna Giuliano, PhD, MPH), University of Sao Paulo in Sao Paulo, Brazil (PI: Luisa Villa, PhD), National Institute of Public Health (INSP) in Cuernavaca, Morelos, Mexico (PI: Eduardo Lazcano-Ponce, MD, PhD), and the University of Puerto Rico in San Juan, Puerto Rico (PI: Jorge Santana-Bagur, MD)
  • Fred Hutchinson Cancer Research Center in Seattle, WA (PIs: Margaret Madeleine, PhD, MPH, and Ann Duerr, MD, PhD) in partnership with Asociacion Civil Via Libre in Lima, Peru (PI: Robinson Cabello, MD), National Institute of Infectious Diseases Evandro Chagas-Oswaldo Cruz Foundation (FIOCRUZ) in Rio de Janeiro, Brazil (PI: Beatriz Grinsztejn, MD, PhD), PATH in Seattle, WA (PI: Silvia de Sanjose, MD, PhD), and Instituto Dermatologico Dominicano y Cirugia de Piel (IDCP) in Santo Domingo, Dominican Republic (PI: Yeycy Donastorg, MD).

For more information about this important clinical trial, please contact the ULACNet Program Director is Vikrant Sahasrabuddhe, MBBS, DrPH in the NCI Division of Cancer Prevention.

References:
US-Latin American-Caribbean Clinical Trials Network (ULACNet) for Prevention of HPV-related Cancers in People Living with HIV
HPV Vaccine May Provide Men with “Herd Immunity” against Oral HPV Infections
HPV Vaccination Linked to Decreased Oral HPV Infections
HPV-Related Cancer Prevention and Control Programs at Community-Based HIV/AIDS Service Organizations: Implications for Future

October, 2019|Oral Cancer News|

Prevalence of Oral HPV Infection Declines in Unvaccinated Individuals

Source: Infectious Disease Advisor
Date: September 30th, 2019
Author: Zahra Masoud

Oral human papillomavirus (HPV) prevalence has decreased in unvaccinated men, possibly as a result of herd protection, but the incidence of such infection has remained unchanged in unvaccinated women from 2009 to 2016 in the United States, according to a study published in the Journal of the American Medical Association.

Since 2011 for women and 2006 for men, prophylactic HPV vaccination for prevention of anogenital HPV infection has been recommended for routine use in the United States. Previous studies have demonstrated that this vaccine has high efficacy in reducing the prevalence of oral HPV infection. However, the vaccine is not indicated to prevent oral HPV infection or oropharyngeal cancers because there are few results from randomized trials. Further, there has been a lack of surveillance studies reporting on herd protection against oral HPV infection, which is defined as a form of indirect protection from infectious diseases that occurs when a large percentage of the population has become immune/vaccinated, thereby providing protection for individuals who are not immune/not vaccinated. Therefore, this study investigated evidence for herd protection against oral HPV infection in unvaccinated men and women in the United States using temporal comparisons of oral HPV prevalence for 4 vaccine types and 33 non-vaccine types.

This study was conducted across 4 cycles (from 2009 to 2016) of the National Health and Nutrition Examination Survey (NHANES), using a cross-sectional, stratified, multistage probability sample of the civilian population in the United States. For the examination component, response rates were 68.5% in the 2009 to 2010 period, 69.5% in the 2011 to 2012 period, 68.5% in 2013 to 2014, and 58.7% in 2015 to 2016. In total, 13,676 participants were included, which represented 174,333,042 individuals in the US population aged 18 to 59 years. The 4 vaccine-type oral HPV were HPV-16, -18, -6, and -11. DNA was collected from oral rinses and was evaluated using PGMY09/11 polymerase chain reaction and linear array genotyping for 37 types of HPV presence. In unvaccinated individuals, sex-stratified analyses were performed along with multivariable logistic regression analyses adjusted for other variables.

