Adolescent, young adult cancer survivors at greater risk for HPV-related malignancies

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Disclosures:
Kirchhoff reports no relevant financial disclosures.

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Key takeaways:

• Although HPV is a modifiable risk factor for certain cancers, the HPV vaccine is underutilized by AYA cancer survivors.
• Overall risk for HPV-related second cancers in survivors of AYA cancers remains low.

Survivors of cancer in adolescence and young adulthood face increased risk for subsequent HPV-related cancer diagnoses, according to research conducted at University of Utah’s Huntsman Cancer Institute.

There are about 40 strains of HPV, some of which can cause cancer. Although the immune system typically controls the virus, AYAs who have previously undergone cancer treatment may have compromised immune systems.

“We know that young cancer survivors are at risk for second cancers, and the risk for HPV-related cancers is modifiable,” lead author Anne C churchHoff, PhD, MPH, investigator in the cancer control and population sciences research program and associate professor of pediatrics at Huntsman Cancer Institute, told Healio. “Yet we’ve done studies here in Utah showing that young survivors are not getting age-recommended vaccines like the HPV vaccine once they are done with their cancer treatment. That got us thinking about the second cancers that are HPV related in this population.”

Kirchhoff spoke with Healio the study, published in Cancer Epidemiology Biomarkers & Prevention, and its potential implications for this patient population.

Healio: How did you conduct this study?

Kirchhoff: I’m a health services researcher who focuses on survivorship for younger cancer populations, and I work with cancer epidemiologists. Knowing that HPV cancers are relatively rare, we realized we need a big data set to be able to study this among cancer survivors. That’s where the national SEER database came in. It’s a wonderful resource for cancer research that collects data on cancer cases and also has information on second cancers. We were able to include SEER registry data starting all the way back in 1973. This allowed us to look at AYA patients with cancer over several decades who were diagnosed with their original cancer between the ages of 15 and 44 years. We were able to get that sample and obtain information on whether they had a second cancer that was HPV related and the risk for that compared with the general population.

Healio: What did you find?

Kirchhoff: One of the positive take-home messages from our work is that HPV-related second cancers are fairly rare in this sample. Less than 1% of the sample had a second cancer that was HPV related. Although rare, the risk among cancer survivors is 70% higher than that of the general population. We also looked at the most common HPV-related second cancers, like oropharyngeal cancer and cervical cancer. The additional risk for survivors seems to be largely coming from oropharyngeal cancers. Interestingly, cervical cancers were a bit less common, although there were certain groups of survivors that tended to have a higher rate of second cervical cancers. We also saw associations of certain treatments, like chemotherapy and radiation, with a higher rate of HPV-related cancers. That was more common among those who had already had an HPV-related cancer.

Healio: What do you think is driving this association between AYA cancer survivorship and subsequent HPV-related cancer diagnosis?

Kirchhoff: Certain treatment-related factors, therapy-related immune dysfunction or latent HPV infection could play a role in the higher risks for AYA cancer survivors. HPV vaccination, therefore, is really important for this population. In the US, the HPV vaccine was rolled out for girls starting in 2006 and for boys in 2011. Our sample looks at diagnoses through 2016, so we don’t have a huge amount of follow-up post vaccine. We also don’t have information on whether they’ve gotten the HPV vaccine. Unfortunately, that’s a limitation of this kind of cancer registry data. I think this indicates that we will need to do longer-term studies that can include information about HPV vaccines and how they affect second HPV-related cancers.

Healio: What do you think will be the implications of this study? Should there be specific recommendations for this population?

Kirchhoff: I think the biggest implication is that there are things we can do to prevent HPV-related cancers. Everyone who is eligible for an HPV vaccine should get it. The vaccine is underutilized by cancer survivors. Patients with a history of cancer need to talk to their doctors about the HPV vaccine. Based on the data we’ve shown and some other studies, they’re just not getting the vaccine at the same level as the general population, which is already not as high as we’d like it to be. A big part of it is the need for oncology and primary care to connect a bit better. We want patients to transition back into primary care knowing the types of care they will need, including age-appropriate vaccinations or catch-up vaccinations such as the HPV vaccine.

Other studies have shown that some cancer survivors aren’t getting cancer-related screenings, like cervical cancer screening, as often as they should. So, another important point is that cancer screening is key for this population.

With all this in mind, making sure the transition back to primary care happens and is managed well is extremely critical to making sure survivors know about HPV vaccination and screening. I think one of the major implications of this overall is that we have tools out there to help people with a cancer history prevent HPV-related second cancers.

References:

For more information:

Anne C Kirchhoff. PhD, MPH, can be reached at Huntsman Cancer Institute, 201 Presidents Circle, Salt Lake City, UT 84112; email: [email protected].

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