MedicalResearch.com Interview with:
Lillian Siu, MD, FRCPC
Princess Margaret Cancer Centre
University Health Network
Medical Research: What is the background for this study? What are the main findings?
Dr. Siu: Our study is a collaboration between researchers at the Princess Margaret Cancer Centre and the Canadian Center for Applied Research in Cancer Control. The study involves a statistical model being applied to a hypothetical population of 192,940 Canadian boys who were 12 years old in 2012, to determine the cost effectiveness of HPV vaccination for the prevention of oropharyngeal cancer. On the basis of this model, HPV vaccination for boys aged 12 years appears to be a cost-effective strategy for the prevention of oropharyngeal cancer in Canada. There are limitations to our study as it is based on statistical modelling with many assumptions. For instance, we could not easily address the impact of herd immunity which refers to the indirect protective effect offered by HPV vaccination in women.
Based on our statistical model, despite its limitations, the vaccine can potentially save $8 to $28 million CAD for a theoretical group of 192,940 Canadian 12-year old boys in 2012 over their lifetime. As stated, this is based on a theoretical model and not a randomized study, the results are relevant especially that HPV-related oropharyngeal cancer is increasing in incidence and HPV is surpassing smoking as a risk factor for this cancer in many developed countries.
Currently, the National Advisory Committee on Immunization (NACI) of the Public Health Agency of Canada recommends HPV vaccination of females 9 through 26 years of age to prevent cervical, vulvar, vaginal and anal cancers, and for anogenital warts; and of males 9 through 26 years of age to prevent anal canal cancers and their precursors, and for anogenital warts. However, funding is also provided for HPV vaccination in young females and not in young males.
Medical Research: What should clinicians and patients take away from your report?
Dr. Siu: As with all vaccinations to prevent diseases, the decision to vaccinate or not to vaccinate should involve an informed discussion between physicians and patients (and parents/families of young patients in the case of pediatrics) regarding benefits and risks. Pediatricians are familiar already with this vaccination given its application in young girls. The data on HPV vaccination in adolescent boys to prevent human papillomavirus (HPV)-related oropharyngeal cancers (a type of cancer which starts at the back of the throat) are mainly indirect as randomized clinical trials have not been done. Pediatricians will need to make recommendation decisions based on their understanding of the available evidence about the value of HPV vaccination in adolescent boys. Doctors should discuss the benefits and risks of HPV vaccination of adolescent boys with their patients and families. Currently the vaccine for adolescent boys is not funded in Canada and it is a personal decision whether patients want to receive such a vaccine, based on the recommendations by their doctors.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Siu: We hope this project will increase awareness from policy makers to further evaluate the funding support for HPV vaccination in adolescent boys in Canada. It is unlikely that a randomized clinical trial in this population will be ever done due to the challenges and feasibility in completing such a study, so indirect evidence such as that provided by statistical models may represent the main source of information to make such decisions.
Donna M. Graham, Wanrudee Isaranuwatchai, Steven Habbous, Claire de Oliveira, Geoffrey Liu, Lillian L. Siu, Jeffrey S. Hoch. A cost-effectiveness analysis of human papillomavirus vaccination of boys for the prevention of oropharyngeal cancer. Cancer, 2014; DOI: 10.1002/cncr.29111
MedicalResearch.com Interview with: Lillian Siu, MD, FRCPC (2015). HPV Vaccine Prevention Of Oropharyngeal Cancer In Boys May Be Cost Effective