From 2009 to 2016, HPV vaccination rates increased from 0% to 5.8% in men and from 7.3% to 15.1% in women. From 2009 to 2010 to 2015 to 2016, vaccine-type oral HPV prevalence declined from 2.7% to 1.6% (P =.009) in unvaccinated men; however, this decline was not heterogenous by age (P =.41 for interaction). During this period, non-vaccine-type oral HPV prevalence remained unchanged (P =.66) among unvaccinated men. From 2009 to 2010 to 2015 to 2016 in unvaccinated women, both vaccine-type and non-vaccine-type oral HPV prevalence remained unchanged (P =.79 and P =.58, respectively).

The 37% decline in vaccine-type oral HPV among unvaccinated men from 2009 to 2016 suggests herd protection against oral HPV infections. This herd protection may arise from the increased rate of HPV vaccination among women and is consistent with herd protection studies against genital HPV infections in unvaccinated women in the United States. The unchanged prevalence of oral HPV among unvaccinated women from 2009 to 2016 does not suggest herd protection; this may reflect low statistical power because of a low prevalence in women.

Overall, the study authors concluded that, “The estimated herd protection should be incorporated into evaluations of cost-effectiveness of HPV vaccination of men older than 26 years. Vaccine trials of oral HPV incidence and persistence in men should inflate sample sizes to account for herd protection.”

Reference

Chaturvedi AK, Graubard BI, Broutian T, Xiao W, Pickard RK, Kahle L, Gillison ML. Prevalence of oral HPV infection in unvaccinated men and women in the United States, 2009-2016. JAMA. 2019;322(10):977-979.

October, 2019|OCF In The News|

AI can predict the chances of surviving oral cancer

Source: medicalxpress.com
Author: University of Warwick

Whole slide images are multi-gigapixel images and cannot be used directly for image analysis tasks particularly training a deep learning based classifier. Therefore, we divide the WSIs into small regions (patches) for processing. A deep learning based classifier is applied on the patches to identify whether the patch contains tumour, lymphocytes or other histological primitives. However, the regions where the lymphocytes are infiltrating the tumour may not be confined within a patch. Besides, there is considerable variation in the size of TIL regions, making the quantification of TILs a non-trivial task. We address this issue by adopting the widely accepted definition of TILs, i.e., lymphocytes that lie in the neighbourhood of tumour areas. The patch labels predicted as lymphocytes or tumour are then used to compute a statistical measure of co-localization, which is further incorporated into the computation of the TILAb score of lymphocytic infiltration. Credit: University of Warwick

 

The chances of surviving oral cancers can be predicted by state of the art AI algorithms—developed by scientists at the Department of Computer Science at the University of Warwick—that precisely calculate the abundance of immune cells in the midst of tumour cells to help better understand the spread of and resistance to cancer.
In 2014 there were more than 11,000 cases of head and neck cancers in the UK and more than 2,300 deaths resulting from the most common of them; oral cavity cancer.

Oral cancer is most prevalent in South Asia, particularly India, Pakistan and Sri Lanka, mainly due to tobacco chewing, betel quid consumption and viral infections such as HPV (Human papillomavirus).

The chances of surviving such cancers can be predicted thanks to research in a pilot study from the University of Warwick’s Department of Computer Science in the paper “A Novel Digital Score for Abundance of Tumour Infiltrating Lymphocytes Predicts Disease Free Survival in Oral Squamous Cell Carcinoma,” published today, Monday 16 September, in the journal Nature Scientific Reports.

Researchers managed to develop a digital score that could measure Tumour Infiltrating Lymphocytes (TILs). The more TILs present the higher the chance of survival and longer disease free survival of oral cancer.

The images were produced by scans from patients at Shaukat Khanum Memorial Cancer Hospital Research Centre in Pakistan, who had all already been treated by radiation and a head and neck surgery. The cancer tissue samples were then sent to University Hospital Coventry and Warwickshire in the UK, where using a state of the art imaging machine researchers were able to digitally produce high-resolution images of the samples at a microscopic scale.

