Recognizing the Crucial Role of Dentists in HPV-Related Cancer Prevention Letter to the Editor References: 1. Increase in oropharyngeal cancers. CDA Essentials. 2024;11(1):22-23. [accessed 2024 Apr 18]. Available: cda-adc.ca/en/services/ essentials/2024/issue1/22 2. Chaturvedi AK, Graubard BI, Broutian T, Pickard R, Tong Z-Y, Xiao W, et al. Effect of prophylactic human papillomavirus (HPV) vaccination on oral HPV infections among young adults in the United States. J Clin Oncol. 2018 Jan 20;36(3):262-67. 3. Nielsen K, Jakobsen K, Jensen J, Grønhøj C, Von Buchwald C. The effect of prophylactic HPV vaccines on oral and oropharyngeal HPV infection—a systematic review. Viruses. 2021;13(7):1339. 4. Tsentemeidou A, Fyrmpas G, Stavrakas M, Vlachtsis K, Sotiriou E, Poutoglidis A, et al. Human Papillomavirus Vaccine to End Oropharyngeal Cancer. A systematic review and meta-analysis. Sex Transm Dis. 2021 Sep 1;48(9):700-07. 5. Parker K, Kemp T, Isaacs-Soriano K, Abrahamsen M, Pan Y, Lazcano-Ponce E, et al. HPV-specific antibodies at the oral cavity up to 30 months after the start of vaccination with the quadrivalent HPV vaccine among mid-adult aged men. Vaccine. 2019;37(21):2864–69. 6. Guo F, Chang M, Scholl M, McKinnon B, Berenson AB. Trends in oropharyngeal cancer incidence among adult men and women in the United States from 2001 to 2018. Front Oncol. 2022 Jul 18;12:926555. 7. Katz J. The impact of HPV vaccination on the prevalence of oropharyngeal cancer (OPC) in a hospital-based population: A crosssectional study of patient’s registry. J Oral Pathol Med. 2021 Jan;50(1):47-51. 8. HPV vaccinations at the dental office. CDA Essentials. 2023;10(3):37-38. [accessed 2024 Apr 18]. Available: cda-adc.ca/en/services/ essentials/2023/issue3/37 We are respectfully writing this letter to the editor on behalf of the Canadian Dental Advisory Committee on HPV Vaccination and the Federation of Medical Women of Canada (FMWC) Task Force: The Need for Action to Prevent HPV-Related Cancers in Ontario (canadavshpv.ca/taskforce). A recent article1 published in CDA Essentials Issue 1, 2024, has raised some concerns regarding messaging on the importance of the HPV vaccine. It is essential to provide updated evidence to our readers, especially in light of the groundbreaking advocacy work being done across Canada for dentists to be supported in prescribing and administering the HPV vaccine for the prevention of HPV-related oropharyngeal cancers (OPC). It was stated in this article that, “…HPV vaccines have not been proven to prevent oropharyngeal cancer...” We would like to clarify, while phase 3 trial data is still awaited, there is sufficient evidence to demonstrate that HPV vaccination has led to a decrease in HPV infection in the oral cavity. Health Canada has provided an indication (GARDASIL-9) for the Human Papillomavirus 9-valent Vaccine for the prevention of oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58. Multiple population-level studies have shown that individuals who received the HPV vaccine have a lower burden of oral HPV infection.2–5 For instance, a study conducted in the U.S. found that HPV vaccination was associated with an estimated 88% reduction in the prevalence of HPV 6/11/16/18-related oral infections among vaccinated young adults, and a 100% reduction among vaccinated men.2 Moreover, population-level data regarding the impact of HPV vaccination on oropharyngeal cancer is available. Studies have indicated a reduced prevalence of OPC among the HPV-vaccinated group as compared to the non-vaccinated group. Additionally, analyses based on national databases have shown a decline in OPC incidence among young adults during the vaccination era compared to the pre-vaccination era.6,7 It is worth noting that dentists in Alberta have already been granted the authority to prescribe, dispense, and administer vaccines within the practice of dentistry. Dr. Lee Darichuck became the first registered dentist in Canada to administer the HPV vaccine within a dental practice in August 2022.8 Similarly, the BC Dental College Registrar acknowledged in March 2023 that HPV vaccine counselling and prescribing are within the dental profession’s scope of practice. Lastly, it is important to clarify that early detection of HPV-related oropharyngeal cancers is challenging, unlike cervical cancer. Currently, there are no effective screening tools available for early detection of HPV-related oropharyngeal cancers, highlighting the need for vaccination. Typically, HPV-related oropharyngeal cancers are discovered at a late stage with lymph node involvement and tumour invasion into the base of the tongue. Considering these important points, we respectfully request that this article be clarified to ensure that the hard work of our dentists and other health professional advocates for increasing vaccination rates for the prevention of preventable cancers is duly recognized and amplified. Dentists have a critical role to play in the sphere of cancer prevention, and it is imperative to highlight their contributions. Vivien Brown, MDCM, CCFP, FCFP, MSCP; Assistant Professor, University of Toronto, Department of Family and Community Medicine; Chair, FMWC HPV Task Force Deborah Saunders, DMD; Medical Director, Department of Dental Oncology, Health Sciences North, Associate Professor Northern Ontario School of Medicine University; Member, FMWC HPV Task Force Cheryl Cable, BSc, DDS, MBA, FRCD(C), Certificate maxillofacial prosthodontics and prosthodontics; Associate Professor, University of Alberta, Faculty of Medicine and Dentistry; Lead, Alberta Head and Neck Cancer Dental Leadership Team 40 | 2024 | Issue 3
RkJQdWJsaXNoZXIy OTE5MTI=