HPV Vaccination beyond Cervical Cancer: Addressing the Rising Threat of Oropharyngeal Malignancies

Purpose of review: The purpose of this letter is to highlight the rising incidence of malignancies associated with Human Papillomavirus (HPV) and how it is important to modify and implement public health policies to increase awareness and prevent the incidence rate of oropharyngeal cancer specifically in male.

Recent findings: Recent findings show a rising rate of HPV-related malignancies in the US and UK over the past two decades, particularly oropharyngeal cancers in men.

Summary: To summarize, the rising threat of HPV-associated oropharyngeal cancer emphasizes the urgent need for increased public health awareness and vaccination efforts specifically in males. Public health initiatives and further research are crucial for this growing issue.

Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections globally. It is caused by a DNA-based virus that specifically targets epithelial tissues of mucous membrane and skin surfaces. Based on its association with the development of certain types of cancer and oncologic disease, it is categorized into High-risk and low-risk HPV. The low-risk type includes HPV-6 and HPV-11, which contribute to 90% of genital warts. The most common oncogenic high-risk HPV types are HPV-16 and HPV-18, which are involved in the development of malignancies like cervical, vaginal, anal, and oropharyngeal cancers [1].

Rising incidence of oropharyngeal cancer

The Age-Standardized Incidence Rates (ASRs) for oropharyngeal cancer were found to be 4.7 per 100,000 in Taiwan and 2.6 per 100,000 in India, likewise higher for other South and Southeast Asian countries including Pakistan. The incidence rate was exponentially higher in males as compared to females [2].

In the United States, HPV associated Oropharyngeal cancer detection was 71.7% during 2000-2004. More recent population-based analyses also indicate a consistent increase in the incidence of HPV-positive OPSCC cases, with positivity rising from 66.37% in 2010 to 79.32% in 2016 among tested cases [3].

In the United Kingdom, it was reported that 51.8% of cases (95% CI: 49.3–54.4) were OPSCC during 2002–2011 [4,5].

In both countries, the incidence rate of oropharyngeal cancer in men is rising rapidly. The occurrence of HPV+ OPSCC has increased over the last 20 years. It occurs more in men, possibly due to vulnerability and transmission potential through sexual activities [6].

Gender disparity in vaccination program

Gender equality are the pillars of Universal Health Coverage (UHC) and Primary Health Care System (PHC). Vaccination of the female population is a well-established point in vaccination policies, with most issues resolved. In contradiction, questions and a lack of policies arise in vaccination policies for men. Here we are discussing the lack of policies for HPV vaccination in men, as HPV is a major leading cancer-causing organism in both males and females. More importantly, males are the reservoir of HPV related infections and cancers, including oropharyngeal cancer, penile cancer, and anal cancer. It is reported that 95% of anal cancers are caused by HPV, and a greater chunk of oropharyngeal cancer is associated with HPV in males. Further, there is increasing discussion that men who have sex with men (MSM) are at greater risk of HPV related infections and neoplasia [7,8].

Missed opportunity in vaccination program

Male genital HPV infection remains relatively understudied as compared to female genital HPV infection.

HPV infections: Understanding of HPV infection in men is important, as men can develop HPV-related diseases as well. This Awareness is essentially important for men who have sex with men(MSM), as anal HPV infection is four times more prevalent among MSM than among men who have sex with women and is associated with a higher risk of HPV related cancer[9]. HPV not only involves neoplasms but also involves infertility and chromosomal disruption. An increasing prevalence of HPV in the semen of males with idiopathic infertility has been mentioned in several studies. Several authors have noted disruption of many seminal parameters, including sperm and sperm movement. Males sexual behavior actions straight away affects females related to HPV infectious pathologies. Therefore, it is essential to include males in HPV vaccination policies for their health and their partners’ safety. According to research the presence of HPV DNA in male genital tract in the seminal fluid and sperm. It also affects motility and male fertility overall. The authors found that infected individuals had higher incidence of hypospermia and also include seminal fluid viscosity [10,11].

The need to update public messaging and policy

Public health efforts and immunization plans must be updated to present HPV vaccination as cancer prevention for everyone, not only women. This includes emphasizing its protection against oropharyngeal cancer in men [12] alongside its protection against cervical cancer, as reported by these studies [13]. Right now, most of the programs focus on women [14], leaving men at risk and allowing continued transmission. To address this, we need clear communication, school vaccination programs [15] for boys, clinician reminders, directives from health ministries, and ensuring equitable vaccine access [16]. These steps will reduce stigma and boost national uptake. Furthermore, to resonate with diverse populations, communications must underscore the prevention of head and neck cancers, the benefits for sexual health, and the implications for fertility.

Call to action

Reducing HPV-related oropharyngeal cancer requires coordinated efforts in research, policy, and healthcare. Governments must offer gender-neutral HPV vaccination, fund catch-up programs for adolescent boys, and integrate vaccination into schools and primary care. Moreover, researchers should monitor oral HPV, evaluate vaccine effectiveness against oropharyngeal cancer, and conduct cost-effectiveness analyses for males. Also, healthcare providers should use reminders, promote public education, and reach out to specific groups, such as men who have sex with men, while ensuring fair coverage. Finally, international organizations must assist low-resource countries with vaccine procurement, research implementation, and ongoing funding.

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