vaccination

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|

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|

British Association of Oral and Maxillofacial Surgeons praise HPV vaccination study

Source: www.nationalhealthexecutive.com
Author: staff

The British Association of Oral and Maxillofacial Surgeons (BAOMS) has welcomed new study findings from the two-year Cancer Research study in Scotland that the HPV vaccination for boys may substantially reduce head and neck cancer. BAOMS had been involved in successfully lobbying for the extension to the HPV to boys last year in England and Northern Ireland.

Life-threatening HPV-related cancers can develop during middle age, but boys had been excluded from the national HPV vaccination programme. Currently the cost of treating HPV-driven mouth and throat cancer to the NHS is approximately £30m a year.

Since the UK-wide immunisation scheme for girls aged 12 and 13 was introduced in 2008, data shows a reduction of up to 90% of pre-cancerous cells in the smear tests among women aged 20.

BAOMS Chair, Patrick Magennis, said: “Between 2010 and 2012 nearly 2,000 men had HPV-related head and neck cancer.

Over half of these oropharyngeal cancers are caused by HPV, and in the last decade alone the incidence of these cancers has doubled in the UK population.

“Current evidence suggests that vaccination of boys in their teenage years will prevent them from developing HPV-related cancers in middle age, so the introduction of male vaccination is timely.”

He welcomed the publication of the new study, which found that, over two years, in the 235 male patients in Scotland with head and neck cancer, HPV was present in 60% of cases. The findings follow an earlier report, which suggested routine vaccination of schoolgirls in Scotland with HPV had led to a dramatic reduction in cervical disease in later life.

Oral and maxillofacial cancer surgeons’ specialist skills include removing mouth, jaw and tongue cancer and replacing the missing parts with flesh and bone borrowed from the leg, hip or arm. They say that effective and timely cancer treatment for HPV-positive oropharyngeal cancer has excellent survival results. But patients frequently have serious and debilitating life-long side-effects from treatment that have a profound impact on the quality of life of the cancer survivors.

Twitter lends insight to HPV-associated oral cancer knowledge

Source: www.oncnursingnews.com
Author: Brielle Benyon

The incidence of human papillomavirus (HPV)-associated oral cancer has risen in recent years, and the virus has now surpassed tobacco and alcohol use as the leading cause of the disease. In fact, while the HPV vaccine is typically associated with preventing cervical cancer, there have been more cases of HPV-associated oral cancer than there have been cervical cancer.1

While the link between oral cancer and HPV may be well-known to healthcare professionals, researchers at Howard University recently took to Twitter to get a glimpse into the public’s knowledge about the topic.

“By looking at the social media data, we wanted to know what people are hearing about oral cancer – especially HPV-caused oral cancer,” study co-author Jae Eun Chung, PhD, associate professor in the Department of Strategic, Legal & Management Communication at Howard University, said. “We wanted to see what the gaps are between the knowledge of the healthcare professionals and the public.”

The researchers collected 3,229 unique tweets over the course of 40 weeks using search terms such as “HPV or papilloma” and “mouth or oral or throat or pharyngeal or oropharyngeal.” They then used a program called nVivo 12.0 to conduct a content analysis that looked at certain phrasing, terms, and themes that commonly appeared.

More than half (54%; 1679 total) of the tweets had information about prevention, while 29% (910) were about the causes of oral cancer. Far fewer tweets were about treatment (5%; 141), diagnosis (3%; 97), symptoms (1%; 42), and prognosis (1%; 25).

Interestingly, the researcher discovered a prominence on the risk of HPV-associated oral cancer in men, with tweets that referred to males outnumbering tweets that referred to females in a 3:1 ratio. Also, the most popular hashtag used in the dataset was #jabsfortheboys, appearing in 89 tweets.

“There was a heavy emphasis on the risk of HPV-associated (oropharyngeal cancer) among men, which is different than what we see with HPV vaccination among girls,” Chung said. “That was very positive news to us, because HPV-associated (oral cancer) rates are higher among the male population and HPV vaccination rates are higher among girls.”

