HJNO May/Jun 2022

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAY / JUN 2022 57 Ashley Brown, MD Terrebonne General Mary Bird Perkins Cancer Center How does HPV infection result in cancer formation? Not all HPV types, or strains, are associ- ated with cancer. HPV-16, 18, 31, and 35 are the most common strains associated with cancer development. HPV can disrupt a nor- mal cellular process in our bodies that pre- vents uncontrolled cell growth. This occurs through the modulation of special genes known as oncogenes and tumor suppressor genes, which are involved in cell growth reg- ulation. It is currently understood that HPV can lead to the degradation of an important protein that helps to block uncontrolled cell growth or can inactivate an important tu- mor suppressor gene, which results in the release of a protein that essentially causes unregulated cell growth. HPV-16 and 18 have proven to be the most carcinogenic or “high risk” of the known strains. Interestingly, epidemiologists have found that HPV infection is nearly ubiquitous, with high infection rates seen amongst young, sexually active women from sampled cervi- cal tissue. The Centers for Disease Control (CDC) estimates that up to 85% of people will be exposed to a strain of HPV in their lifetime. All HPV infection, however, does not result in carcinogenesis. In fact, in most cases, the immune system is able to effec- tively clear the virus within a year of infec- tion. It is thought that certain lifestyle or en- vironmental factors may contribute to the risk of carcinogenesis from HPV, including smoking, HIV infection, or other causes of an immunocompromised status. Withwhat cancers is HPV associated? HPV has been found to be associated with cancers of the regions of the body that it is most likely to infect. Cancers of the oral cavity, oropharynx, cervix, penis, anal canal, vagina, or vulva are sometimes related to HPV infection. Worldwide, up to 70% of all cervical cancers are thought to be caused by high-risk HPV strains. Certain tests during the diagnosis and staging of a cancer, spe- cifically blood tests or testing from a biopsy specimen, can indicate whether a tumor is likely to be related to HPV infection. HPV testing is also a routine part of cervical can- cer screening and may guide management to prevent cancer formation in women who test positive for HPV. Screening for HPV is not routinely performed in other scenarios. Does HPV infection affect cancer care? HPV tumor status is prognostic or pre- dictive of outcomes for certain head and neck cancers. In a randomized trial, cancers of the oropharynx that are HPV mediated were shown to respond better to standard treatments and had better overall survival compared to patients with the same type of head and neck cancer that was not as- sociated with HPV infection. The staging of HPV-mediated oropharyngeal cancers versus non-HPV-mediated (therefore, likely smoking and alcohol exposure-related) are different. As such, treatment options may vary for patients who may otherwise have clinically similar disease burden depending on their tumor HPV status. There are numer- ous trials examining whether chemotherapy or radiation treatments may be reduced in number or dosage based on HPV status. To date, no data has been able to support this change conclusively, and standard of care treatments are used for patients regard- less of HPV status outside of a clinical trial setting. Can HPV infection be prevented? HPV infection can be prevented. To date, there are 3 FDA-approved HPV vaccines, which vary in the number of strains that they offer protection against (bivalent, quadriva- lent, or 9-valent). All three of these vaccines provide at least 97% efficacy in prevention of HPV-associated cervical disease and precancerous lesions and, therefore, likely subsequent development of cervical cancer; the data for anal, penile, or oropharyngeal disease is limited at this time. Per the CDC, vaccination against HPV is recommended as a part of the standard vaccination schedule for children starting at age 11 to 12 or as early as age 9. It is important for parents to dis- cuss the risks, benefits, and recommenda- tions for HPV vaccination with their child’s pediatrician or family medicine doctor. Vac- cination is currently recommended as well for adolescents up to age 26; the benefit of vaccination in adults 27-45 is less clear as individuals in this cohort are more likely to have been previously infected with HPV; a thoughtful discussion with the patient’s pri- mary care provider is warranted to discuss the recommendation for vaccination in this situation. n Ashley Brown, MD, practices at Terrebonne General - Mary Bird Perkins Cancer Center.She specializes in cancers of the central nervous system, breast, and gynecologic. Brown earned a medical degree from The Medical College of Wisconsin in Milwaukee and internal medicine preliminary training at Ochsner Clinic Foundation. She completed a residency at Stephenson Cancer Center at the University of Oklahoma Health Science Center (OUHSC) in Oklahoma City. While in residency, she served as the chief resident of the department of radiation oncology at OUHSC. Brown is a member of the American Society for Radiation Oncology, American Society of Clinical Oncology, American College of Radiology, and the National Medical Association.