Epidemiology of HPV-associated oropharyngeal cancer

Abstract

Squamous cell carcinoma of the oropharynx is increasing in incidence in epidemic proportion. This site specific increase in incidence is due to an increase in human papillomavirus (HPV)-related squamous cell carcinoma, while the incidence of tobacco related squamous cell carcinoma is decreasing. In particular, the incidence of HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is increased among middle aged white men, and sexual behavior is a risk factor. HPV-related oropharyngeal squamous cell carcinoma represents a growing etiologically distinct subset of head and neck cancers with unique epidemiological, clinical, and molecular characteristics that differ from those of HPV-unassociated cancers. In this review, we discuss the epidemiology of HPV-related OPSCC, the prevalence of oral/oropharyngeal HPV infection, and efforts aimed at reducing the incidence of HPV-related OPSCC.

Keywords: Epidemiology; Human papillomavirus; Oropharyngeal cancer.

Figure 1. Fig 4, Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, Jiang B, Goodman MT, Sibug-Saber M, Cozen W, Liu L, Lynch CF, Wentzensen N, Jordan RC, Altekruse S, Anderson WF, Rosenberg PS, Gillison ML. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011 Nov 10;29(32):4294-301.

(A) Observed and projected incidence rates and bootstrap 95% CIs (ages 30 to 84 years) for oropharyngeal cancers overall (solid squares), oropharyngeal cancers among men (solid circles), oropharyngeal cancers among women (open circles), and cervical cancers (open squares). (B) Projected annual number of patients (ages 30 to 84 years) of oropharyngeal cancers overall, oropharyngeal cancers among men, oropharyngeal cancers among women, and cervical cancers through the year 2030. (C) Observed and projected incidence rates for oropharyngeal (solid squares), oral cavity (open squares), larynx (solid circles), and other pharynx (open circles) cancers. (D) Projected annual number of patients with oropharyngeal, oral cavity, laryngeal, and other pharynx cancers through the year 2030. Observed incidence rates during 1973 to 2007 from nine registries within the Surveillance, Epidemiology, and End Results (SEER) program were used in age-period-cohort models to project expected incidence through the year 2030. Projected incidence rates were applied to the 2008 US population projections to calculate the annual number of patients. Oropharyngeal cancers included base of tongue (International Classification of Diseases for Oncology, 3rd Edition [ICD-O-3] topography code C019), lingual tonsil (C024), soft palate not otherwise specified (NOS; C051), uvula (C052), tonsil (C090-099), oropharynx (C100-109), and Waldeyer ring (C142). Oral cavity cancers included lip (C000-009), oral tongue (C020-23, C028, and C029), gum (C030-039), floor of mouth (C040-049), hard palate (C051, C058, and C059), and other and unspecified parts of the mouth (C060-069). Laryngeal cancers included glottis (C320), supraglottis (C321), subglottis (C322), laryngeal cartilage (C323), overlapping lesion of larynx (C328), and larynx NOS (C329). Other pharynx cancers included nasopharynx (C110-119), pyriform sinus (C129), postcricoid region (C130), hypopharynx (C130-139), and pharynx NOS (C140 and C148). Oropharyngeal cancers included both HPV-related and HPV-unrelated (soft palate NOS and uvula) anatomic subsites because projections were conducted for all head and neck cancer sites. Oropharyngeal, oral cavity, laryngeal, and other pharynx cancers were restricted to squamous cell histologies (ICD-O-3 codes 8050-8076, 8078, 8083, 8084, and 8094). Cervical cancers (C530-539) included all histologic subtypes.