HPV-positive Head & Neck Cancer – Driving Change in Clinical Practice
Human papillomavirus (HPV) is linked to 5% of all cancers worldwide. Since 2008 girls in the UK received HPV vaccination to reduce the incidence of cervical cancer. Research carried out in Liverpool provided evidence that HPV is also linked to a high incidence in head and neck cancer. This evidence was pivotal to the UK's government's 2019 introduction of a HPV vaccination programme for boys.
The challenge
Human papillomavirus (HPV) is linked to various cancers including Head and Neck cancer in the form of oropharyngeal squamous cell carcinoma (oropharyngeal cancer or OPSCC). Since the 1990s there has been a continued rise in oropharyngeal cancer numbers with data showing cases rising faster than any other solid tumour type. Despite a recognised link between HPV infection and oropharyngeal cancer, there was a lack of robust data evidencing the UK burden of HPV positive disease nor the health economic impact. As a direct consequence, when the UK instigated a nationwide HPV vaccination programme in 2008 it was offered only to females for potential cervical cancer reduction alone.
The research approach
Professors Andrew Schache and Terry Jones and colleagues at the University of Liverpool led multi-centre research studies to address this knowledge gap.
Professors Schache and Jones produced research demonstrating that greater than 50% of all UK oropharyngeal cancers are HPV positive; a finding in contrast to previous best evidence considered by the Joint Committee on Vaccination and Immunisation (JCVI) of at most 28% HPV positive. In addition, the disease incidence doubled in the single decade between 2002 and 2011 to over 2,200 cases per year. while the cost of oropharyngeal cancer treatment rose by 75% from 17m to 30m in just 4 years from 2006 to 2010.
Calls for gender neutral HPV vaccination have been made since before female-only HPV vaccination commenced in the UK in 2008. These intensified as other nations began vaccinating males. Evidence from the team’s research evidenced the efficacy and cost effectiveness of vaccinating boys, and informed a reversal in the existing policy advising against gender neutral vaccination.
Working in partnership
Policy implementation is set for September 2019 when all males in Year 8 of UK secondary education will be vaccinated using the HPV vaccine. This ensures a subsequent mitigation of substantial population harm both through decreased cancer incidence and reduced burden of treatment related morbidity.
Outputs and outcomes
The implementation of this research will result in substantial clinical, health economic, societal and, most importantly, individual benefit. Effects will not be seen for many years, as throat cancers are most common in adults in their 40s and 50s. However by 2058, with OPSCC cases expected to rise, over 14,000,000 boys will have been offered the HPV vaccine. Conservative estimates from Public Health England (PHE) have concluded that almost 29,000 male cancers will be prevented as a result of this change to UK vaccination policy. As HPV vaccination also conveys protection against other (low risk) HPV disease types, all those vaccinated will also receive protection from diseases such as of genital warts, the debilitating sexually transmitted disease.
Additionally, to address the increasing disease burden in the short to medium term, the group have directed best practice clinical guidelines providing a consistent, evidence-based regime for HPV diagnostics and intervention in oropharyngeal cancer in UK clinical practice.
