Cohort profile: indigenous human papillomavirus and oropharyngeal squamous cell carcinoma study - a prospective longitudinal cohort

Abstract

PurposeOur aims are to: (1) estimate prevalence, incidence, clearance and persistence of oral human papillomavirus (HPV) infection among Indigenous Australians; (2) identify risk factors associated with oropharyngeal squamous cell carcinoma (OPSCC)-related HPV types (HPV 16 or 18); (3) develop HPV-related health state valuations and; (4) determine the impact on OPSCC and cervical cancers, and the cost-effectiveness of extending publicly-funded HPV vaccination among Indigenous Australians.ParticipantsParticipants were recruited from February 2018 to January 2019. Twelve-month follow-up occurred from March 2019 to March 2020. Participants provided socio-demographic characteristics, health-related behaviours including tobacco and alcohol use and sexual history. Health state preferences in regard to HPV vaccination, knowledge regarding HPV infection, OPSCC and cervical cancer were collected using a two-stage standard gamble approach. Participants provided saliva samples and DNA for microbial genotyping was extracted.Findings to dateOf the 910 participants who were positive for β-globin at baseline, 35% had any oral HPV infection. The most prevalent HPV types were 13 or 32 (Heck’s disease; 23%). The second most prevalent types were associated with OPSCC (HPV 16 or 18; 3.3%). Of the 645 participants who were positive for β-globin at 12-month follow-up, 43% had any HPV infection. Of these, 33% were HPV types 13 or 32 and 2.5% were HPV 16 or 18. Some 588 participants had β-globin positive oral samples at baseline and 12-month follow-up. The prevalence of any oral HPV infection increased from 34% at baseline to 44% at 12-month follow-up; due to increases in HPV types 13 or 32 (20% at baseline and 34% at 12-month follow-up).Future plansFurther funding will be sought to continue follow-up of this cohort, and to include (after a full medical history) a thorough clinical examination of the external head and neck; a complete oral examination and examination of the oropharynx. Blood tests for early stage OPSCC will also be undertaken.

The effectiveness of HPV vaccination on the incidence of oropharyngeal cancers in males: A review

“…25 Unfortunately this study did not distinguish between vaccinated and unvaccinated individuals when describing HPV-positivity, thus it is unclear whether lack of vaccination led to this percentage increase. 25 Katz et al in 2020, used a cross-sectional study format and interrogated the correlation of OPC with HPVvaccination using hospital databases (Table 5) 26 . They found a relative risk ratio increase of 23.8 (P = 0.0015) of developing oropharyngeal cancer in the male subgroup if they were not vaccinated 26 .…”

“…An ongoing prospective longitudinal cohort study into Indigenous Australians by Jamieson et al, demonstrated evidence of HPV-vaccination in only 8.3% of participants, but did not distinguish between males and females (Table 5). 25 The researchers followed 910 individuals over 12 months obtaining data on HPV-positivity, HPV-vaccination as well as various other healthcare related data. They noted that 3.3% of males were positive for oral HPV16/18 and this increased to 3.9% at 12 months follow up.…”

“…The included studies have given rise to the following themes: a link between HPV and OPC; a potential bene t to the vaccination of males to reduce rates of OPC and the likely cost-effectiveness of pangender HPV-vaccination 15,24,25,26,27,28,29,30 . These themes will be discussed further below.…”

The Prevalence of High- and Low-Risk Types of HPV in Patients with Squamous Cell Carcinoma of the Head and Neck, Patients with Chronic Tonsillitis, and Healthy Individuals Living in Poland

“…One interesting finding of our study is the high prevalence (37.5%) of HPV infection in the normal oral mucosa of healthy individuals. Other studies of cancer-free individuals reported values from 0% to 81.1% in normal oral mucosal cells, exfoliated cells from normal tonsils, or oral gargles and tonsillar washings [ 37 , 38 , 45 , 46 , 86 , 90 , 91 , 92 , 93 ]. In Polish population, a low frequency (1.08%) was observed in normal oral squamous cells [ 38 ], while a higher prevalence in oropharyngeal swabs was observed in couples (19.8% in women and 28.4% in men) and in 5.6% of couples, both partners were infected (in 81.8% of cases with identical HPV types).…”

Focal Epithelial Hyperplasia

“…Even so, it is currently unknown what effect FEH lesions coinfected with high-risk genotypes, such as HPV16 or HPV18, have on a possible malignant transformation, and the correlation to other HPV-positive oral indications, since they have not been systematically reported. This type of study is currently ongoing among indigenous Australians [ 25 ].…”