HPV Vaccination for Prevention of Throat, Mouth, and Other Cancers

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• Rising Incidence of HPV-Related Cancers
• Challenges in Proving Vaccine Efficacy
• The Critical Need for Male HPV Vaccination
• HPV-Related Cancers Beyond Cervical Cancer
• Broad-Spectrum vs. Targeted HPV Vaccines
• Public Health Implications and Future Outlook

Rising Incidence of HPV-Related Cancers

Oropharyngeal cancers, including cancer of the tongue, mouth, larynx, and pharynx, have seen a significant increase over the past two to three decades. Dr. Jack Cuzick, MD, confirms that a large proportion of these head and neck cancers are directly caused by the human papillomavirus (HPV), the same virus responsible for cervical cancer. This epidemiological shift underscores a growing public health concern, moving the focus of HPV prevention beyond gynecological health.

Challenges in Proving Vaccine Efficacy

While HPV vaccination is expected to prevent these cancers, Dr. Jack Cuzick, MD, highlights a major challenge in obtaining direct proof. For cervical cancer, medical professionals can detect and eradicate precursor lesions, providing strong indirect evidence that vaccination prevents cancer. In contrast, head and neck cancers lack a known, easily identifiable precursor lesion. Furthermore, these HPV-related cancers typically do not manifest until patients are 50 or 60 years old, meaning it will take decades to gather conclusive data on the vaccine's preventive impact for oropharyngeal cancer.

The Critical Need for Male HPV Vaccination

This long latency period raises crucial questions about vaccination strategies. Dr. Jack Cuzick, MD, makes a compelling case for vaccinating boys against HPV, not just girls. He points out that the burden of genital warts, which are also caused by HPV, is actually more common in males. Vaccinating boys provides a direct benefit to their health while also contributing to herd immunity, ultimately protecting the entire population from the spread of oncogenic HPV strains.

HPV-Related Cancers Beyond Cervical Cancer

The conversation with Dr. Anton Titov, MD, reveals that the protective scope of the HPV vaccine extends far beyond cervical and oropharyngeal cancers. Dr. Cuzick identifies other significant malignancies linked to HPV infection, including penile cancer and anal cancer. The prevention of these cancers represents a major, often overlooked benefit of widespread vaccination programs, offering protection against a wider range of serious diseases for all individuals.

Broad-Spectrum vs. Targeted HPV Vaccines

Dr. Jack Cuzick, MD, discusses the viral targets of vaccination. He notes that while many cancers are predominantly linked to HPV type 16 (and to a lesser extent, type 18), cervical cancer is associated with a broader range of HPV types. A vaccine targeting only type 16 could be highly effective for cancer prevention. However, Dr. Jack Cuzick, MD, advocates for the use of a broad-spectrum vaccine. This approach also protects against HPV types 6 and 11, which cause genital warts, providing comprehensive protection against both cancerous and non-cancerous outcomes of HPV infection.

Public Health Implications and Future Outlook

The insights from Dr. Cuzick have profound implications for public health policy. Adopting a universal HPV vaccination strategy for all adolescents, regardless of gender, is the most sensible and effective path forward. This approach maximizes the prevention of multiple cancers and other HPV-related conditions. As Dr. Anton Titov, MD, discusses with Dr. Jack Cuzick, MD, the full cancer prevention benefits will unfold over the coming decades, solidifying HPV vaccination as one of the most powerful tools in modern preventive oncology.

Full Transcript

Dr. Anton Titov, MD: Oropharyngeal cancers, cancer of the tongue, cancer of the mouth, cancer of larynx and pharynx have increased over the last 20 to 30 years. Oral cancers are also caused by HPV, human papilloma virus. It is the same virus that causes cervical cancer.

There is recent progress in HPV vaccinations and testing for cervical cancer. There is better availability of HPV vaccine in women.

What can be done to prevent oropharyngeal cancers? How can we prevent cancer of the tongue and cancer of larynx and pharynx, especially in men?

Dr. Jack Cuzick, MD: It is absolutely true that a large proportion of the oropharyngeal cancers and base of the tongue cancers are HPV-related. HPV vaccine should prevent those cancers. There are several reasons why we cannot be absolutely certain about that.

For cervix cancer, we have a method of detecting the precursor cancer lesions. We can see that we can eradicate the precursor lesions in cervical cancer. Then we are pretty certain that we are going to be eradicating cervical cancer.

Although at this stage we do not have direct proof, even in the cervix, that we are preventing cancer, it is almost certain because we are preventing a precursor lesion to cervical cancer. We understand it very well.

For head and neck cancers, we don't have a precursor lesion. These cancers are not going to show up until age 50 or 60. Therefore, it’s going to take a long time to assess HPV vaccine results in cancer of larynx or cancer of pharynx.

But it does raise important questions about vaccinating against HPV not only in girls but also in boys. Certainly, the genital warts problem is more common in boys than in girls. There is a major benefit of HPV vaccination at a young age.

But there are other cancers. Head and neck cancers, oropharynx cancer are the most common. There are also penile cancers and some anal cancers that are also HPV-related. Those cancers should also benefit from eradication of HPV by vaccination.

In fact, the cancer protection effect should be even larger because the majority of those cancers are related to HPV type 16. But cervix cancer is more related to a range of different HPV types. So vaccination could be more targeted with type 16 HPV vaccine.

Although the sensible thing would be to use the broad-spectrum HPV vaccine. Sometimes you want to prevent genital warts, so you need to vaccinate against HPV type 6 and HPV type 11. You want to prevent other cancers; they are mostly HPV type 16, and a little bit HPV type 18. But you should just use one HPV vaccine for everybody.

Dr. Anton Titov, MD: That would work for prevention of oropharyngeal cancers?

Dr. Jack Cuzick, MD: Yes.