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Multicenter Study
. 2025 Dec;21(1):2486768.
doi: 10.1080/21645515.2025.2486768. Epub 2025 Apr 23.

Human papillomavirus (HPV) related oropharyngeal cancers in Canada: A multicenter retrospective cohort study

Voica Racovitan  1 , Elizabeth Goodman  2 , Winson Y Cheung  3 , Anthony C Nichols  4 , Lisa Caulley  5 , Sabrina Wurzba  6
Affiliations
Multicenter Study

Human papillomavirus (HPV) related oropharyngeal cancers in Canada: A multicenter retrospective cohort study

Voica Racovitan et al. Hum Vaccin Immunother. 2025 Dec.

Abstract

Oral human papillomavirus (HPV) infection is a risk for oropharyngeal cancer (OPC), now the leading HPV-related cancer in males in Canada. P16 positivity is a marker of HPV positivity. Since 2015, all major Canadian cancer centers perform routine p16 tumor marker testing of OPCs to define their HPV status but recent data on the HPV-attributable fraction for OPC in Canada do not exist. A retrospective chart review was conducted of all squamous cell OPC cases in patients 18 years and older diagnosed from 2016 to 2020 in 4 major Canadian hospital-based regional oncology centers to determine the HPV attributable fraction for OPC in Canada using p16 as a surrogate marker for HPV. 1154 OPC cases were identified. Most patients (85.4%) were male; about one-third 26 (31.4%) had never smoked. Most OPC (80.6%) were P16 positive. p16 positivity was 27 associated with younger age (mean age p16+ 61.6 vs. p16- 66.5 years, p < 0.0001), male sex 28 (p16+ males 84.0% vs p16+ females 60.9%, p < 0.0001), lower tumor stage (Stage 1 p16+ 29 88.1% vs Stage 4 p16+ 69.4%, p < 0.001), and non-smoking (never smoked 92.3% vs past 30 smoker 82.8% vs current smoker 65.0%, p < 0.001). Logistic regression confirmed these 31 associations. This study, the largest cohort of Canadian patients with OPC yet reported, demonstrates the high attributable fraction for HPV-related OPC. HPV-related OPC was more likely in men, younger individuals, and never smokers. These findings highlight the burden of HPV-related OPC in Canada and support gender-neutral HPV vaccination as an important public health strategy to prevent head and neck cancer.

Keywords: Canada; Human papillomavirus; oropharyngeal cancer; p16; risk factors.

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Conflict of interest statement

Voica Racovitan is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and may hold stock in Merck & Co., Inc., Rahway, NJ, USA.

Elizabeth Goodman is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and may hold stock in Merck & Co., Inc., Rahway, NJ, USA.

Winson Cheung received support from Merck Canada Inc., Kirkland, QC, Canada. for this study but declares no other competing interests.

Anthony Nichols received support from Merck Canada Inc., Kirkland, QC, Canada. for this study and grant funding from Novartis Canada Inc for other clinical trials. He holds personal stock in Need Oncology but declares no other competing interests.

Lisa Caulley received support from Merck Canada Inc., Kirkland, QC, Canada. for this study but declares no other competing interests.

Sabrina Wurzba received support from Merck Canada Inc., Kirkland, QC, Canada. for this study.

Figures

Figure 1.
Figure 1.
Number of OPC cases identified at 4 regional Canadian cancer centers by year during the observation period of 2016–2020 as well as proportion who were p16 +by year overall and stratified by sex.
See this image and copyright information in PMC

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