ATLANTA -- Medical students and resident trainees are largely unaware of the association between human papilloma virus (HPV) and oropharyngeal squamous cell carcinoma, according to researchers.
In a survey returned by more than 1,900 medical students and 1,000 residents, recognition of the link between HPV and cervical cancer was nearly universal, but only about half of the respondents were aware of the relationship between HPV and head and neck cancer, Benjamin Laitman, MD, PhD, of the Icahn School of Medicine at Mount Sinai in New York City, reported here at the 2018 meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"What surprised me a bit was the resident data, in that the pediatricians, family medicine docs, and ob/gyn doctors that we surveyed throughout the country knew minimally more than medical students did about the association between HPV and head and neck cancer," Laitman told app. "That's really frightening given that this is now the most common cancer from HPV, per the Centers for Disease Control and Prevention."
From 1988 to 2004, the incidence of HPV-positive head and neck cancer increased by 225%, and the annual number of HPV-positive head and neck cancers now surpasses that of cervical cancer. Only about 60% of teens in the U.S. have initiated the HPV vaccine "so it's imperative that our physicians are adequately counseling patients on the manifestations of HPV," said Laitman.
With the FDA recently approving the HPV vaccine for use in adults up to age 45, "it's possible that we could start giving this to more and more adults who either have delayed [their] sexual debut in terms of intercourse or who change partners later in life, where they could get exposed to different strains of the virus that could lead to various forms of cancer," he said.
As part of the study, surveys were sent to medical schools and residency programs, targeting programs that would deliver the HPV vaccine. Respondents were asked to select all true options on knowledge-based questions and were also asked about their vaccine practices and attitudes.
A total of 3,034 responses were obtained: 1,944 medical students from 26 states and 1,090 residents from 46 states. Of the residents, 87 (8.0%) were from ear, nose, and throat (ENT) programs, 37.1% were from pediatric residency programs, 31.2% were from family medicine, and 23.8% were from obstetrics/gynecology.
Approximately 97.0% of the non-ENT residents counseled patients on the HPV vaccine. While 89.1% said they always mentioned the risk of cervical cancer with HPV infection when counseling patients, only 14.7% said they always mentioned the risk of head and neck cancer.
For those who did discuss the vaccine but didn't routinely discuss the association between HPV and head and neck cancer, 4.5% indicated that they were concerned about the safety or efficacy of the vaccine, 6.7% answered that they didn't have time to discuss the risks, and 11.1% said they felt uncomfortable discussing with families how HPV is transmitted in the head and neck.
"However, the vast majority -- 61.5% -- of respondents reported just not having enough knowledge about the association between HPV and head and neck cancer," Laitman said. "Residents across the board correctly identified cervical cancer, genital cancer, genital warts, and anal cancer as potential sequelae of HPV, but much more infrequently selected head and neck manifestations, although ob/gyn residents did select head and neck cancer significantly more frequently than their counterparts. In comparison, ENT residents had high knowledge rates across the board."
While 100% of medical students enter medical school knowing that HPV can lead to cervical cancer, only about 16% knew that it leads to head and neck cancer, the survey found.
Interestingly, said Laitman, "those with the most knowledge -- i.e., ENT residents -- are not prescribing the HPV vaccine or not prescribing it to populations in need." He raised the question as to whether otolaryngologists should be counseling patients about the HPV vaccine and administering it in ambulatory settings, practices routinely left to primary care, pediatricians, or ob/gyn specialists, he said.
Disclosures
Laitman reported having nothing to disclose.
Primary Source
American Academy of Otolaryngology-Head and Neck Surgery Foundation
Genden E, Laitman B “HPV+ head and neck cancer knowledge and vaccination counseling: Are we training tomorrow’s physicians about today’s epidemic?” AAO-HNSF 2018.