The presence of lymphocytes in the vicinity of the tumor cells doesn’t only help determine the stage of the cancer, it can be used to predict the progression of it accurately.

The more TILs present in the scans indicates the patient’s immunity to the cancer and the response to treatment, and the density and spatial arrangement of TILs correlates with the chances of overall survival and disease free survival.

Professor Nasir Rajpoot from the Department of Computer Science at the University of Warwick, who led the study, comments:

“We are only beginning to unravel the remarkable potential of wealth of information present in pathology image data. This pilot study shows that with the help of modern cancer image analytics algorithms, we can precisely calculate the score of abundance of TILs in oral cancers in an objective manner and then use that score for risk stratification in terms of disease free survival.”

Prof Hisham Mehanna, Professor of Head & Neck Oncology at the University of Birmingham, comments:

“This is a very exciting development. Not only is this one of the first artificial intelligence based scores to be validated in oral cancer, this score also seems to have a strong prognostic power, which could eventually lead to stratifying patients for different treatment modalities.”

Dr. Asif Loya, Medical Director at the Shaukat Khanum Memorial Cancer Hospital & Research Centre in Pakistan where the patient samples were sourced from, comments:

“With almost 13,000 new cases every year, oral cancers have the highest incidence rates among cancers in Pakistan, second highest mortality rate, and a very low five-year survival. However, there is little known about the histological signatures corresponding to patient subgroups with differing outcomes in this part of the world. Histologic risk assessment is strongly predictive of local disease-free and overall survival in oral squamous cell carcinoma thus there is need for a validated scoring system to be used as an aid in treatment decision making in these cancers in our patients . Strong pilot data from this collaborative research using the objective assessment method of digital analysis may play a role in establishing such prognostication models so that treatment decisions related to elective neck dissection (END) and adjuvant radiotherapy can be made more appropriately.”

September, 2019|Oral Cancer News|

HPV ‘Herd Immunity’ Is on the Rise Among Adults

Source: www.webmd.com
Author: Dennis Thompson, HealthDay Reporter

The United States could be approaching a state of herd immunity against human papillomavirus (HPV), a virus linked to several cancers.

Oral HPV infections declined by 37% among unvaccinated 18- to 59-year-old men between 2009 and 2016, according to a Sept. 10 report in the Journal of the American Medical Association.

That included a decline in infections of HPV16, the strain found in more than 9 out of 10 cases of head and neck cancer related to the virus, said senior researcher Dr. Maura Gillison, a professor of medicine at MD Anderson Cancer Center in Houston.

Researchers say men are benefitting from increased HPV vaccination rates among American women, who receive the vaccine to prevent virus-caused cervical cancer.

“In contrast to cervical cancers, we have no means by which to screen for HPV-positive head and neck cancers,” Gillison said. “The vaccine is our best hope for prevention.”

HPV vaccination has been recommended for girls since 2006 and for boys since 2011. The virus has been linked to cancers of the cervix, penis, anus, mouth and throat.

Vaccination rates among boys and girls are steadily rising, according to the U.S. Centers for Disease Control and Prevention.

About half of teens were up to date on the HPV vaccine in 2017, and two-thirds of 13- to 17-year-olds had received the first dose to start the series. On average, the percentage of teens who started the HPV vaccine series rose by 5 percentage points each year between 2013 and 2017, the CDC says.

“At least 75% vaccine coverage of boys and girls would be necessary to eradicate HPV16, the HPV type that is most likely to lead to cancer development,” Gillison said.

But vaccination rates have lagged among males.

To see if males are receiving some protection from greater HVP vaccination among females, Gillison and her colleagues reviewed U.S. federal health survey data gathered between 2009 and 2016.

They found that by 2016, about 15% of women and 6% of men had received the vaccine.

Despite lower vaccination rates among males, oral HPV infections declined from 2.7% to 1.6% in men between 2009 and 2016.

