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. 2013 Aug;20(4):212-9.
doi: 10.3747/co.20.1375.

The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population

A C Nichols  1 , D A Palma, S S Dhaliwal, S Tan, J Theuer, W Chow, C Rajakumar, S Um, N Mundi, S Berk, R Zhou, J Basmaji, G Rizzo, J H Franklin, K Fung, K Kwan, B Wehrli, M I Salvadori, E Winquist, S Ernst, S Kuruvilla, N Read, V Venkatesan, B Todorovic, J A Hammond, J Koropatnick, J S Mymryk, J Yoo, J W Barrett
Affiliations

The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population

A C Nichols et al. Curr Oncol. 2013 Aug.

Abstract

Background: Sexually transmitted infection with the human papillomavirus (hpv) is responsible for a significant burden of human cancers involving the cervix, anogenital tract, and oropharynx. Studies in the United States and Europe have demonstrated an alarming increase in the frequency of hpv-positive oropharyngeal cancer, but the same direct evidence does not exist in Canada.

Methods: Using the London Health Sciences Centre pathology database, we identified tonsillar cancers diagnosed between 1993 and 2011. Real-time polymerase chain reaction was then used on pre-treatment primary-site biopsy samples to test for dna from the high-risk hpv types 16 and 18. The study cohort was divided into three time periods: 1993-1999, 2000-2005, and 2006-2011.

Results: Of 160 tumour samples identified, 91 (57%) were positive for hpv 16. The total number of tonsillar cancers significantly increased from 1993-1999 to 2006-2011 (32 vs. 68), and the proportion of cases that were hpv-positive substantially increased (25% vs. 62%, p < 0.002). Those changes were associated with a marked improvement in 5-year overall survival (39% in 1993-1999 vs. 84% in 2006-2011, p < 0.001). When all factors were included in a multivariable model, only hpv status predicted treatment outcome.

Interpretation: The present study is the first to provide direct evidence that hpv-related oropharyngeal cancer is increasing in incidence in a Canadian population. Given the long lag time between hpv infection and clinically apparent malignancy, oropharyngeal cancer will be a significant clinical problem for the foreseeable future despite vaccination efforts.

Keywords: Human papillomavirus; epidemiology; hnscc; oropharyngeal cancer.

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Figures

FIGURE 1
FIGURE 1
Proportion of tonsillar carcinomas positive and negative for the human papillomavirus (hpv) (A) by year of diagnosis and (B) during three sequential time intervals.
FIGURE 2
FIGURE 2
(A) Disease-free and (B) overall survival for tumours positive and negative for the human papillomavirus (hpv).
FIGURE 3
FIGURE 3
(A) Recurrence-free and (B) overall survival during three sequential time intervals.
See this image and copyright information in PMC

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