Primary prevention
Smoking, alcohol use, and social history should be obtained at initial consultation. Smoking cessation and alcohol counselling should be offered, as patients are at risk of secondary primaries because of field cancerisation. There is currently no recommendation for human papillomavirus (HPV)-positive patients to change their sexual behaviour.
The 9-valent HPV vaccine can prevent high-risk HPV infection and, thus, the development of HPV-associated oropharyngeal cancer. Patients should be educated on the safety and importance of the vaccine, particularly in children prior to the age of sexual debut. Early postmarket studies demonstrated the success of the vaccine in decreasing the incidence of HPV-associated cancers, including oropharyngeal cancer, in vaccinated cohorts.[31][32] Larger public health vaccination efforts are expected to drive down the rising incidence of HPV-associated oropharyngeal cancer over the next few decades.
In Europe, the 9-valent HPV vaccine is approved in men and women from the age of 9 years to protect against pre-cancerous lesions and cancers in the cervix, vulva or vagina and anus, as well as against genital warts, caused by nine types of HPV (types 6, 11, 16, 18, 31, 33, 45, 52 and 58). In the US, the vaccine is also indicated for the prevention of oropharyngeal cancers and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58. The oropharyngeal cancers and head and neck cancer indication for the 9-valent vaccine in the US is an accelerated approval based on effectiveness of the vaccine in HPV-associated anogenital disease. Continued approval for this indication may change, based on the results of a confirmatory trial.
The primary target population recommended by the World Health Organization (WHO) for the vaccine is girls aged 9-14 years, prior to becoming sexually active. Vaccination of secondary target populations (e.g., females aged 15 years or more, or males), is recommended by the WHO only if this is feasible, cost-effective, and does not divert resources from vaccination of the primary target population or from cervical cancer screening programmes.[33]
Local vaccination guidelines may vary and should be consulted. In England, from 2019, all boys and girls aged 12-13 years are routinely offered the HPV vaccination. People who miss their vaccination offered at school can get the HPV vaccination for free until they turn 25. Men who have sex with men up to and including the age of 45 years are eligible for free HPV vaccination when they visit sexual health or HIV clinics in England.[34]
The US Centers for Disease Control and Prevention (CDC) recommends routine vaccination against HPV for girls and boys aged 11 or 12 years, but early vaccination from the age of 9 onwards may be considered.[35] The American Academy of Pediatrics recommends routine HPV vaccination between the ages of 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series.[36] The CDC recommends catch-up HPV vaccination for all persons up to and including the age of 26 years who are not adequately vaccinated.[8] Shared clinical decision-making regarding HPV vaccination is recommended for some adults aged 27-45 years who are not adequately vaccinated and who are most likely to benefit from vaccination.[37][38]
Secondary prevention
Patients should be counselled about the importance of abstention from smoking and alcohol consumption to reduce the incidence of second primaries. Patient support such as Alcoholics Anonymous, cancer survivor groups, and psychological counselling may help.
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