HPV-relateret kræft i hoved og hals

Anne Mette Hvid Larsen, Kasper Lindgaard Lauridsen, Sofie Nancy Glud Heiredal, Ane Berger Bungum, Lærke Bloch Noer & Sofie Hvid Tolstrup

Studenteropgave: Semesterprojekt

Abstrakt

De nyeste tal fra Danmarks cancerregister viser, at der nærmest er sket en fordobling af pati-enter med hovedhalskræft fra 479 patienter i 1978 til 738 patienter i 2010. Samtidig ses en halvering i patienter med livmoderhalskræft fra 676 i 1975 til 357 patienter i 2010. Endvidere har det i mange år været vist, at Human Papillomavirus (HPV) kan lede til livmoderhalskræft, og man har derfor udviklet de forebyggende vacciner, Gardasil® og Cervarix®. Gardasil® har siden 2009 indgået som en del af det danske børnevaccinationsprogram og bliver derfor tilbudt og finansieret af staten til alle piger. Nyere forskning har nu vist, at 30 % - 90 % af hovedhalskræfttilfælde, skyldes HPV, og i 75 % af tilfældene har drenge og mænd været de ramte. Alligevel indgår HPV-vaccinen ikke i drengenes børnevaccinationsprogram, da det er vurde-ret, at der endnu ikke findes tilstrækkelig evidens for, at vaccinerne vil kunne bremse den sti-gende tendens indenfor HPV-relateret hovedhalskræft. Idet det er den samme virus, der forår-sager kræft i begge regioner, kunne man forestille sig, at vaccinen ville have samme effekt begge steder. Helt så simpelt er det dog ikke, og formålet med denne opgave er at komme nærmere et svar om, hvorvidt man med fordel kan tilbyde vaccinen til mænd også. Man tilby-der allerede vaccinen til drenge i USA, Canada og Australien, som har set samme stigning af HPV-positive tilfælde af hovedhalskræft. I undersøgelser derfra konkluderes, at stigningen af hovedhalskræft skyldes HPV, og endvidere at omkostningerne ved at tilbyde vaccinen til alle er mindre, end hvis man ikke gør. Før vaccinen blev tilbudt alle piger, har man lavet en række kvantitative forsøg, som viste effektiviteten af HPV-vaccinen overfor livmoderhalskræft. Desværre er lignende undersøgel-ser endnu ikke foretaget, og dette er ikke ligeså enkelt. Ud fra sammenligninger af, hvorledes HPV inficerer i hovedhalsregionen og livmoderhalsregionen, er der tegn på, at en HPV-infektion i hovedhalsområdet forløber på samme vis som i livmoderhalsen. Men dette er sta-dig et område, der ikke er kortlagt til detalje. Det er dog allerede vist, at vaccinen har en gavn-lig effekt hos drenge i forhold til kondylomer og anal- og peniskræft. Konklusionen er derfor, at det bør genovervejes om ikke vaccinen burde blive en fast del af børnevaccinationspro-grammet for både drenge og piger. The latest numbers from the Danish Cancer Registry shows an increase of patients with head and neck cancer. In 1978 there were 479 patients and in 2010 this number of patients was 738. In the same period of time, there has been a decrease in patients with cervical cancer from 676 patients in 1975 to 357 patients in 2010. Additionally it has been known for a long time that Human Papilloma Virus (HPV) can lead to cervical cancer, which is why preventive vaccines, such as Gardasil® and Cervarix®, have been made. Since 2009 Gardasil® has been a part of the Danish children’s health program, and the state therefore offers and finances the vaccine to all girls. Recent research has shown that 30 % - 90 % of all cases of head- and neck cancer are caused by HPV where 75 % of these patients are boys. However, a lack of evidence of the vaccine possibly turning around the increasing tendency regarding to HPV-related head-and neck cancer, the HPV-vaccine is not a part of the boys’ health program. Since it is the same types of HPV causing cancer in both regions, one would think the vaccine could have the same effect in preventing cancer. Unfortunately it is not that simple, and therefore the main focus of this report is trying to determine whether men would benefit from the vaccine. In the United States, Canada and Australia, whom have seen the same increase of HPV-caused head- and neck cancer, the vaccine is already offered to boys. From their studies they conclude that the increase in head- and neck cancer patients is caused by HPV, and furthermore they conclude that the cost of offering the vaccine to both girls and boys, are much smaller than if you do not. Before the vaccine was offered to all girls, a number of quantitative studies were made, which showed the impact of HPV vaccine on cervical cancer. Unfortunately, we found that a similar study is not yet made in Denmark and that this is not as simple as for the cervical cancer. From a comparison of how HPV infects in the head- and neck region and in the cervical re-gion, there are signs that these types of HPV-infections is proceeding equally. This knowledge is still not defined into detail, but it is known that the HPV-vaccine has a great efficiency towards condyloma, anal and penis cancer. It is to discuss if the HPV-vaccine should be reconsidered as a regular part of the Children’s Health Program for both boys and girls.

UddannelserBasis - Naturvidenskabelig Bacheloruddannelse, (Bachelor uddannelse) Basis
SprogDansk
Udgivelsesdato11 jan. 2013

Emneord

  • Livmoderhalskræft
  • Hovedhalskræft
  • Human Papillomavirus
  • HPV