Interestingly, prevention of oral HPV infections and the head and neck cancers they cause is not listed as a reason to get the vaccine, Gillison said. No clinical trials have been undertaken to show that the HPV vaccine could prevent such cancers.

The decrease in HPV infections among the unvaccinated men is consistent with a decline in genital HPV infections among unvaccinated women between 2004 and 2014, the researchers noted.

“This study demonstrates that even with suboptimal uptake of the HPV vaccine, important gains are being made in herd immunity against oral HPV types included in the vaccine,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore. He was not involved with the study.

“Oral HPV infection is a major factor in the development of head and neck cancer, and this vaccine has the potential to be game-changing as more individuals are vaccinated,” Adalja said.

HPV-positive head and neck cancers are the most rapidly rising cancers in the United States among men under age 60, Gillison said.

She called on doctors to use the data from this and other studies to promote HPV vaccination.

“I can guarantee that all of my patients diagnosed with HPV-positive head and neck cancer would exchange two or three shots for three months of toxic cancer therapy in a heartbeat,” she said.

“The HPV vaccine, together with the hepatitis B vaccine, are the two most important advances in the history of cancer prevention, period,” Gillison concluded.

September, 2019|Oral Cancer News|

Which HPV vaccination schedule is best: 1, 2 or 3 doses?

Source: www.precisionvaccinations.com
Author: Don Ward Hackett

A new cervical cancer prevention study of women first offered Human Papillomavirus (HPV) vaccine found that 1-dose of quadrivalent HPV vaccine was as effective as 3-doses at preventing histologically confirmed, high–grade cervical lesions.

This Australian study’s finding published online on July 15, 2019, supports the hypothesis that the 1-dose HPV vaccination schedule may be a viable strategy when working towards the global elimination of cervical cancer.

These researchers said ‘If one dose could prevent precancerous cervical lesions, then global cervical cancer prevention would be greatly facilitated.’

This is an important goal since about 90 percent of cervical cancer cases are caused by HPV. This study included 250,648 women in Australia with 19.5 percent unvaccinated, 69.8 percent had received 3-doses, 7.3 percent 2-doses, and 3.4 percent just 1-dose of the HPV vaccine.

This study’s limitations include some degree of under–linkage and inaccurate data linkage because Australia does not have a unique national identifier, which impacts the classifications of vaccinated women as unvaccinated.

Additionally, these researchers said ‘we believe that these data support decision-makers to consider how a 1-dose HPV vaccination schedule, or a planned schedule with a 3–5 year interval between doses, could reduce vaccine demand globally, which currently exceeds vaccine supply.’

But the Gardasil 9 vaccine manufacturer appears to be resolving this supply/demand imbalance. During July 2019, Merck said it is spending $1.68 billion, opening 2 new Gardasil production plants, and adding 525 related jobs.

To clarify the Gardasil 9 vaccine dosing schedule, the Centers for Disease Control and Prevention (CDC) publish the following information:

Who should still receive a 3-dose schedule?
The CDC continues to recommend a 3-dose schedule for persons starting the HPV vaccination series on or after the 15th birthday, and for persons with certain immunocompromising conditions. The 2nd vaccine dose should be given 1–2 months after the 1st dose, and the 3rd dose, should be given 6 months after the first dose.

Who should receive just 2-doses?
Two doses of the HPV vaccine are recommended for all boys and girls at ages 11-12; the vaccine can be given as early as age 9. If you wait until they’re older, they may need three doses instead of two.

In the USA, HPV vaccines have been licensed for use among women since 2006 and among men since 2010.

HPV infections are so common that nearly all men and women will get at least one type of HPV at some point in their lives. Nearly 80 million Americans are currently infected with some type of HPV, says the CDC. About 14 million Americans, including teens, become infected each year. HPV is spread through intimate skin-to-skin contact. You can get HPV by having vaginal, anal, or oral sex with someone who has the virus.

