Slowing the Rise of Oropharyngeal Cancers

Evidence of the possible efficacy of the HPV vaccine in preventing orophyaryngeal cancer is suggested by data from a randomized clinical trial of its efficacy in the prevention of cervical cancer, according to Dr. D’Souza. “What we see in preliminary data from the existing HPV vaccine trials is that none of the women randomized to receive the HPV vaccine developed oral HPV 16/18 infection, whereas some women who did not receive the HPV vaccine did develop those infections,” she said.

Because oropharyngeal cancers disproportionately affect men, Dr. Sturgis said that he would particularly like to see an increase in the number of boys who get vaccinated, stating that the current recommendation for boys is less rigorous than he would like.

Why the Low Uptake of the Vaccine?

According to Abbey B. Berenson, MD, MMS, PhD, director of the division of pediatric and adolescent gynecology at University of Texas Medical Branch in Galveston and author of the 2010 National Health Interview Survey article, the main barriers to the uptake of the HPV vaccine cited in the literature are:

• Cost;
• Lack of knowledge of and poor attitude toward the vaccine; and
• Inability to take time off of work to see a doctor.

Another study drilled these factors down a bit. The lead author of this study, Rebecca Perkins, MD, assistant professor in the department of obstetrics and gynecology, Boston University Medical Center, Boston, said that provider recommendation of the vaccine seems to be the most important factor for all adolescents regardless of race, ethnicity and income (Hum Vaccin Immunother. 2013 Apr 9;9). The study also highlighted the influence of parental attitude toward vaccines in general and toward the HPV vaccine in particular.

Parental beliefs and awareness of the HPV vaccine, said Dr. D’Souza, are the strongest predictors of the vaccine uptake. She cited the high interest in and uptake of the vaccine in other countries that administer the vaccine routinely in schools via an opt-out system, so that most adolescents receive it by default. “In the U.S., we don’t have a standardized way of delivering it, and we depend on families to ask for it and pediatricians to recommend it,” she said, adding that the problem for some parents is that they focus more on the vaccine’s association with sex rather than on its potential to prevent cancer.

One well-publicized reason has been the reluctance of some parents to provide a vaccine for a sexually transmitted disease because of fears that it may send children the message that they are condoning or encouraging sexual promiscuity.