Knowledge Gaps on the HPV / Head / Neck Link for Docs in Training

ATLANTA – Researchers say that medical students and resident trainees largely ignore the link between human papillomavirus (HPV) and oropharyngeal squamous cell carcinoma.

In a survey of more than 1,900 medical students and 1,000 residents, the link between HPV and cervical cancer was almost universally recognized, but only about half of respondents were aware of the link between HPV and HIV. Head and neck cancer, Benjamin Laitman, MD, Ph.D., of Mount Sinai Medical School's Icahn School in New York, reported at the 2018 meeting of the American Academy of Otolaryngology Foundation.

"What surprised me a little bit was the data on the residents, as the pediatricians, family physicians and gynecologist obstetricians we interviewed across the country knew very little about medical students on the association between HPV and cancer of the head and neck ", Laitman said MedPage today. "It's really scary since it's now the most prevalent cancer of HPV, according to the Centers for Disease Control and Prevention."

From 1988 to 2004, the incidence of HPV-positive head and neck cancers increased by 225% and the annual number of HPV-positive head and neck cancers now exceeds that of cervical cancer. In the United States, only about 60% of adolescents have initiated the HPV vaccine "so it is imperative that our doctors adequately advise patients about HPV outbreaks," Laitman said.

Since the FDA recently approved the use of HPV vaccine in adults under 45, "we may be able to start giving it to more and more adults who have delayed [their] sexual debut or changing partners later in life, where they could be exposed to different strains of the virus that can 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 real options on knowledge-based questions, as well as their practices and attitudes regarding immunization.

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 ENT programs, 37.1% from pediatric residency programs, 31.2% from family medicine and 23.8% from obstetrics / gynecology.

About 97.0% of non-ENT residents advised patients about the HPV vaccine. Although 89.1% 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. neck.

For those who discussed the vaccine but did not systematically discuss the link between HPV and head and neck cancer, 4.5% said they were worried about the safety or the safety. Vaccine effectiveness, 6.7% responded that they had no time to discuss risks and 11.1% said they were not comfortable discussing with families about how HPV is transmitted in the head and neck.

"However, the vast majority of respondents – 61.5% – said they did not have enough knowledge about the association between HPV and head and neck cancer," Laitman said. "Residents as a whole have correctly identified cervical cancer, genital cancer, genital warts and anal cancer as potential HPV sequelae, but less common manifestations of the head and neck, although ob / gyn residents chose head and neck cancer much more frequently In comparison, ENT residents had high rates of knowledge in all areas. "

According to the survey, while 100% of medical students enter the medical school knowing that HPV can cause cervical cancer, only 16% of them knew that "the only way to prevent cervical cancer is because of HPV. it caused cancer of the head and neck.

Interestingly, said Laitman, "those with the most knowledge – ENT residents – do not prescribe the HPV vaccine or prescribe it to populations in need." He asked whether otolaryngologists should inform patients about the HPV vaccine and administer it on an outpatient basis, practices that are usually reserved for primary care, pediatricians or specialists in obstetrics / gynecology. he declares.

2018-10-10T13: 30: 00-0400