New HPV Vaccine Recommendations Could Have Multiple Benefits
By Bryan Tutt
recommendations for vaccination against human papillomavirus (HPV) are
intended to prevent cervical cancer but may also decrease the incidence
rates of other cancers.
Since the first HPV vaccine was approved in 2006, the U.S. Centers for
Disease Control and Prevention (CDC) has recommended that girls be
vaccinated against HPV beginning at age 11 years. However, vaccination
rates among teenage girls have remained low, around 30%. To further
decrease the spread of HPV and thus the incidence rate of cervical
cancer, the CDC recently recommended the routine vaccination of boys
beginning at age 11 or 12 years.
“The reasoning for the new recommendation was to control cervical
cancer by preventing the spread of the virus, but a side benefit could
be a reduction in the number of oropharyngeal cancers as well,” said
Erich M. Sturgis, M.D., M.P.H., a professor in the Department of Head
and Neck Surgery and the Department of Epidemiology at The University
of Texas MD Anderson Cancer Center. This benefit occurs because HPV-16
and HPV-18, the two virus strains that cause about 70% of all cervical
cancers, also have been linked to cancers of the oropharynx as well as
cancers of the anus, penis, vagina, and vulva.
What’s the Difference?
patients know that there are two vaccines against the human
papillomavirus (HPV), but most do not know the differences between the
two. Physicians may find the information below useful in addressing
patients’ questions about the two vaccines.
Gardasil (Merck & Co.) was approved by the U.S. Food and Drug Administration (FDA) in 2006 for girls and women.
Cervarix (GlaxoSmithKline) was approved by the FDA in 2009 for girls and women.
vaccines protect against the two most common cancer-causing HPV
strains, HPV-16 and HPV-18; Gardasil also protects against HPV-6 and
HPV-11, which cause genital warts. For this reason, in 2009 the FDA
approved the use of Gardasil for boys and men. Cervarix is not approved
in the United States for use in boys or men.
Both vaccines are given in a series of three injections over 6 months,
and both vaccines have been reported to be effective and well tolerated.
While the cervix remains the most common site for cancers related to
HPV, Dr. Sturgis said that by 2020 there will likely be more
HPV-related oropharyngeal cancers than cervical cancers. A decline in
cervical cancer rates has occurred over the past 30 years in developed
countries because of the implementation of routine screening with
gynecological examinations and Papanicolaou tests. Such screening often
detects cervical dysplasia, which can be effectively treated before it
develops into cancer.
A similar decline has occurred in the incidence rates of head and neck
cancers related to tobacco and alcohol use. “As we’ve seen less smoking
in the United States over the past 40 years, over the past 20 years
we’ve seen declines in the incidences of virtually all head and neck
cancers except oropharyngeal—tonsil and base of tongue—cancer,” Dr.
Sturgis said. “This difference seems to be attributable to a dramatic
rise in the incidence of the subgroup of oropharyngeal cancers related
It is believed that HPV is introduced into the oropharynx principally
via oral sex. “There have probably been changes in sexual behavior in
the past 30-plus years that have helped cause the higher incidence of
HPV-related oropharyngeal cancers,” Dr. Sturgis said.
The prevention of oropharyngeal cancers is especially important because
they are seldom detected in their early stages. Dr. Sturgis said that
unlike cervical or anal dysplasia, premalignant oropharyngeal growths
are not detectable by any current screening tests. Screening for the
virus itself is unlikely to have any clinical relevance because most
people are exposed to HPV without developing a chronic infection or
subsequent HPV-related lesions. Instead, Dr. Sturgis said, “If a
patient has symptoms like bleeding, ulceration, a neck mass, or pain in
the throat that persist for 2 weeks, the patient should see an ear,
nose, and throat doctor.”
The two most important steps in preventing oropharyngeal cancer are
avoiding tobacco products and preventing HPV infection. “I would
strongly recommend that boys and girls get vaccinated against HPV as
recommended by the CDC,” Dr. Sturgis said.
information, contact Dr. Erich Sturgis at
articles in OncoLog, March 2012 issue:
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