These HPV vaccines have received a great deal of national press recently, said Dr. Sewell. In clinical trials, they have been shown to prevent persistent infection of the genital mucosa by HPV; however the oropharyngeal mucosa was not examined. Further studies are warranted to determine the potential effects of these vaccines on oropharyngeal cancer, but it is within reason that these vaccines might also prevent HPV-associated head and neck cancers.
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September 2006Hopefully, as these cervical cancer vaccines become more available and widely used, the secondary effect would be a decrease in the incidence of oropharyngeal cancer, said Dr. Sturgis.
In my practice, it is not unusual to see patients 30 to 40 years of age with advanced Stage III to IV disease. – -Maura L. Gillison, MD, PhD
Survival Rates Improving, More Research Needed
While the incidence of oropharyngeal cancer has remained stagnant for nearly 30 years, the good news is that survival rates have significantly improved in recent decades with the more widespread adoption of multidisciplinary care with radiation central to the treatment of oropharyngeal cancer. The prognosis for people with oropharyngeal cancer depends on the age and health of the person, disease stage, treatments used, and potentially the etiology of the disease.
In my practice, it is not unusual to see patients 30 to 40 years of age with advanced Stage III to IV disease, said Dr. Gillison. The critical piece of prognostic information, though, is the presence of high-risk HPV in the tumor (usually type 16) and not p16 as indicated in the Yale study, even after adjusting for age, lymph node status, and heavy alcohol consumption. An HPV-positive tumor translates to a 60% or greater reduction in death rates, according to Dr. Gillison’s research.
Uncertainty still exists though as most HPV-positive tumors occur in non-smoking patients, said Dr. Sturgis. I doubt that the HPV-positive prognostic factor plays as big a part as is suggested since it is confounded by the fact that patients who are non-smokers have been shown to have a better survival rate than smokers. Additionally, many studies have mixed two rather distinct groups (oral cavity and oropharyngeal cancer patients) as well as other important differences. Research is still needed in this area for clarification.
Dr. Gillison said: My plan over the next five to ten years is to continue studying and gathering data on HPV and oropharyngeal cancers so that we can develop better screening and treatment strategies.