While spreading HPV vaccination and oral cancer is important on a global scale, the United States might have some catching up to do, as the 5 most mentioned Twitter users discussing the topic were located outside of the US–1 in New Zealand, 2 in Australia, and 2 in the United Kingdom.

“That’s kind of sad, because there are more Twitter users from the United States than from any other country,” Chung said.

Ultimately, Chung explained, these findings outlined an area where the country can benefit from more education and social media campaigns.

“In conclusion, this study provides some insight as to how the public makes sense of HPV-associated oral cancer,” she said. “More education and campaigns are needed, and US residents can benefit from more active involvement of US-based health education.”

Reference
1. Chung JE, Mustapha I, Gu X, Li J. Understanding public perception about human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) through Twitter. Presented at: D.C. Health Communication Conference; Fairfax, Virginia; April 26-27, 2019.

The epidemic of throat cancer sweeping the industrialized world

Source: www.mercurynews.com
Author: Dr. Bryan Fong

Tonsils – Angina Pectoris

Over the past three decades, a dramatic increase in a new form of throat cancer has been observed throughout the industrialized world. The good news is that it’s potentially preventable — if parents get their children vaccinated.

The disease shows up primarily in men, typically between the ages of 45 and 70. Those who are affected often lead healthy lifestyles. They do not have extensive histories of smoking tobacco or consuming alcohol, which are risk factors for traditional throat cancers.

The rate of this new cancer has been increasing 5 percent per year and today, it is more than three times as common as in the mid-1980s. If you think this scenario sounds like a slow-moving infectious medical drama (think Contagion or World War Z), you would be right.

The source of this cancer is a virus, the human papillomavirus (HPV) — the same virus that causes most cervical cancer in women. It’s widely known that parents should get their girls vaccinated. Now, with the surge in oral HPV cancers, especially in men, parents should get their boys vaccinated too.

Currently, vaccination against HPV is recommended by the Centers for Disease Control for children and young adults ages 9-26. The vaccination includes a series of two or three injections; the side effects are mild.

Ideally, the vaccinations should be administered before someone becomes sexually active. That’s because HPV is spread via sexual activity. Risk of HPV infection and throat cancer increases with the number of lifetime partners.

Men have a lower immune response to the virus than women, which explains the predilection of this disease for men. It’s difficult to know if someone has an active oral HPV infection because there are no symptoms. Currently, there is no widely accepted test for HPV in men.

Chronic infection leads to cellular changes within the lymphatic tissues in the throat, specifically the tonsils and base of tongue. Over the course of 20-30 years, these changes can result in the formation of cancer.

Throat cancer caused by HPV is insidious. The primary tumor in the tonsil or base of tongue often causes little to no symptoms. Early signs of this cancer may be a mild sore throat, occasional blood-tinged oral saliva, or increased or new snoring.

Often, the first sign of the cancer is a lump in the neck after the cancer has spread into the lymphatic system. The lump may arise quickly and then shrink to varying degrees, lulling one into complacency.

Early stage cancer can be treated with surgery or radiation. More advanced cancers are treated with combined therapy such as surgery followed by radiation therapy, or chemotherapy in conjunction with radiation therapy.

Finally, some good news. Treatment for HPV-related throat cancer is successful in about 90 percent of cases and is significantly more successful than treatment of non-HPV related throat cancer.

But, as successful as medicine has been in treating this cancer, an even better alternative is prevention via vaccination. Initial studies have shown that vaccination produces an immune response to HPV and reduces the rate of HPV infection. Given time and good vaccination coverage, a decline in throat cancer is expected.

In summary, here are a few simple take-home messages: If you have a lump in the neck or a chronic sore throat, don’t procrastinate. Have your doctor check it out. If you are a partner of someone with these symptoms, strongly encourage your partner to see his or her doctor.

If you have children ages 9-17, talk to your pediatrician about HPV vaccination. If you are 18-26 years old, talk to your primary care doctor about vaccination. These simple steps may save your life or the life of your loved one.

Note: Dr. Bryan Fong is the senior practicing head and neck surgical oncologist for Northern California Kaiser Permanente.

