The Role of Vaccination in the Prevention of Head and Neck Cancer
Human papillomavirus (HPV) is the main cause of cervical cancer and is also associated with head and neck cancer. The effect of prophylactic HPV vaccines on premalignant head and neck lesions is not measurable, but it is universally believed that HPV vaccines are able to prevent a considerable number of oropharyngeal cancers and a small proportion of oral cavity and larynx cancers. Recent studies on the effect of HPV vaccination on oral HPV infections provide further support of this hypothesis. The question then remains whether current vaccination programmes, in which only girls are vaccinated against HPV infections, should be extended to boys to increase the impact on future head and neck cancers. This question is particularly relevant because the burden of oropharyngeal cancer is on the rise in the United States and several other countries and it is disproportionally higher in men. The extension of a girls’ only HPV vaccination programme to a sex-neutral programme depends on a number of factors including herd effects received from the girls’ only programme and the price of the vaccine. HPV infection models predict a substantial impact of sex-neutral vaccination on future cancer in men and women when the coverage of the girls’ only vaccination programme is only 40–70%. At a higher uptake of 80%, a main argument in favour of sex-neutral vaccination is that it leads to near elimination of HPV16 and HPV18, thought to be responsible for the majority of the HPV-related head and neck cancers. Financial barriers to sex-neutral vaccination have been largely removed in countries that were successful in negotiating a low price for the vaccine.
KeywordsHuman papillomavirus Oropharynx Sex-neutral vaccination Herd effects Cost-effectiveness
JB has received consultancy fees from Roche, GlaxoSmithKline, and Merck/ SPMSD; these fees were collected by his employer. JB was supported by the Comparing Health Services Interventions for the Prevention of HPV-Related Cancer project, under European Commission FP7 Framework Health 2013 Innovation 1 (grant 603019). JB is grateful to Federica Inturrisi, Thomas Klausch and Venetia Qendri for suggestions and comments.
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