Cervical cancer is the only type of HPV cancer with a recommended screening test. The other types of HPV cancer may not be detected until they cause health problems. HPV vaccination helps prevent these cancers by preventing infections that cause these cancers, says the CDC. HPV vaccines, like any medicine, can cause side effects, which you are encouraged to report to the CDC or a healthcare provider.

August, 2019|Oral Cancer News|

Updated HPV vaccine recommendations follow big HPV infection drops shown in new study

Source: www.forbes.com
Author: Tara Haelle

A vial of the human papillomavirus (HPV) vaccine Gardasil. (AP Photo/Charles Rex Arbogast)

Adults up to age 45 are now recommended to discuss with their doctors getting the human papillomavirus (HPV) vaccine, which prevents 3% of all cancer in women and 2% of all cancer in men—an estimated 34,000 cancers a year in the U.S. Following confirmation from the director of the Centers for Disease Control and Prevention (CDC), the recommendations also extend the age in men from age 21 to age 26, the same as in women.

The decision from the CDC’s Advisory Committee on Immunization Practices (ACIP) July 26 came the same day The Lancet published the largest study to date on the vaccine’s effectiveness. The meta-analysis of 65 studies found drops of 31%-83% of HPV infections and genital warts in men and women, depending on age and diagnosis.

HPV is responsible for nearly all cervical cancer, over 90% of anal cancer, 70% of oral, throat and neck cancers and over 60% of penile cancer. Though HPV is primarily transmitted through sexual contact, non-sexual transmission occurs as well.

Previously, the HPV vaccine had been recommended for females and males in a series of two doses up to age 14 or three doses up to age 26 in women and age 21 in men. Men ages 22-26 could also get the vaccine.

ACIP’s unanimous vote to extend the recommendation to age 26 in men corresponds to evidence showing the vaccine’s substantial benefits for men. In fact, research shows men to be up to six times more likely than women to develop an oral infection with the highest risk strain of HPV.

ACIP’s 10-4 vote regarding adults ages 27-45 who haven’t received the HPV vaccine emphasizes shared decision-making with their providers. The HPV vaccine is not licensed by the FDA for adults older than 45 since data on its effectiveness does not exist for this age group.

The “decision from ACIP emphasizes what the data has shown—that the HPV vaccine is safe and effective for use in patients ages 27 to 45, and that use of the vaccine in this age group should be the result of shared decision-making between patients and their trusted physicians,” Christopher M. Zahn, M.D., vice president of Practice Activities at the American College of Obstetricians and Gynecologists (ACOG) said in a statement.

“Obstetrician-gynecologists are encouraged to discuss with their patients ages 27 to 45 the potential benefits of HPV vaccination, addressing the reduced efficacy compared to vaccination within the younger target age range as well as the reduced risk of high-grade disease and cervical cancer,” Zahn said, adding getting the vaccine at the recommended age of 11-12 years offers the most benefit.

“Women’s decisions will also likely consider their individual circumstances, preferences, and concerns, and the role of the obstetrician-gynecologist is to provide unbiased information in a balanced, thorough way in order to aid that decision-making,” he said.

New research finds big drops in HPV-related infections

The new study found that HPV infections with strains 16 and 18 dropped 83% among girls ages 13-19 and by 66% among women ages 20-24 up to eight years after vaccination.

The HPV 16 and 18 strains in Gardasil cause 70 percent of all cervical, vaginal, vulvar and anal cancers. Gardasil 9 also protects against HPV 6 and 11, which cause 90% of genital warts, and against five other strains (31, 33, 45, 52, and 58). Together, the strains in Gardasil 9 represent 90% of HPV-related cancers.

HPV infections caused by HPV 21, 33 and 45 cut in half (54%) among vaccinated girls ages 15-19, according to the new research. Similarly, genital warts diagnoses fell by 67% in these girls and by 48% in boys of the same age. Older men (up to 24) and women (up to 29) also saw declines in genital warts by 31%-54%.

Rates of grade 2 cervical neoplasia, a precursor to cancer, also dropped by half (51%) in screened girls 15-19 and by 31% in women 20-24 years.

