American Association of Oral and Maxillofacial Surgeons

Position Paper

Human Papillomavirus Vaccination
Background
Human papillomavirus – the most common sexuallytransmitted disease in the United States – may be acquired
shortly after initiating sexual activity.1 This virus is aknown cause of cervical cancer in women as well assome vulvar, vaginal, penile, anal and oropharyngeal
cancers.2 An association between HPV and squamouscell carcinoma of the oral cavity has also been reported.2In fact, studies2, 3 have determined that HPV DNA has
been identified in 91 percent of both cervical and analcancers in addition to vaginal (75 percent), oropharyngeal(70 percent), vulvar (69 percent), penile (63 percent)and oral (10 percent) cancers. In 2015, 43,371 new casesof HPV-associated cancers were reported by the Centers
for Disease Control and Prevention compared to 30,115
cases in 1999.2 From 2012-16, an average of 43,999
HPV-associated cancers were reported annually to theCDC, with 34,800 (79 percent) attributable to HPV.4

Increases in Oropharyngeal Cancers
In 1999, cervical cancer (13,125 cases) was the mostcommon HPV-associated cancer, with 3,750 more casesof cervical cancer diagnosed than oropharyngeal cancer.2
In 2015, oropharyngeal cancer (18,917 cases) was themost common HPV-associated cancer, including 15,479
cases in men and 3,438 cases in women.2 From 1999
through 2015, decreases were seen in the annual rates
of cervical cancer (1.6 percent) and vaginal squamouscell carcinoma (0.6 percent) while oropharyngeal
squamous cell carcinoma rates increased 2.7 percent
in men and 0.8 percent in women. Anal and vulvar cancer
rates increased, and penile cancer rates remained stable
during this time period. Several factors might account for
the increase in oropharyngeal and anal cancers, includingchanges in sexual behaviors. Also, lack of routine
tonsillectomy in the current generation might account for
the increased prevalence of oropharyngeal cancer during
this time period.2

HPV Vaccinations
Clearly, HPV vaccination strategies will reduce theprevalence of all these HPV-associated cancers.
PAGE 1 Human Papillomavirus Vaccination

Vaccines for the prevention of human papillomavirus
were introduced in 2006 when the Food and Drug
Administration licensed quadrivalent Gardasil to protect
against HPV types 6, 11, 16 and 18. Thereafter, the FDA
licensed bivalent Cervarix (HPV types 16 and 18) in 2009
and 9-valent Gardasil (HPV types 6, 11, 16, 18, 31, 33,45, 52 and 58) in 2018. Although the CDC established
an 80 percent U.S. HPV vaccination rate as part of its
Healthy People 2020 initiative, the HPV vaccination rate
has lagged behind the vaccination rate for Tdap (tetanus,diphtheria, acellular pertussis) and MCV4 (meningococcalconjugate vaccine, quadrivalent). 5 The 2016 NationalImmunization Survey-Teen (NIS-Teen) identified coverage
rates among adolescents ages 13 to 17 of 88 percent forTdap (≥1 dose) and 82.2 percent for MCV4 (≥1 dose)compared to lower rates for HPV vaccination rates.
In 2018, 51.1 percent of adolescents ages 13 to 17 werecurrent with the HPV vaccine series, and 68.1 percent
had received one or more doses.6
The American Association of Oral and Maxillofacial
Surgeons (AAOMS) supports the following HPV
vaccination positions of the CDC and the American
Cancer Society:• HPV vaccination is safe. As of 2017, more than
270 million doses had been distributed internationally,and no serious safety concerns emerged.7• HPV vaccination is for males and females. Thesevaccines prevent infections associated with the mostcommon types of HPV that are associated with many
oral and oropharyngeal cancers. It has been estimatedthat between 80-90 percent of people will be infectedwith at least one type of HPV in their lifetime.8• HPV vaccines are recommended for boys and girls ages
11 or 12 before HPV exposure occurs. The vaccine canbe started as early as age 9 and should be completed by
the child’s 13th birthday. The vaccine is given in two
shots with six to 12 months between shots. Three shotsof the HPV vaccine are required for children who start
the vaccine at age 15 or older (up to age 26 for both
women and men).

References:
1. Satterwhite CL, Torrone E, Meites E, et al: Sexually transmitted
infections among US women and men: prevalence and incidence
estimates, 2008. Sex Transm Dise 40: 187-193, 2013.
2. Van Dyne EA, Henley SJ, Saraiya M et al: Trends in humanpapillomavirus-associated cancers – United States, 1999-2015.
MMWR 67: 918-924, 2018.
3. Duncan LD, Winkler M, Carlson ER et al: p16
Immunohistochemistry Can Be Used to Detect Human
Papillomavirus in Oral Cavity Squamous Cell Carcinoma, J Oral
Maxillofac Surg 71: 1367-1375, 2013.
4. Senkomago V, Henley SJ, Thomas CC et al: Human papillomavirusattributable cancers – United States, 2012-2016. MMWR 68: 724728, 2019.
5. Lollier A, Rodriguez EM, Saad-Harfouche FG et al: HPVvaccination: pilot study assessing characteristics of high and low
performing primary care offices. Preventive Medicine Reports 10:157-161, 2018.
6. Walker TY, Elam-Evans LD, Yankey D et al: National, regional, state,and selected local area vaccination coverage among adolescents
aged 13-17 years – United States, 2018. MMWR 68: 718-723, 2019.
7. American Cancer Society: HPV vaccination: Just the facts, 2017.
8. Chesson HW, Dunne EF, Hariri S, Markowitz LE: The estimatedlifetime probability of acquiring human papillomavirus in the UnitedStates. Sex Transm Dis 41: 660-664, 2014.

© 2020 American Association of Oral and Maxillofacial Surgeons.
No portion of this publication may be used or reproduced without
the express written consent of the American Association of Oral andMaxillofacial Surgeons.

PAGE 2 Human Papillomavirus Vaccination

Position Paper