HPV-16 infection may be a risk factor for squamous-cell carcinoma of the head and neck.

In several countries, increased incidence of squamous cell carcinoma (SCC) of the tongue in young adults has been suspected during the last decades. Some reports indicate a lower survival rate for young patients compared to older patients. In other reports, there has not been any considerable difference in survival when comparing young adults to older patients, whereas some authors have shown better survival for young adults. This disease is rare in young adults, and early reports were based on comparable small numbers and selected patients. Our aim was first to perform a population-based study to determine if an increased incidence in SCC of the tongue could be verified in a larger population comprising the Scandinavian countries Denmark, Finland, Sweden and Norway. A second aim was to determine survival rates for young adults compared to older patients. The material was based on the annual cancer incidence and survival reports from the Scandinavian cancer registries. The study period was 1960 -1994. During that period, 5,024 SCCs of the tongue were reported. Of these, 276 (5.5%) were young adults (20 -39 years). The incidence increased at all ages except for women 65-79 years old. The increase was most pronounced in young adults: 0.06 -0.32 for men and 0.03-0.19 for women, counted by 100,000 person-years. Relative survival was significantly better for young adults compared to older patients.

Human papillomavirus has emerged as the leading infectious cause of cervical and other anogenital cancers. We have studied the relation between human papillomavirus infection and the subsequent risk of anal and perianal skin cancer. A case -cohort study within two large Nordic serum banks to which about 760 000 individuals had donated serum samples was performed. Subjects who developed anal and perianal skin cancer during follow up (median time of 10 years) were identified by registry linkage with the nationwide cancer registries in Finland and Norway. Twenty-eight cases and 1500 controls were analysed for the presence of IgG antibodies to HPV 16, 18, 33 or 73, and odds ratios of developing anal and perianal skin cancer were calculated. There was an increased risk of developing anal and perianal skin cancer among subjects seropositive for HPV 16 (OR=3.0; 95%CI=1.1 -8.2) and HPV 18 (OR=4.4; 95%CI=1.1 -17). The highest risks were seen for HPV 16 seropositive patients above the age of 45 years at serum sampling and for patients with a lag time of less than 10 years. This study provides prospective epidemiological evidence of an association between infection with HPV 16 and 18 and anal and perianal skin cancer. Anal epidermoid carcinoma is a rare tumour, but its incidence has increased over the past 30 years (Goldman et al, 1989;Frisch et al, 1993;Melbye et al, 1994). Sexual behaviour and smoking are risk factors (Daling et al, 1992;Frisch et al, 1997). A high proportion of anal tumours are associated with human papillomavirus (HPV) infection (Melbye and Frisch, 1998). HPV 16 DNA has been reported in up to 93% of invasive squamous anal tumours and 69% of anal carcinoma in situ (Tilston, 1997).Most epidemiological studies on HPV infection and anal cancer have been case -series and case -control studies using samples taken after the cancer has been diagnosed. Such studies may be subject to differential misclassification related to the presence of the disease, and provide no information on the temporal order of events. Prospective studies are generally considered crucial for causality inference. As primary prevention of HPV infection by vaccination is being evaluated, it is important to establish which cancers are likely to be amenable to prevention. Prospective seroepidemiological studies have linked HPV to vulvar, vaginal and to a subset of head and neck cancers (Bjørge et al, 1997a;Mork et al, 2001).HPV serology, using capsids of HPV 16, 18 and 33, has been validated as a type-restricted marker of past or present HPV infection (Dillner, 1999). A serologic association of HPV 16 with incident anal cancer has been shown (Heino et al, 1995). In a study of the role of HPV in non-cervical anogenital cancers, we found that HPV 16 seropositivity conferred an increased risk for noncervical anogenital cancers, but not for anal cancer (Bjørge et al, 1997a). This was in spite of the fact that the proportion of anal cancer cases (25%) being HPV 16 seropositive was higher than for other non-cervical anogenital cancers (24%). This...

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The trends were not considered materially biased by potential artefacts. The increasingly higher proportion of oropharyngeal SCC cancers is more likely explained by other factors, including an increasing high-risk HPV prevalence among recent cohorts. These results will likely have consequences on treatment and health care provision in the near future.