Human Papillomavirus (HPV) Vaccine Update

Cheryl Lau, PharmD Candidate Class of 2021; Hayden Carrion, PharmD Candidate Class of 2021; Michele Pisano, PharmD, BCGP, CDE; Carmela Avena-Woods, BS Pharm, PharmD, BCGP

Disclosures

US Pharmacist. 2020;45(9):17-20. 

In This Article

HPV and Cancer

Persistent, oncogenic, high-risk HPV infection is a main risk factor for developing HPV-associated cancers and precancers. Nearly all cases of cervical cancer are related to HPV infection, with HPV type 16 accounting for about 50% of cases and HPV type 18 accounting for 20% of cases.[1] Routine cervical screening should be started at age 21 and continue through age 65 years to prevent invasive cervical cancer. A Pap test, which involves collecting cervical cells to screen for changes or development of lesions that may lead to cervical cancer, is recommended every 3 years for women ages 21 to 65 years; women aged 30 to 65 years should also have an HPV test. Women who test negative for both the HPV and Pap tests can lengthen the screening interval to 5 years.[7]

Pap tests have played a large part in reducing cervical cancer incidence and mortality. A common misconception is that a Pap test can replace the HPV vaccine to protect against cervical cancer. Pap tests can only identify cervical precancers, and they fail to address other HPV-related anogenital or oropharyngeal cancers. While there are 12,000 new HPV-related cases of cervical cancer per year nationally, there are also 12,000 new cases of vaginal, vulvar, anal, and oropharyngeal cancers in women and 19,000 new cases of anal, penile, and oropharyngeal cancers in men.[8]

HPV types 16 and 18 cause almost 90% of anal cancers and precancerous anal lesions. Overall, women have a higher incidence of anal cancer than do men, but a lower incidence compared with men who have sex with men.[2] HPV infection accounts for approximately 39% to 43% of cases of vulvar cancer, with HPV types 16 and 18 causing approximately 35% to 77% of HPV(+) vulvar cancers; 35% to 40% of penile cancers; and 70% to 80% of HPV(+) penile cancers.[1] HPV infections also play a role in the development of oropharyngeal cancers, cancer found around the oropharynx and base of the tongue and tonsils.

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