Christine G. Gourin, MD, MPH, associate professor of the department of otolaryngology–head and neck surgery and director of the clinical research program in head and neck cancer at Johns Hopkins University in Baltimore, believes this type of stigma is dangerous. “The fact is that HPV infection is widespread, with up to 90 percent of adults contracting an infection at some point in their lives,” she said, particularly emphasizing the importance of the vaccine for prevention of oropharyngeal cancers because of the lack of good methods for early detection and screening for these types of cancers. Dr. Gourin emphasized both the reduction in mortality rates and the prevention of the significant disability these cancer patients suffer. “Because patients who develop these cancers are often younger than the typical head and neck cancer patient, they have many years ahead of them to live with the disability and sequelae of treatment, including disfigurement, trouble swallowing and radiation side effects,” she said.
Explore This IssueAugust 2013
How Otolaryngologists Can Improve Vaccination Rates
Dr. Sturgis emphasized the need to recognize the new profile of patients who present with oropharyngeal cancers. “Unlike the traditional profile of older men with a history of drinking and smoking, oropharyngeal cancers as related to HPV occur in men with a median age of 50 to 55 years, who have not smoked or with only a minimal smoking history, who often do not have an obvious lesion but show up with a lump in the neck, and often are of a higher socioeconomic status,” he said.
He emphasized the need for otolaryngologists to understand that the vaccine works best when administered in adolescence prior to exposure. Vaccinating someone at, for example, 30 or 35 may not prevent them from getting a cancer at 45 because they may already have been exposed. As many otolaryngologists see only older patients, one question that arises is whether adults should be vaccinated. “If an adult comes to me and wants the vaccine, what I say to the patient is that you have likely already been exposed to HPV, and we have no certain confidence that the vaccine will protect you now,” said Dr. Sturgis. However, he emphasized that because of the high safety of the vaccine, he doesn’t see a risk in adults receiving it, other than the fact that insurance may not cover it.
For Dr. Perkins, communication between providers and patients is the key that drives vaccination. “I think that otolaryngologists can help inform their patients about the link between HPV and oropharyngeal cancers and [explain] that vaccination should prevent many of them,” she said. “As a gynecologist, I do this when I am treating adult women for abnormal Pap smears. I tell them that we didn’t have a vaccine to prevent HPV when they were young, but we do now, and they can help prevent the disease in their daughters through vaccination.”