High Rates of Oropharynx Cancer Tied to HPV

As many as 75% of cases of oropharynx cancer in the United States may be related to human papillomavirus (HPV), according to a new study published in Cancer Epidemiology, Biomarkers & Prevention. The large study found that the incidence of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) in the United States was 4.62 per 100,000 persons.

“Patients with HPV-related oropharynx cancers are now one of the most common patients we see in the DFBWCC Head and Neck Oncology Program,” corresponding author Danielle Margalit, MD, MPH, a radiation oncologist at the Brigham and Women’s Hospital and the Dana-Farber Cancer Institute in Boston, said in a press release. “Through our study, we now have a clearer picture of the extent to which oropharynx cancer affects Americans.”

Margalit and colleagues used data from the SEER HPV Status Database that included more than 12,000 patients with head and neck squamous cell carcinoma diagnosed from 2013-2014. Of the included cases, 76.3% had disease of the oropharynx.

During that time period the incidence of HPV-positive OPSCC was 4.62 per 100,000 people compared with a rate of 1.38 per 100,000 people with HPV-negative OPSCC.

The highest incidences of HPV-positive OPSCC occurred in men (8.0 per 100,000) and white patients (5.47 per 100,000). In all, white men younger than 65 years of age had the highest incidence of HPV-positive OPSCC (9.34 per 100,000). According to the researchers, with this incidence HPV-positive OPSCC “represents the sixth most common incident non-skin solid cancer in the US”.

HPV-positive OPSCC was associated with a lower cancer-specific mortality than HPV-negative OPSCC (adjusted hazard ratio=0.40; P<.001), but the same was not true for non-OPSCC.

“This reinforces just how important it is to educate patients about the HPV vaccine, the importance of quitting smoking, as well as safe sex practices - particularly oral sex, which is how we believe oral HPV is mostly contracted,” Margalit said.

Multivariable analyses showed that higher odds of HPV-positive disease was associated with the oropharynx site, smaller primary tumors, higher N-stage, ages 60-64 year, white race, non-Hispanic ethnicity, and male sex.

 “From a public health perspective, the best way to address the rise in HPV-positive OPSCC is through preventative measures,” Margalit said in a press release. “The HPV vaccine targets the type of HPV that causes the majority of OPSCC and is expected to decrease the cases of HPV-positive OPSCC in the future.  The vaccine is recommended for children through age 26 and for some older adults as well. OPSCC requires intensive treatment once it develops, and, unfortunately, we’re not seeing everyone get the vaccines that could prevent it.”