Cervical cancer can take up to 20 years to develop, so the vaccine, first approved in 2006, has not been available long enough for a sizable evidence base showing a reduction in cancer incidence. Dramatic declines in HPV infection rates, however, are expected to translate to similar declines in HPV-caused cancer rates, and immunity from the vaccine is long-lasting.

Multiple large reviews of the HPV vaccine have found it to be among the safest vaccines available. While the actual shot itself can be particularly painful, the only regularly reported side effects are pain, redness and soreness at the injection site and, in some teens, temporary fainting, which is common with many vaccines in adolescents. Among 13,000 people in the clinical trials for Gardasil 9, five people also reported fever, allergy to the vaccine, asthmatic crisis, headache and tonsillitis, though not all of these were determined to be caused by the vaccine.

The most effective way to reduce cervical cancer has been and remains regular screenings. However, screenings only detect early development of abnormal tissue that could become cancerous whereas the HPV vaccine prevents the viral infections that leads to those tissue abnormalities in the first place.

Since there is no current way to screen for throat/mouth/neck or anal cancer in women or men (or penile cancer in men), the HPV vaccine remains the only way to prevent those cancers.

HPV vaccine benefits ‘exceed expectations,’ may lead to elimination of cervical cancer

Source: NBC News
Date: June 27, 2019
Author: Katie Sullivan

A new study suggests that the benefits of the vaccine extend to people who aren’t vaccinated — meaning the more people who are vaccinated, the better.

The HPV vaccine is far more effective than expected, with benefits extending beyond those who receive the vaccine, a study published Wednesday finds.

The new study, published in The Lancet, suggests that the more people who receive the vaccine, the better. That’s because vaccination not only reduces rates of HPV infection and the presence of precancerous cells in the cervix in people who receive the vaccine, it also reduces rates of HPV-related diseases in people who were not vaccinated.

The findings come as a U.S. federal advisory panel recommended Wednesday that the HPV vaccine be given to both men and women up to age 26.

HPV, or human papillomavirus, is the leading cause of cervical cancer. The virus can also cause other cancers, including cancers of the penis, head and neck, as well as conditions like genital warts.

The HPV vaccine was first introduced in 2006. Since then, more than 115 countries and territories have implemented it in their vaccination programs. The World Health Organization recommends that girls ages 9 to 13 receive two doses of the vaccine.

“The impact of the HPV vaccination has actually exceeded expectations,” said Lauri Markowitz, associate director of science for HPV at the Centers for Disease Control and Prevention, who worked on the study. “The trials showed that HPV vaccines are very effective, and data from the real world has confirmed that.”

Indeed, the reductions in HPV infections and precancerous cells “are a first sign that vaccination could eventually lead to the elimination of cervical cancer as a public health problem,” the study’s lead author, Mélanie Drolet, an epidemiologist at Laval University in Canada, said in a statement.

The Lancet study expanded upon a 2015 meta-analysis that had looked at the real-world effects of the vaccine. The new analysis was updated to include a total of 65 studies, which spanned eight years and included more than 60 million people living in 14 countries. Each study measured either changes in the number of new HPV infections, genital warts diagnoses or cases of abnormal cells associated with cervical cancer in countries before and after they adopted routine HPV vaccination in girls. (Two countries included in the analysis, the U.S. and Australia, also recommend the vaccine for boys.)

The impact of the HPV vaccination has actually exceeded expectations.

The researchers found that, in these countries, there was a significant decrease in the prevalence of two strains of HPV that cause 70 percent of cervical cancers, HPV 16 and 18. (There are more than 100 strains of HPV, 14 of which are known to cause cancer. The HPV vaccine protects against up to 9 strains.) In addition, there was a decrease in the prevalence of precancerous cells in the cervix, which can develop into cancer.

What’s more, in countries where at least half the population that was targeted for vaccination had actually received the vaccine, researchers saw evidence of herd immunity, meaning there was a decrease in the prevalence of HPV-related diseases even among those who weren’t vaccinated. This is because vaccination leads to fewer HPV hosts.