February, 2019|Oral Cancer News|

Scientists Confirm There’s Nothing But Misinformation On Anti-Vax Sites

Source: Huffington Post, LIFE
Author: Agata Blaszczak-Boxe
Date: 11/04/18

Many websites that promote unscientific views about vaccinations use pseudoscience and misinformation to spread the idea that vaccines are dangerous, according to a new study.

For example, of the nearly 500 anti-vaccination websites examined in the study, nearly two-thirds claimed that vaccines cause autism, the researchers found. However, multiple studies have shown that there is no link between vaccines and autism.

About two-thirds of the websites used information that they represented as scientific evidence, but in fact was not, to support their claims that vaccines are dangerous, and about one-third used people’s anecdotes to reinforce those claims, the scientists found.

Some websites also cited actual peer-reviewed studies as their sources of information, but they misinterpreted and misrepresented the findings of these studies.

“So the science itself was strong, but the way it was being interpreted was not very accurate,” said study author Meghan Moran, an associate professor in Johns Hopkins University Bloomberg School’s Department of Health, Behavior and Society. “It was being distorted to support an anti-vaccine agenda.”

In the study, the researchers looked at websites with content about childhood vaccines. They used four search engines to find the sites — Google, Bing, Yahoo and Ask Jeeves — and searched for terms including “immunization dangers” and “vaccine danger” as well as other phrases. Their final sample of 480 anti-vaccination websites included a mix of personal websites, blogs, Facebook pages and health websites. The researchers examined the content of the websites, looking for vaccine misinformation, the sources of the misinformation and the types of persuasive tactics that the sites used to convince people that vaccines are dangerous.

In examining the websites, the researchers also observed a lot of misunderstanding and misinterpretation of epidemiological principles, Moran told Live Science.

For example, epidemiologists know that correlation does not imply causation. “Just because two things happen at the same time, that doesn’t mean that one is causing the other,” Moran said. But some of the websites presented timelines that showed that, as rates of immunization went up over a certain period of time, so did autism diagnoses, Moran said.

Although it is true that both have increased over the same period, the anti-vaccine websites frequently implied that “it must be that the immunizations were causing autism, which we know is not true,” Moran said.

Another tactic commonly employed by the websites in the study was the use of anecdotes and stories of parents of children with autism, the researchers said. Because such stories are easy for other parents to connect to, they help to make the anti-vaccine agenda that these sites are promoting appear “a lot more vivid and powerful,” Moran said.

Some of the sites also included information promoting positive health behaviors, the researchers said. For example, 18.5 percent of them promoted eating healthy, about 5 percent promoted eating organic food and 5.5 percent recommended breast-feeding.

The biggest takeaway from the findings is that researchers and health officials “need to communicate to the vaccine-hesitant parent in a way that resonates with them and is sensitive to their concerns,” Moran said in a statement. “In our review, we saw communication for things we consider healthy, such as breast-feeding, eating organic, the types of behavior public health officials want to encourage. I think we can leverage these good things and reframe our communication in a way that makes sense to those parents resisting vaccines for their children.”

The new findings were presented today (Nov. 3) at the American Public Health Association’s Annual Meeting in Chicago.

 

November, 2018|Oral Cancer News|

Oral treatment may not be far off for head and neck cancer patients

Source: app.secure.griffith.edu.au
Author: staff, Griffith University

A highly promising approach to treating HPV-driven head and neck cancer is on the way, and it could be in the shape of a simple oral medication. This is according to new breakthrough research led by Griffith University, which has conducted trials showing that the drug, Alisertib, tested in trials to treat other cancers such as lung and kidney, can also successfully destroy the cancer cells associated with head and neck cancer.

Human Papilloma Virus (HPV) is the main culprit in head, neck and oral cancers. The virus is thought to be the most common sexually transmitted infection (STI) in the world, and most people are infected with HPV at some time in their lives.

The latest trials – which have taken place over the past three years at Griffith’s Gold Coast campus – have shown a particular enzyme inhibitor in the drug, has the ability to prevent proliferation of HPV cancer cells in advanced head and neck cancers.

A 100 per cent success rate
Led by Professor Nigel McMillan, program director from Griffith’s Menzies Health Institute Queensland, the trials have shown a 100 per cent success rate in the drug eradicating the cancerous tumours in animals.

