High Risk Human Papillomavirus in Head and Neck Squamous Cell Carcinoma Patients at Kenyatta National Hospital, Kenya

 Background : Human Papillomavirus (HPV) has been associated with a subset of Head and Neck Squamous Cell Carcinoma (HNSCC) in particular Oropharyngeal Carcinoma. Objective: To determine the prevalence and Clinicopathological predictors of high-risk HPV among patients with HNSCC at Kenyatta National Hospital (KNH) Nairobi, Kenya. Materials: One hundred and sixty(160) patients who presented themselves to the ENT clinic between 2015 and 2017 with HNSCC had their history taken. A complete physical examination was done along with the appropriate haematological and radiological work-up. Two tissue biopsies were taken from the primary tumour for histology and real time polymerase chain reaction. Methodology: One hundred and sixty(160) patients with HNSCC aged 16 to 87 years were recruited and set in groups of six. These groups were based on the primary site of the tumour present such as; Oral cavity, Oropharynx, Nasopharynx, Hypopharynx, Larynx and Sinonasal. There were 117 (73.1%) males and 43 (26.9%) female participants. Twelve 12(7.5%) patients tested positive for high risk HPV. The HPV genotypes detected were 56, 52 and 33. There were no predictors for HPV positivity. Conclusion: High risk HPV prevalence was low among HNSCC patients at Kenyatta National Hospital. No HPV 16 nor 18. The positive patients did not have profiles that matched those of HPV-positive HNSCC globally. Key Words: Human papillomavirus, carcinoma, head and nec

African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings

Background International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. Methods Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. Results Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. Conclusions Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources

Human Papillomavirus-Associated Oropharyngeal Cancer: Global Epidemiology and Public Policy Implications.

Global trends in human papillomavirus (HPV)-associated head and neck cancers (HNC), specifically in the oropharynx subsite, have been dynamically changing, leading to new staging and treatment paradigms. Epidemiologic studies have noted regional variations in HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). While HPV vaccination remains the main preventative approach, vaccination policy in relation to gender neutrality is heterogeneous and particularly sparse in low- and middle-income countries, where the burden of global cancer cases and HPV-associated HNC are not well-characterized in certain regions. This review summarizes the existing literature on regional variations of HPV-associated OPSCC and gender-neutral vaccine policies. Based on available data, the incidence of HPV-associated OPSCC is highest in North America, Europe, and Oceania. As of 2022, 122 of 195 (63%) World Health Organization (WHO) member states had incorporated HPV vaccinations nationally; of these, 41 of 122 (34%) member states have introduced gender-neutral vaccine coverage. Future research is needed to describe continued evolving trends in HPV-associated OPSCC, understand underlying risk factors leading to regional variation in disease, and implement gender-neutral policy more broadly

Human Papillomavirus–Associated Head and Neck Malignancies in Sub-Saharan Africa: A Systematic Review

PurposeThe proportion of head and neck cancers (HNCs) with human papillomavirus (HPV) positivity in sub-Saharan Africa (SSA) is poorly characterized. Characterizing this has implications in staging, prognosis, resource allocation, and vaccination policies. This study aims to determine the proportion of HPV-associated HNC in SSA.Materials and methodsThis systematic review included searches from PubMed, EMBASE, Web of Science, African Index Medicus, Google Scholar, and African Journals Online. All English publications reporting the proportion of HNC specimens from SSA patients who tested positive for HPV and/or p16 were included. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Case Series Studies.ResultsIn this systematic review of 31 studies and 3,850 patients, the overall p16 positivity was 13.6% (41 of 1,037 patients tested) with the highest proportion among oropharyngeal cancers (20.3%, 78 of 384 patients) and the overall HPV polymerase chain reaction positivity was 15.3% (542 of 3,548 samples tested) with the highest proportion among nasopharyngeal cancers (16.5%, 23 of 139 patients). Among the 369 HPV strains detected, the most common genotypes were HPV 16 (226 patients, 59.2%) and HPV 18 (78, 20.4%).ConclusionHPV was found to be associated with a significant proportion of HNC in SSA. The genotypes reported suggest that the nine-valent vaccine and gender-neutral vaccination policies should be considered. Given that these studies may not accurately capture prevalence nor causation of HPV in HNC subsites, additional research is needed to provide a more thorough epidemiologic understanding of HPV-associated HNC in SSA, including risk factors and clinical outcomes