These countries also saw a decrease in genital warts diagnoses among unvaccinated boys and older women. And among girls within the age groups targeted for vaccination, there were fewer diagnoses of three HPV strains that the vaccine does not specifically protect against, a phenomenon called cross-protection. Countries in which people in multiple age groups received the vaccine also saw a greater decrease in HPV-related disease.

“This paper shows that with a broader age range that’s targeted, you’ll find greater impact in your vaccination program,” Markowitz told NBC News.

Lagging vaccination rates

Despite the widespread benefits of the vaccine, however, HPV vaccination rates in the U.S. are still lagging behind those of other adolescent immunizations. The U.S. was the first country to implement HPV vaccination for both genders, but the CDC has found that many parents and health care providers don’t yet see a need to vaccinate boys. Parents have also expressed concerns about the vaccine and its costs, the CDC found.

According to Debbie Saslow, managing director of HPV and gynecological cancers at the American Cancer Society, the lagging rates are not entirely because parents are against vaccinating their kids; rather, the way some doctors are presenting the vaccine also plays a role.

Two required vaccinations, for tetanus and meningitis, are administered at the same time as HPV, around age 12. Saslow said HPV is usually presented as an optional third vaccine at that time, and one that patients can delay another year.

“Providers often think they’re recommending all three vaccines, but they’re actually making the third, the HPV vaccine, optional,” Saslow told NBC News. “They’re just suggesting it or doctors are setting it apart from the other two in some way.”

The fact that HPV is a sexually transmitted infection could also be a hard concept for parents to come to terms with. Saslow said beliefs about sex may be a factor that deters parents from opting to have their children vaccinated against HPV.

“Despite all that, vaccination rates are continuing to grow,” she said.

Indeed, the number of adolescents in the U.S. who received at least one dose of the HPV vaccine has increased by 5 percent each year since 2013. The CDC recommendseveryone receive the first dose by age 12. Though adults up to age 45 can still be vaccinated, the vaccine may be less effective. And while the WHO does recommend that girls 9 to 13 get vaccinated against HPV, it does not yet recommend that all genders receive the vaccination. That could change in response to study results that continue to show the vaccine has substantial impact on public health.

Cancer prevention

That impact on public health is cancer prevention. Ultimately, that’s the “main goal of the HPV vaccination program,” Markowitz said. “We’re seeing an impact on one of the HPV outcomes that is close to a cancer outcome.” (Because cervical cancer can take decades to develop, it’s not yet possible to study the effects of the vaccine on cervical cancer rates, Drolet noted in the statement.)

In particular, the study found the HPV vaccine led to a reduction in the rates of abnormal pap smear findings. Pap smears are used to detect abnormal cells in the cervix that can sometimes develop into cancer. Five to nine years after a population was vaccinated against HPV, the researchers found a more than 50 percent reduction in cases of these pre-cancerous cells in girls 15 to 19. In vaccinated women 20 to 24, there were one-third fewer cases of these cells.

A separate study, published in April in The BMJ, found a 90 percent reduction in cases of pre-cancerous cells in young women in Scotland within the first decade of introducing the HPV vaccine.

But vaccination is only one piece of cervical cancer prevention; screening is also necessary.

Whether or not a person has received the HPV vaccine, getting cervical cells regularly tested — through Pap tests and HPV screening — is still a crucial to reducing cases of cervical cancer and early detection, said Diane Harper, senior associate director of the Michigan Institute for Clinical and Health Research. Rates of invasive cervical cancer dropped significantly in the U.S. when cancer screening was introduced in the 1940s, and there were less than half the number of cases in 2007 that there were in 1973, largely due to screening.

“Vaccination and screening together make a program,” Harper told NBC News. “Very few HPV cases progress into cancer, but the only way we’re going to find those that do is through the screening program.”

June, 2019|Oral Cancer News|