The COVID-19 pandemic set back efforts to reach a human papillomavirus (HPV) vaccine goal of 80% coverage to help stem the rise of oropharyngeal cancer (OPC) among men in the United States.
A report in Lancet Regional Health Americas advises, "Rapid recovery of the declined HPV vaccination uptake during the COVID-19 pandemic is also crucial to prevent future excess OPC burden."
The University of Texas School of Public Health warned about the sharp increase in OPC incidence and sought to project the impact of maintaining the current HPV vaccination uptake and achieving the Healthy People goal on incidence and burden of the cancer.
To do that, the study team used an open-cohort micro-simulation model of OPC natural history among contemporary and future birth cohorts of men, accounting for sexual behaviors, population growth, aging, and herd immunity. That included data from nationally representative databases, cancer registries from all 50 states, large clinical trials, and literature.
The researchers evaluated the status quo scenario (i.e., the current HPV vaccination uptake remained stable) and alternative scenarios of improvements in uptake rates in adolescents (aged 9-17 years) and young adults (aged 18-26 years) by 2025 to achieve and maintain the 80% goal.
The primary outcome was defined as changes in OPC incidence and burden from 2009 to 2100. The study also assessed the impact of disruption in HPV vaccine uptake during the COVID-19 pandemic.
Researchers point out that OPC incidence is projected to rise until the mid-2030s, reaching the age-standardized incidence rate of 9·8 (95% uncertainty interval [UI] 9·5-10·1) per 100 000 men, with the peak annual burden of 23,850 (UI, 23 200-24 500) cases.
Study results indicate that, under the status quo scenario, HPV vaccination could prevent 124,000 cases (UI, 117 000-131 000) by 2060; 400,000 cases (UI, 384 000-416 000) by 2080 and 792,000 cases (UI, 763 000-821 000) by 2100 among men.
"Achievement and maintenance of 80% coverage among adolescent girls only, adolescent girls and boys, and adolescents plus young adults could prevent an additional number of 100 000 (UI, 95 000-105 000), 118 000 (UI, 113 000-123 000), and 142 000 (UI, 136 000-148 000) male OPC cases by 2100," the researchers explain. "Delayed recovery of the HPV vaccine uptake during the COVID-19 pandemic could lead to 600 (UI, 580-620) to 6200 (UI, 5940-6460) additional male OPC cases by 2100, conditional on the decline in the extent of the national HPV vaccination coverage and potential delay in rebounding."
According to background information in the study, HPV-associated OPC incidence is rising rapidly in several high-income countries, including Australia, Canada, Denmark, the Netherlands, Norway, Sweden, the United Kingdom, as well as the U.S. In fact, in the U.S., OPC incidence and burden—the annual number of cases—among men exceeded cervical cancer, making OPC the most common HPV-associated cancer.
The Advisory Committee on Immunization Practices recommends routine HPV vaccination at ages 11 to 12 years and catch-up vaccination through age 26 years. The Healthy People program (nationwide health promotion and disease prevention program) of the Department of Health and Human Services had set a target to achieve 80% HPV vaccination coverage among adolescents by 2020. However, in 2019, only 54% of adolescents and 21% of young adults were up-to-date on their HPV vaccine schedule.
"Recent studies have indicated no improvements in HPV vaccination coverage among adolescents, growing HPV vaccine hesitancy among parents, increase in safety concerns, and a further decline in the HPV vaccine uptake during the COVID-19 pandemic," the authors explain. "HPV vaccination could translate into OPC prevention in future years. Yet, the potential long-term impact of maintaining the current HPV vaccination uptake and improvements in coverage on OPC incidence and burden remains unclear."
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