Elsevier

Preventive Medicine

Volume 53, Supplement 1, 1 October 2011, Pages S5-S11
Preventive Medicine

Review
The role of HPV in head and neck cancer and review of the HPV vaccine

https://doi.org/10.1016/j.ypmed.2011.08.001Get rights and content

Abstract

Recent data demonstrate that human papillomavirus also plays a role in cancers other than ano-genital cancers, specifically head and neck cancers, and non-cancerous conditions such as recurrent respiratory papillomatosis. As more and more information about the role of infection in non-cervical diseases is amassed, additional questions about whether prophylactic human papillomavirus vaccines will effectively prevent these conditions are raised. This article reviews the epidemiology of oral human papillomavirus infection and the role of human papillomavirus in head and neck cancers. In addition, it will review the known clinical indications for human papillomavirus vaccination, and highlight other potential clinical targets for the vaccine that have not yet been demonstrated in clinical trials but for which there is biologic plausibility.

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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