Epidemiology of Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma

Abstract

Human papillomavirus (HPV) is now established as the principal cause of an increase in incidence of a subset of head and neck squamous cell cancers (HNCs) in numerous geographic regions around the world. Further study of the epidemiology of HPV-positive HNC will be critical to the development and implementation of public health interventions to reverse these global incidence trends. Here, recent data are reviewed to provide insight into several topics, including incidence trends and projections for HPV-positive HNC; the worldwide HPV-attributable fraction; sex disparities in cancer risk; the epidemiology of oral HPV infection; the latency period between infection and cancer; the potential impact of prophylactic HPV vaccination; and prospects for secondary prevention through screening for oral HPV infection or seroreactivity to viral antigens. The identification of a single necessary cause for any cancer provides a rare and perhaps extraordinary opportunity for cancer prevention.

Fig 1.

Shown are incidence rates for oropharyngeal cancers among (A) men and (B) women, stratified by cohort year of birth (in 10-year overlapping groups) and age (in 5-years groups). Data were derived from nine cancer registries covered by the National Cancer Institute's SEER program (1973 to 2011). Oropharyngeal cancers include the base of tongue, lingual tonsil, soft palate, uvula, tonsil, oropharynx, and Waldeyer's ring.

Fig 2.

Shown are male-female incidence rate ratios (RRs) for oropharynx cancers, stratified by age in rows (5-year groups) and calendar periods in columns (5-year groups). The diagonals across the age groups and calendar years represent birth cohorts. The scale for the color-coded RRs is also shown on the right. Data were derived from nine cancer registries covered by the National Cancer Institute's SEER program (1973 to 2011). Oropharyngeal cancers include the base of tongue, lingual tonsil, soft palate, uvula, tonsil, oropharynx, and Waldeyer's ring. HPV, human papillomavirus.

Fig 3.

Shown are the associations of lifetime number of oral sex partners with oral human papillomavirus (HPV) prevalence among men (solid line) and women (dashed line) in the US population age 14 to 69 years. Data are based on the National Health and Nutrition Examination Survey (NHANES) 2009 to 2010 and 2011 to 2012 cycles. The shaded areas represent the 95% CIs. Reprinted by permission from the American Association for Cancer Research: Chaturvedi A, Graubard B, Broutian T, et al: NHANES 2009 to 2012 findings: Association of sexual behaviors with higher prevalence of oral oncogenic human papillomavirus infections in U.S. men. Cancer Res [epub ahead of print on April 14, 2015].

Fig 4.

Shown are (A) the prevalence of 12 oral oncogenic human papillomavirus (HPV) types, (B) the number of individuals with prevalent infection with 12 oral oncogenic HPV types, and (C) the incidence rate per 100,000 of oropharyngeal cancer for ages 14 to 69 years in the US population. Oral HPV data are based on the National Health and Nutrition Examination Survey 2009 to 2010 and 2011 to 2012 cycles. Cancer incidence data are based on incidence rates in the year 2011 from nine cancer registries covered by the National Cancer Institute's SEER program (1973 to 2011). Oropharyngeal cancers include the base of tongue, lingual tonsil, soft palate, uvula, tonsil, oropharynx, and Waldeyer's ring.