ReviewThe role of HPV in head and neck cancer and review of the HPV vaccine
Section snippets
Role of HPV in head and neck cancers
Over the last decade it has become clear that human papillomavirus (HPV) not only causes genital and anal cancers, but also causes a subset of head and neck squamous cell carcinoma (HNSCC). In addition to the estimated ~ 492,800 cervical cancers caused worldwide by HPV each year, HPV also causes an estimated ~ 30,000 oropharyngeal cancers, HPV is detected in ~ 25% of all HNSCC (Kreimer et al., 2005), and the majority of these HPV-associated HNSCC are oropharyngeal (tonsillar and base of tongue)
Oral HPV prevalence and natural history
While it is now clear that HPV is an important cause of oropharyngeal cancer, risk factors for oral HPV infection and the natural history of infection are not as well understood. Oral HPV infection (as measured by HPV DNA detection in exfoliated oral cells from an oral rinse or swab) is uncommon (≤ 1% prevalence) in children (Smith et al., 2007), although one study reported higher rates (~ 15%) among infants (Rintala et al., 2005). HPV acquisition appears to increase around sexual debut with
Proven clinical indications
In the U.S., two HPV vaccines are currently available. The quadrivalent vaccine, Gardasil® (HPV4), protects against infection with HPV types -6, -11, -16 and 18. This vaccine was first licensed in 2006 for use in females ages 9–26 years old for the prevention of cervical, vaginal and vulvar cancers (U.S. Food and Drug Administration, 2011a). In 2009 licensure was expanded to also include males in this age range as clinical trial data demonstrated the vaccines effectiveness in preventing genital
Conclusion
HPV vaccines have a clear role in preventing many ano-genital cancers and conditions related to HPV infection. Overall, the high efficacy of the vaccines and excellent safety profile suggest that these vaccines will provide major health benefits to the population. As data emerges on the efficacy of these vaccines against HPV-related head and neck cancer, and ongoing studies evaluate the long term efficacy of the vaccine against both ano-genital and non-ano-genital endpoints, it is likely that
Conflict of interest statement
The authors have received research support from a consultant for Merck Inc. Amanda Dempsey serves as an advisory board consultant regarding implementation of male HPV vaccination for Merck, a maker of HPV vaccine. Merck does not support any of Dr. Dempsey's research. Merck played no role in the development of content for this article.
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