“Head and neck cancers can unfortunately be very difficult to treat, just by the very nature of where they are located in and around the throat, tongue and mouth,” says Professor McMillan.

“This part of the body contains some delicate areas such as the vocal chords and areas relating to speech, taste, smell, saliva etc, therefore there can be some significant side effects with the current treatment options.

“Quality of life is a major consideration in this patient group and therefore a simple oral treatment regimen will have massive benefit over other treatments in terms of reducing some quite drastic side effects.”

In Australia, there are over 5000 new cases of head and neck cancer each year. First line treatments include radiation and surgery (increasingly of the robotic type), followed by chemotherapy, however survival rates of around 70 per cent have remained unchanged for the past 35 years.

Half of all head and neck cancers are known to be caused by the HPV virus, with four times as many men (784) as women (250) estimated to have already died from the disease in Australia during 2018.

In the United States, there are now more cases of head and neck cancer than there are cervical cancer, a disease which is now set to become much more rare in Australia due to the introduction a decade ago of the world-leading national (HPV) vaccination program for schoolchildren.

Professor McMillan says the next step in the research is for the drug to be extended to human trials at the Gold Coast with patients for whom other treatments have so far proved unsuccessful.

October, 2018|Oral Cancer News|

FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old

The U.S. Food and Drug Administration today approved a supplemental application for Gardasil 9 (Human Papillomavirus (HPV) 9-valent Vaccine, Recombinant) expanding the approved use of the vaccine to include women and men aged 27 through 45 years. Gardasil 9 prevents certain cancers and diseases caused by the nine HPV types covered by the vaccine.

“Today’s approval represents an important opportunity to help prevent HPV-related diseases and cancers in a broader age range,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. ”The Centers for Disease Control and Prevention has stated that HPV vaccination prior to becoming infected with the HPV types covered by the vaccine has the potential to prevent more than 90 percent of these cancers, or 31,200 cases every year, from ever developing.”

According to the CDC, every year about 14 million Americans become infected with HPV; about 12,000 women are diagnosed with and about 4,000 women die from cervical cancer caused by certain HPV viruses. Additionally, HPV viruses are associated with several other forms of cancer affecting men and women.

Gardasil, a vaccine approved by the FDA in 2006 to prevent certain cancers and diseases caused by four HPV types, is no longer distributed in the U.S. In 2014, the FDA approved Gardasil 9, which covers the same four HPV types as Gardasil, as well as an additional five HPV types. Gardasil 9 was approved for use in males and females aged 9 through 26 years.

The effectiveness of Gardasil is relevant to Gardasil 9 since the vaccines are manufactured similarly and cover four of the same HPV types. In a study in approximately 3,200 women 27 through 45 years of age, followed for an average of 3.5 years, Gardasil was 88 percent effective in the prevention of a combined endpoint of persistent infection, genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to HPV types covered by the vaccine. The FDA’s approval of Gardasil 9 in women 27 through 45 years of age is based on these results and new data on long term follow-up from this study.

Effectiveness of Gardasil 9 in men 27 through 45 years of age is inferred from the data described above in women 27 through 45 years of age, as well as efficacy data from Gardasil in younger men (16 through 26 years of age) and immunogenicity data from a clinical trial in which 150 men, 27 through 45 years of age, received a 3-dose regimen of Gardasil over 6 months.

The safety of Gardasil 9 was evaluated in about a total of 13,000 males and females. The most commonly reported adverse reactions were injection site pain, swelling, redness and headaches.

The FDA granted the Gardasil 9 application priority review status. This program facilitates and expedites the review of medical products that address a serious or life-threatening condition.

The FDA granted approval of this supplement to the Gardasil 9 Biologics License Application to Merck, Sharp & Dohme Corp. a subsidiary of Merck & Co., Inc.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

October, 2018|Oral Cancer News|

HPV-related cancer rates outpace vaccinations

Source: www.ctpost.com
Author: Cara Rosner, Conn. Health

Cancers linked to the human papillomavirus, commonly called HPV, rose dramatically in a 15-year period, even as the rates of young people being vaccinated climbed, the Centers for Disease Control and Prevention reported.

