Impact of human papillomavirus on head and neck squamous cell cancers in Gabon

In Africa, most efforts in the prevention of HPV related cancer are focused on CC,
associated with HPV infection in 80 % of cases. Cervical cancer (CC) is the most frequently
diagnosed and the main cancer-related cause of death in the female population in Africa
as well as in Gabon, 4], 11], 12]. Nevertheless, in Gabon, systematic HPV screening has not been integrated yet in
the cervical neoplasia detection process. HPV DNA screening relies essentially on
PCR with specific/degenerated primer systems or on hybrid capture systems largely
used in developed countries. These systems are still too expensive to implement systematic
HPV DNA screening in Africa, 19]. However, an immunohistochemical approach could be an affordable alternative with
p16 staining as marker of active HPV infection. The public health in Africa and Gabon
is currently working on the implementation of efficient programs of early CC screening
that would group cervix cytology and HPV detection. Finally, this also should allow for
developing prevention strategies by integrating systematic anti-HPV vaccination in
the young female population. These efforts to prevent CC raise the issue of other
HPV-attributable cancers such as HNSCC.

OPSCC are the most frequent HPV-attributable HNSCC 20], 21]. The authors of a recent study on a West African cohort reported that, in Senegal,
the low prevalence (3.4 %) of HPV in HNSCC lesions in 117 patients suggested no significant
association with HPV infection, independently of upper airways anatomic sites. However,
it is important to underline the small number of OPSCC included (only 4/117 cases)
which could lead to underestimate the true impact of HPV in HNSCC 22]. To our knowledge, no team has ever evaluated the cause/effect link between HPV and
HNSCC yet, particularly for OCSCC and OPSCC, in Middle Africa including in Gabon.
Furthermore, the prevalence of HPV in HNSCC as well as the main HPV types remain undocumented.
Nevertheless, this point is essential to evaluate beforehand the potential impact
of anti-HPV vaccination in preventing HNSCC. Bi- and tetravalent vaccines currently
under clinical trials have been developed against the main genital HPV types. A new
generation nonavalent vaccine could enlarge the anti-HPV spectrum, however, it is
still necessary to document whether HPV in the upper airways could be targeted 23]. Furthermore, the HPV status would have an effective prognostic value on the treatment
response and on the survival of HNSCC patients 24], 25]. Kreimer et al. reported that even the presence of specific HPV 16/18 antibodies could predict HNSCC
development, stressing the potential clinical value of HPV status 26]. Thus, the HPV status appears as a promising tool: i) to plan an adapted prevention strategy, ii) as a biomarker for a better follow-up of HNSCC patients, particularly in non-smokers
and non-alcohol consumers 21].