{"id":1196,"date":"2016-10-14T15:26:23","date_gmt":"2016-10-14T14:26:23","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1196"},"modified":"2016-10-14T15:26:23","modified_gmt":"2016-10-14T14:26:23","slug":"prevention-of-anogenital-cancers-in-women-may-be-an-additional-benefit-of-hpv-vaccination","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2016\/10\/14\/prevention-of-anogenital-cancers-in-women-may-be-an-additional-benefit-of-hpv-vaccination\/","title":{"rendered":"Prevention of anogenital cancers in women may be an additional benefit of HPV vaccination"},"content":{"rendered":"

Cervical cancer is evidently the most important, but by no means the only, health risk that vaccination against HPV aims to avert. The potential impact of vaccination on other cancers (not to mention genital warts) may also be a factor in estimating the cost benefit of achieving higher vaccination coverage, as well as determining priorities for vaccination programmes (e.g. the relative importance of achieving high coverage for males).\u00a0 Recent studies have investigated the role of HPV in the rising incidence of head and neck \u2013 especially oropharyngeal \u2013 cancers (Field & Lechner\/STIs<\/a>; King & Sonnenberg\/STIs<\/a>), and in the development of anal cancers amongst MSM (Poynten & Garland\/STIs<\/a>).\u00a0 The dramatic impact of vaccination programmes on the prevalence of genital warts has already been attested both in Australia, where vaccination was introduced in 2007 (Chow & Fairley\/STIs<\/a> ), and, more recently in the UK (Canvin & Mesher\/STIs<\/a> ).<\/p>\n

In addition to these benefits of HPV vaccination, a recent Danish nationwide cohort study (Sand & Kjaer<\/a> (S&K)) draws attention to another relatively limited, but nevertheless significant, benefit in the shape of a range of anogenital cancers in women \u2013 i.e. anal, vaginal and vulvar cancers.\u00a0 These seem to be strongly associated with the occurrence of high grade cervical intraepithelial neoplasia (CIN2 & 3), and should therefore be numbered\u00a0amongst the adverse effects of HPV that vaccination may help to prevent.\u00a0 Given the relative rarity of these cancers (total yearly incidence in UK, both male and female, is currently about a quarter of that of oropharyngeal cancers), an important advantage of S&K\u2019s study is its impressive scale.\u00a0 It\u00a0investigates no less than 2.8 million women born 1918-1990 over the period from 1978 to 2012. Also, unlike similar studies, it is able to\u00a0control not only for age, but for a range of potential confounders such as socio-economic status and smoking.\u00a0 The use of CIN2\/CIN3 as a proxy for HPV infection seems well supported by the evidence (Tachezy & Vonka\/STIs<\/a>; Azwa & Harun (STIs)<\/a>).<\/p>\n

The key findings of the study were as follows.\u00a0 Relative risk of anal, vulvar and vaginal cancers following CIN2\/3 as against no such history was found to be greatly increased: RR 2.8<\/strong>, 2.5<\/strong>, 8.3<\/strong> after CIN2; 4.1<\/strong>, 3.9<\/strong>, 17.4<\/strong> after CIN3.\u00a0 Risk was particularly high in the first year after CIN; but the increased risk persisted, suggesting the effect could not be attributed to surveillance bias.\u00a0 So, for example, analysis showed increased risks of anal, vulvar and vaginal cancers at \u226525 years after CIN3 diagnosis of RR 4.8<\/strong>, 3.2<\/strong>, and 5.5<\/strong>, respectively.\u00a0 In non-cervical anogenital cancer, HPV16 was the most frequently detected HPV type.\u00a0 The fact that cancer risk following CIN3 is substantially greater than it was following CIN2 suggests to the authors that the cause of both may be attributable to an inadequate immune response to HPV in certain women, leading to a failure to clear the infection.\u00a0 The propensity of persistent HPV to spread to the entire anogenital region explains the range of cancers (anal, vaginal, vulvar) in respect to which these women seem to be at heightened risk (see Simpson & Turner\/STIs<\/a> ).<\/p>\n","protected":false},"excerpt":{"rendered":"

Cervical cancer is evidently the most important, but by no means the only, health risk that vaccination against HPV aims to avert. The potential impact of vaccination on other cancers (not to mention genital warts) may also be a factor in estimating the cost benefit of achieving higher vaccination coverage, as well as determining priorities […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[151,2316,4362,4358],"tags":[],"class_list":["post-1196","post","type-post","status-publish","format-standard","hentry","category-epidemiology","category-hpv","category-hpv-and-cancer","category-hpv-vaccination"],"yoast_head":"\nPrevention of anogenital cancers in women may be an additional benefit of HPV vaccination - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2016\/10\/14\/prevention-of-anogenital-cancers-in-women-may-be-an-additional-benefit-of-hpv-vaccination\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Prevention of anogenital cancers in women may be an additional benefit of HPV vaccination - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"Cervical cancer is evidently the most important, but by no means the only, health risk that vaccination against HPV aims to avert. 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