The 43,371 new cases of HPV-associated cancers reported nationwide in 2015 marked a 44 percent jump from the 30,115 cases reported in 1999, according to a CDC analysis. HPV vaccination rates have improved over the years, but not fast enough to stem the rise in cancers, the CDC said.

Oropharyngeal, or throat, cancer was the most common HPV-associated cancer in 2015, accounting for 15,479 cases among males and 3,438 among females. HPV infects about 14 million people each year. Between 1999 and 2015 rates of throat and vulvar cancer increased, vaginal and cervical cancer rates declined, and penile cancer rates were stable, according to the CDC.

“The (overall rise) seems to be mostly driven by oropharyngeal cancers,” said Dr. Sangini Sheth, assistant professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine.

“Vaccination is key to preventing those cancers,” said Sheth, who also is an associate medical director and director of colposcopy and cervical dysplasia at Yale New Haven Hospital’s Women’s Center. “Oropharyngeal cancer is most common in men, and HPV vaccination rates, while they are rising in the U.S. and Connecticut, became routine for boys later (than girls). And the rate of vaccinations among boys has definitely lagged that of girls. Hopefully, we will see vaccinating our boys have an impact on oropharyngeal cancer, but that’s going to take time.”

The push to vaccinate adolescents against HPV is a relatively recent development. The vaccination was included in the routine immunization program for females in 2006 and for males in 2011, according to the CDC.

At one time, the HPV-vaccine was viewed largely to prevent sexually transmitted diseases, and some parents “resented” it and thought it was unnecessary for their children, according to Dr. Richard Brauer, section head of otolaryngology at Greenwich Hospital. Now it’s marketed as a cancer vaccine and parents have become more receptive, said Brauer, who also has a private practice, Associates of Otolaryngology, in Greenwich.

In 2017, 65.5 percent of adolescents aged 13 to 17 nationwide had at least one dose of the HPV vaccine, up 5.1 percentage points from 2016, according to CDC data released in August.

In Connecticut, 75.4 percent of girls aged 13 to 17 had one dose of the vaccine, 67.1 percent had two doses and 58.4 received three doses. Among males, 67.3 percent received one dose, 58.8 percent got two and 37.8 percent got three, the 2017 data show. But even amid overall gains, hurdles remain. Gender disparity persists, and many teens received the first vaccine dose but failed to get necessary subsequent doses.

Children who are 11 or 12 years old should get two shots of HPV vaccine six to 12 months apart, according to the CDC. Adolescents who get their shots less than five months apart need a third dose of the vaccine, as do all children older than 14. Three doses also are recommended for people ages nine to 26 who have certain immunocompromised conditions.

“It falls on the parent” whether children get vaccinated, said Dr. Bradford Whitcomb, chief of gynecologic oncology at UConn Health. “People associate HPV with female stuff. It needs to be pushed that we’re not just preventing female cancers.”

While it’s encouraging that vaccination rates are climbing, “we just may not see the benefit of that for years to come,” Whitcomb said. “It’s going to take a longer time, especially with the development of cancer, to see the effect. After the HPV infection, it can take years for a cancer to develop.”

Many people exposed to HPV will never get cancer, doctors said. The most common HPV-associated cancer among women is cervical cancer. Data show rates of that cancer are falling, but there are racial disparities.

Between 2011 and 2015, Hispanic women had the highest incidence rates of cervical cancer at 8.9 percent, according to an analysis by the Kaiser Family Foundation. That compares with 8.4 percent among black women, 7.4 percent among white women and 6.1 percent among Asian and Pacific Islander women.

Cervical cancer mortality rates also showed racial disparities during that time. Black women had the highest mortality rate at 3.7 percent, compared with 2.6 percent among Hispanics, 2.2 percent among whites and 1.8 percent among Asians and Pacific Islanders, data show.

It is crucial for doctors to talk to young patients and their parents about the HPV vaccine, even if it spurs conversations parents may feel awkward having, Sheth said.

