Human Papillomaviruses in Head and Neck Carcinomas

Abstract

adenocarcinoma in situ related to vaccine HPV types was reported in both trials. However, it would be important to know the overall rates of grade 2 or 3 cervical intraepithelial neoplasia or adenocarcinoma in situ regardless of HPV types. Without these data, it is difficult to infer both the effectiveness of vaccination and the role of nonvaccine HPV types in overall rates of prein-vasive lesions. What do these results mean for cervical-cancer screening? Screening should continue in all vac-cinated women, given the cumulative lifetime risk of exposure to other oncogenic HPV types and the unknown duration of anti-HPV immu-nity. The effect of vaccination on cervical cyto-logic findings was not reported in either trial, but if vaccination reduces the rates of abnormal findings, this benefit would be important. Of note, a trial of a monovalent HPV-16 vaccine re-ported no effect on cytologic abnormalities. 12 Policymakers, clinicians, and parents have a keen sense of urgency about HPV vaccination. On one hand, the vaccine has high efficacy against certain HPV types that cause life-threatening dis-ease, and it appears to be safe; delaying vaccina-tion may mean that many women will miss an opportunity for long-lasting protection. On the other hand, a cautious approach may be warrant-ed in light of important unanswered questions about overall vaccine effectiveness, duration of protection, and adverse effects that may emerge over time. HPV vaccination has the potential for profound public health benefit if the most opti-mistic scenario of effectiveness is realized.