Clinical Perspectives

Moffitt’s HPV Research Impacts Practice and Policy Worldwide

April 27, 2020

Cancer Research Month

When people hear the phrase cancer research, they usually think about cutting-edge immunotherapies, clinical trials or lab work using cells and microscopes. What you may not realize is that some of the most influential work done at Moffitt Cancer Center has looked at a very common virus known to cause cancer – human papillomavirus (HPV).

HPV causes six types of cancer among men and women – cervical, vaginal, vulvar, penile, anal and oropharyngeal (a type of head and neck cancer occurring in the tonsils, soft palate and base of tongue). Moffitt’s research of this virus has increased the understanding of its natural history, helped determine the efficacy of the HPV-vaccine and supported licensure of two different HPV vaccines, examined provider and parental knowledge and behaviors of the vaccine, and guided policy changes in vaccine uptake. More recently, Moffitt is collaborating with partners, institutions and organizations around the world to support a goal of eliminating HPV-related cancers, beginning with cervical cancer.

Dr. Anna Giuliano, senior member of Moffitt’s Cancer Epidemiology Program and founding director of the Center for Immunization and Infection Research in Cancer, is a world-renown HPV researcher. Giuliano’s seminal work, the HPV Infection in Men (HIM) Study, was the first study to examine the natural history of HPV in men. Key findings include the following:

  • infrequent condom use, current tobacco use and herpes simplex virus 2 and chlamydia infections increase genital HPV burden;
  • circumcision provides partial protection against HPV (with protection varying by HPV type);
  • antibody status in men is related to anal and not genital infection, indicating the specificity of the immune response to natural infection based on anatomic site.

Her work has led to the licensure of the HPV vaccine for males and gender-neutral vaccination recommendations globally. Giuliano’s research also informed the expanded-age vaccination recommendations, which suggests people ages 27 to 45 discuss the HPV vaccine with their doctor to determine if they should receive it.

Giuliano’s latest efforts include a study of the natural history of oral HPV, a collaboration with researchers at Weill Cornell Medicine in New York and Universidad de São Paulo in Brazil to conduct three different clinical trials related to the prevention of HPV-related cancers in people living with HIV. She is also performing research to develop a method to screen for oropharyngeal cancer using an oral gargle sample. Additionally, she works closely with colleague Dr. Susan Vadaparampil, Associate Center Director of Moffitt’s Office of Community Outreach, Engagement and Equity, to be the leading voices in the call to eliminate HPV-related cancers. 

Activities to eliminate HPV-related cancers first began in 2018 with a call to action from the Director General of the World Health Organization. Shortly after that announcement, Giuliano drafted and led a small leadership group to finalize the HPV-Related Cancer Elimination statement, which was endorsed by all 70 National Cancer Institute-designated cancer centers. The statement was also endorsed by the American Cancer Society (ACS), American Association for Cancer Research (AACR), Prevent Cancer Foundation, American Society of Clinical Oncology (ASCO), American Society of Preventative Oncology and the Association of American Cancer Institute (AACI). In 2019, Moffitt initiated and was a key leader in a congressional briefing - "Let’s End HPV-Related Cancers." The event, which was attended by 120 people, was co-hosted by AACR, the Biden Cancer Initiative, ACS Cancer Action Network, ASCO, AACI, Prevent Cancer Foundation, St. Jude Children’s Research Hospital and the Union for International Cancer Control. And this year, Moffitt invited health care providers, insurers and other stakeholders to attend the Florida Leadership Summit to Eliminate HPV-Related Cancers, held in partnership with ACS.

Giuliano and Vadaparampil are not the only Moffitt researchers whose work addresses HPV and its related cancers. Moffitt’s Center for Immunization and Infection Research in Cancer (CIIRC) is a multidisciplinary group of researchers and scientists with expertise in immunology, radiation oncology, mathematical oncology, head and neck oncology, genitourinary oncology, molecular oncology, health outcomes and behavior and cancer epidemiology, all working together to plan a coordinated effort to eliminate HPV-related cancers.

The impact of Moffitt’s efforts is evident. The Florida Cancer Control and Research Advisory Council recently released the new five-year Cancer Control Plan for Florida. Goal No. 4 is to “Eliminate cervical cancer as a public health problem in Florida by increasing vaccination against human papillomavirus (HPV) and increasing cervical cancer screening.” While many countries have set goals to eliminate cervical cancer, Florida is the first state to make it a goal.

Learn more about Moffitt’s HPV research.