JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
that knowledge about oropharyngeal cancer prevention greatly influenced their decisions positively about vaccinating their sons. 33 In the study of the 2010 National Health Interview Survey, those men who had increased interactions with their healthcare provider had much greater knowledge about HPV and the HPV vaccine. 8 Thus, a significant, potential source for improving male HPV vaccination rates lies with physicians and educating patients about its cancer-preventing properties. FDA approval of the vaccine in girls for prevention of cervical cancer clearly increases acceptance rates amongst parent of teenage girls. If the relationship of HPV with head and neck cancer in men was greatly emphasized by their physician, parents may be more likely to accept vaccination for their sons. This current study is limited by the small sample size and somewhat low response rate. In addition, the views reflected by the respondents in the studies may not be applicable to other regions in the country. Louisiana’s one or more HPV dose vaccination rate amongst 13-17 year olds in 2014 was 53.2% for girls and at 44.7% for boys, which was fairly similar to national rates of 60.0% and 41.7%, respectively. 26 Despite being a state with vaccination rates just above or below the U.S. overall rates, this study shows there is still a large educational gap, irrespective of years in practice, to be reconciled among primary health care providers. Although this survey demonstrates a lack of knowledge of HPV (+) OPC, it does not define why this educational gap exists. Further, research should focus on efficacy of education and awareness of HPV (+) OPC.
5. Recommendations on the use of quadrivalent human papillomavirus vaccine in males-- Advisory Committee on Immunization Practices (ACIP) 2011; MMWR 50:1705-8. 6. Safaeian M, Kemp TJ, Pan DY, et al. Cross-protective vaccine efficacy of the bivalent HPV vaccine against HPV31 is associated with humoral immune responses: Results from the Costa Rica Vaccine Trial. Human Vaccines & Immunotherapeutics 2013; 9. 7. Jemal A, Simard EP, Dorell C, et al. Annual Report to the Nation on the Status of Cancer, 1975-2009, featuring the burden and trends in human papillomavirus(HPV)-associated cancers and HPV vaccination coverage levels. J Natl Cancer Inst 2013; 105:175-201. 8. Lu PJ, Williams WW, Li J, et al. Human papillomavirus vaccine initiation and awareness: U.S. young men in the 2010 National Health Interview Survey. Am J Prev Med 2013; 44:330-8. 9. Petrosky E, Bocchini JA, Jr., Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morbidity and mortality weekly report 2015; 64:300-4. 10. Dorell CG, Yankey D, Santibanez TA, Markowitz LE. Human papillomavirus vaccination series initiation and completion, 2008-2009. Pediatrics 2011; 128:830-9. 11. Syrjanen K, Syrjanen S, Lamberg M, Pyrhonen S, Nuutinen J. Morphological and immunohistochemical evidence suggesting human papillomavirus (HPV) involvement in oral squamous cell carcinogenesis. Int J Oral Maxillofac Surg 1983; 12:418-24. 12. Brandsma JL, Abramson AL. Association of papillomavirus with cancers of the head and neck. Archives of Otolaryngology - Head & Neck Surgery 1989; 115:621-5. 13. Niedobitek G, Pitteroff S, Herbst H, et al. Detection of human papillomavirus type 16 DNA in carcinomas of the palatine tonsil. J Clin Pathol 1990; 43:918- 21. 14. Fouret P, Monceaux G, Temam S, Lacourreye L, St Guily JL. Human papillomavirus inhead andneck squamous cell carcinomas innonsmokers. Archives of Otolaryngology - Head & Neck Surgery 1997; 123:513-6. 15. Paz IB, Cook N, Odom-Maryon T, Xie Y, Wilczynski SP. Human papillomavirus (HPV) in head and neck cancer. An association of HPV 16 with squamous cell carcinoma of Waldeyer’s tonsillar ring. Cancer 1997; 79:595-604. 16. Franceschi S, Munoz N, Bosch XF, Snijders PJ, Walboomers JM. Human papillomavirus and cancers of the upper aerodigestive tract: a review of epidemiological and experimental evidence. American Association of Cancer Research . 1996; 5:567-75. 17. Gillison ML, Koch WM, Capone RB, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst 2000; 92:709-20. 18. Rampias T, Sasaki C, Psyrri A. Molecular mechanisms of HPV induced carcinogenesis in head and neck. Oral Oncology 2014; 50:356-63. 19. Gillison ML, Broutian T, Pickard RK, et al. Prevalence of oral HPV infection in the United States, 2009-2010. JAMA 2012; 307:693-703. 20. Agrawal N, Frederick MJ, Pickering CR, et al. Exome sequencing of head and neck squamous cell carcinoma reveals inactivating mutations in NOTCH1. Science 2011; 333:1154-7. 21. Stransky N, Egloff AM, Tward AD, et al. The mutational landscape of head and neck squamous cell carcinoma. Science 2011; 333:1157-60. 22. Gillison ML, D’Souza G, Westra W, et al. Distinct risk factor profiles for human papillomavirus type 16-positive and human papillomavirus type 16-negative head and neck cancers. J Natl Cancer Inst 2008; 100:407-20. 23. Herrero R, Quint W, Hildesheim A, et al. Reduced prevalence of oral human papillomavirus (HPV) 4 years after bivalent HPV vaccination in a randomized clinical trial in Costa Rica. PloS one 2013; 8:e68329. 24. Hildesheim A, Wacholder S, Catteau G, et al. Efficacy of the HPV-16/18 vaccine: final according to protocol results from the blinded phase of the randomized Costa Rica HPV-16/18 vaccine trial. Vaccine 2014; 32:5087-97. 25. Reagan-Steiner S, Yankey D, Jeyarajah J, et al. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13- 17 Years--United States, 2014. MMWR Morbidity andMortality Weekly Report 2015; 64:784-92. 26. Stokley S, Jeyarajah J, Yankey D, et al. Human papillomavirus vaccination coverage among adolescents, 2007-2013, and postlicensure vaccine safety monitoring, 2006-2014--United States. MMWR Morbidity and Mortality Weekly Report 2014; 63:620-4. 27. D’Souza G, Cullen K, Bowie J, Thorpe R, Fakhry C. Differences in oral sexual behaviors by gender, age, and race explain observed differences in prevalence of oral human papillomavirus infection. PloS one 2014; 9:e86023.
CONCLUSION
Based on current projections, HPV (+) OPCmay become themost common HPV associated malignancy in the early 21 century. Currently, vaccination rates in the U.S. are low compared to other countries, and state directed mandates are unlikely in the near future. Even though the health care providers who responded to this survey demonstrated a high rate of recommending vaccination to their patients, most were not aware of the role of HPV in OPC, and some demonstrated a difference in strength of recommendation based on age and gender. Parents may likely be more receptive to vaccination if they were made aware of HPV vaccine’s role in prevention of cancer. Education and awareness of HPV (+) OPC is integral at not only the patient level, but to providers as well who are at the front line of vaccination. Otolaryngologists should actively educate pediatricians and primary care providers to increase vaccination rates.
REFERENCES
1. Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011; 29:4294-301. 2. O’Rorke MA, Ellison MV, Murray LJ, Moran M, James J, Anderson LA. Human papillomavirus related head and neck cancer survival: a systematic review and meta-analysis. Oral Oncology 2012; 48:1191-201. 3. Chesson HW, Ekwueme DU, Saraiya M, Watson M, Lowy DR, Markowitz LE. Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States. Vaccine 2012; 30:6016-9. 4. Gillison ML, Chaturvedi AK, Lowy DR. HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer 2008; 113:3036-46.
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