“Clinicians need to feel comfortable normalizing the HPV vaccine and really present the HPV vaccine as a cancer prevention tool,” she said.

Note:
This story was reported under a partnership with the Connecticut Health I-Team, a nonprofit news organization dedicated to health reporting. (c-hit.org)

September, 2018|Oral Cancer News|

Head and neck cancer: An overview of head and neck cancer

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss the prevalence of cancers of the head and neck, emphasizing the potential risk factors and importance of prevention.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Welcome to this CURE Connections® program titled “Head and Neck Cancer: Through the Eyes of a Patient.” I’m Meryl Kaufman, a certified speech-language pathologist and founder of Georgia Speech and Swallowing LLC. I am joined today by Dr. Itzhak Brook, a professor of pediatrics and medicine at Georgetown University School of Medicine, who was diagnosed with throat cancer in 2006. Together we will discuss the prevalence of head and neck cancer, what unique challenges patients may face and how one can adjust to life after receiving treatment for their disease. Dr. Brook and I also serve as board members on the Head and Cancer Alliance.

Dr. Brook, let’s talk about head and neck cancer in general. What’s the difference between head and neck cancer associated with the traditional risk factors, such as smoking and drinking, and HPV-related head and neck cancers?

Itzhak Brook, M.D., M.Sc.: The traditional head and neck cancer is related to smoking and alcohol consumption. It’s usually associated with a high rate of laryngeal cancer. And HPV-related cancer is a relatively new arrival on the scene of head and neck cancer, and it’s associated with a condition of infection by a venereal disease. The virus HPV is usually associated with a posterior tongue cancer or an oropharyngeal cancer.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly, yes. So the HPV viruses typically in the oropharynx, the tonsil and the tongue basis are certainly rising in incidence as compared with the traditional head and neck cancers, which are decreasing in incidence. In fact, it’s anticipated that in the year 2020, the HPV-related oropharyngeal cancers are going to surpass HPV-related cervical cancers, which are typically what you think of with the HPV virus. So that is a new patient population, but the good news is that the survival rates are better for the HPV-related head and neck cancers versus the non-HPV-related cancers. Can you speak a little bit about the incidence of the two?

Itzhak Brook, M.D., M.Sc.: The incidence of head and neck cancer is not as high as others like colon cancer, breast cancer in women or lung cancer, but it’s around the ninth or 10th cause of cancer in the world in this country. In countries where there is smoking and alcohol consumption, it’s a higher rate. HPV is usually happening in younger people, in the late 30s or early 40s. And fortunately, we hope that it could be prevented by vaccination. Although it’s approved that it can, it’s not yet available because the incubation period for the cancer, as you may call it, takes 20, 30 years, so we don’t really know. Fortunately, even though HPV is very common, the occurrence of HPV-related cancer is very, very rare.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Correct. In terms of the vaccination for the HPV virus, I agree, the proof certainly isn’t definitively out there yet, but the vaccine protects against the strain of virus that ultimately can lead to head and neck cancer. So the thought is that by preventing the contraction of the virus, hopefully we can also prevent these head and neck cancers, which is why the American Academy of Pediatrics and the CDC (Centers for Disease Control and Prevention) recommend that children between the ages of 11 and 12, female and males, are vaccinated prior to sexual debut in the hopes of preventing these cancers down the road, certainly. So yes, head and neck cancer does account for about 6 percent of all cancers worldwide, with about 500,000 cases worldwide. And in the United States, we anticipate about 65,000 a year, I believe, and they do occur more frequently in men, almost twice as often in men than in women and typically in people over the age of 50 in the traditional head and neck cancers. But certainly, there is a change in that with the introduction of the HPV-related cancers. Can you talk a little bit about prevention in terms of things that we can do to prevent the risky behaviors?

Itzhak Brook, M.D., M.Sc.: Of course, with the traditional cancers, it can be prevented by not smoking or drinking alcohol in high quantities. But there’s the behavioral changes that men and women can change that can reduce the risk of acquiring it. It’s a sexually transmitted disease. Oral sex has been the No. 1 cause, so you think of condoms or men using them also when having oral sex may prevent it.

September, 2018|Oral Cancer News|