Upper age-limits for US male HPV-vaccination for oropharyngeal cancer prevention: A microsimulation-based modeling study
Menée à l'aide d'une simulation et de données portant sur les hommes américains hétérosexuels âgés de 15 à 84 ans en 2021, cette étude estime l'âge au moment de l'infection par le papillomavirus humain (HPV) puis évalue le bénéfice de la vaccination entre 27 et 45 ans pour la prévention du cancer de l'oropharynx lié au HPV
HPV-positive oropharyngeal cancer is the most common HPV-associated cancer in the United States. The age at acquisition of oral HPV infections that cause oropharyngeal cancer (causal infections) is unknown; consequently, the benefit of vaccination of US men aged 27-45 remains uncertain.We developed a microsimulation-based, individual-level, state-transition model of oral HPV16 and HPV16-positive oropharyngeal cancer among heterosexual US men aged 15-84 years, calibrated to population-level data. We estimated the benefit of vaccination of men aged 27-45 for prevention of oropharyngeal cancer, while accounting for direct- and indirect/herd-effects of male and female vaccination.In the absence of vaccination, most (70%) causal oral HPV16 infections are acquired by age 26, and 29% are acquired between ages 27-45. Among men aged 15-45 in 2021 (1976-2006 birth cohorts), status-quo vaccination of men through age 26 is estimated to prevent 95% of 153,450 vaccine-preventable cancers. Assuming 100% vaccination in 2021, extending the upper age-limit to 30, 35, 40, or 45 for men aged 27-45 (1976-1994 cohorts) is estimated to yield small benefit (3.0%, 4.2%, 5.1%, and 5.6% additional cancers prevented, respectively). Importantly, status-quo vaccination of men through age 26 is predicted to result in notable declines in HPV16-positive oropharyngeal cancer incidence in young men by 2035 (51% and 24% declines at ages 40-44 and 45-49, respectively) and noticeable declines (12%) overall by 2045.Most causal oral HPV16 infections in US men are acquired by age 26, underscoring limited benefit from vaccination of men aged 27-45 for prevention of HPV16-positive oropharyngeal cancers.