Long-term impact of HPV vaccination and COVID-19 pandemic on oropharyngeal cancer incidence and burden among men in the USA: A modeling study

Abstract

Background Oropharyngeal cancer (OPC) incidence is rising rapidly among men in the United States of America (USA). We aimed to project the impact of maintaining the current HPV vaccination uptake and achieving 80% national (Healthy People) goal on OPC incidence and burden. Methods We developed 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. We used data from nationally representative databases, cancer registries from all 50 states, large clinical trials, and literature. We evaluated the status quo scenario (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 to project OPC incidence and burden from 2009 to 2100. We also assessed the impact of disruption in HPV vaccine uptake during the COVID-19 pandemic. Findings 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. Under the status quo scenario, HPV vaccination could prevent 124 000 (UI, 117 000-131 000) by 2060, 400 000 (UI, 384 000-416 000) by 2080, and 792 000 (UI, 763 000-821 000) by 2100 OPC cases 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. 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. Interpretation Oropharyngeal cancer burden is projected to rise among men in the USA. Nationwide efforts to achieve the HPV vaccination goal of 80% coverage should be a public health priority. Rapid recovery of the declined HPV vaccination uptake during the COVID-19 pandemic is also crucial to prevent future excess OPC burden. Funding National Cancer Institute and National Institute on Minority Health and Health Disparities of the USA

Estimated projection of oral cavity and oropharyngeal cancer deaths in Spain to 2044

“…This could be especially important in younger age groups, in which mortality will tend to stabilize or decrease gradually. The long-term benefits of the HPV vaccine will largely depend on the duration of its protection [15]. Extensive vaccination campaigns with prolonged protection for at least 30 years are likely to be required to assess whether HPV vaccination has a significant impact on OPC mortality.…”

Current Evidence of a Deintensification Strategy for Patients with HPV-Related Oropharyngeal Cancer

“…Vaccination for HPV is part of an effort to decrease the incidence of oropharyngeal cancer, but only adolescents and young adults (aged < 26 years) were candidates. Modeling studies anticipate a consistent increase in the incidence of oropharyngeal cancer in the older age group for at least one to two decades [ 67 , 68 , 69 ].…”

Impact of the COVID-19 pandemic on cancer incidence and mortality

“…Luo and colleagues' findings have application for countries beyond Australia and for diseases beyond colorectal cancer. The pandemic hindered vaccinations for the human papillomavirus (HPV), 7 , 8 which is essential to reducing risks of cervical and oropharyngeal cancers. 8 Compounding reductions in HPV vaccination, cervical cancer screening was also disrupted during the pandemic.…”

“…The pandemic hindered vaccinations for the human papillomavirus (HPV), 7 , 8 which is essential to reducing risks of cervical and oropharyngeal cancers. 8 Compounding reductions in HPV vaccination, cervical cancer screening was also disrupted during the pandemic. 9 For example, HPV vaccination coverage among girls aged 12–13 years in the UK dropped from 88% in the 2018–19 school year to 59% in the 2019–20 school year; 10 this occurred alongside a reduction in rates of cervical screening in the adult population.…”

“…Modelling projections for the USA indicate up to 6200 additional oropharyngeal cancer cases among men by the year 2100 due to the HPV vaccine campaign interruption. 8 …”