Oropharyngeal cancer epidemic and human papillomavirus

Abstract

A growing body of research shows that human papillomavirus (HPV) is a common and increasing cause of oropharyngeal squamous cell carcinoma (OSCC). Thus, the International Agency for Research against Cancer has acknowledged HPV as a risk factor for OSCC, in addition to smoking and alcohol consumption. Recently, in Finland, the United Kingdom, the Netherlands, the United States, and Sweden, incidence of OSCC has increased, and an increase in the proportion of HPV-positive tumors was noted. On the basis of these data and reports indicating that patients with HPV-positive cancer have their first sexual experience at a young age and have multiple partners, we postulate that increased incidence of OSCC in the United States and some countries in northern Europe is because of a new, primarily sexually transmitted HPV epidemic. We also suggest that individualized treatment modalities and preventive vaccination should be further explored.

Figure 1

Survival rates for patients with human papillomavirus (HPV)–positive tonsillar cancer compared with those for patients with HPV-negative cancer. Circles indicate patients who died of tonsillar cancer during the follow-up period; plus signs indicate patients who were removed from the study for other reasons (e.g., died from a cause other than tonsillar cancer, left the country); p<0.0005. Data from Lindquist et al. (13), with permission of Elsevier (www.elsevier.com).

Figure 2

Age-standardized incidence of tonsillar and base of tongue cancers, Stockholm, Sweden, 1970–2006.

Figure 3

Estimated age-standardized incidence of human papillomavirus (HPV)–positive and HPV-negative tonsillar cancer squamous cell carcinoma cases per 100,000 person-years, Stockholm, Sweden, 1970–2006. Error bars indicate 95% confidence intervals. Data from Näsman et al. (13), with permission of John Wiley and Sons (www.interscience.wiley.com).