Discussing the diagnosis of HPV-OSCC: Common questions and answers

Abstract

Human papillomavirus (HPV) is responsible for a rising proportion of oropharyngeal squamous cell cancers (OSCC). HPV-positive OSCCs (HPV-OSCC) are associated with oral HPV infection and sexual behavior. Patient questions regarding risk factors, prognosis and implications for past, present and future relationships often arise. This manuscript addresses frequently asked questions by patients with HPV-OSCC and their families. A framework for clinicians to address these conversations and the limitations of our present knowledge base is also presented. HPV and its role in OSCCHuman papillomavirus (HPV), a sexually transmitted infection, is now responsible for the overwhelming majority of oropharyngeal squamous cell cancers (OSCC) in the United States (U.S.). Historically, tobacco and alcohol use accounted for the majority of head and neck cancers. However, with the decline of tobacco use in the U.S., the incidence of smoking-related (HPV-negative) oropharyngeal malignancies has decreased. 1 The proportion of oropharyngeal cancers attributable to HPV (HPV-positive OSCC; HPV-OSCC) has risen substantially in the U.S. Indeed, while only 16% of OSCCs in the 1980s were HPV-positive, approximately 73% of tumors in the 2000s were HPV-positive. Not only is the proportion of OSCCs that are HPV-positive rising, but the incidence of OSCC is also rising. From 1988 to 2004, there was a 28% increase in incidence of OSCC in the U.S., which was primarily among younger men, ages 50-59. 1 Currently, the incidence of OSCC in the U.S. is 6.2 per 100,000, and 1.4 per 100,000 among men and women, respectively. 2 There is also data emerging that HPV is etiologically associated with a smaller subset of oral cavity tumors. 3 HPV-OSCC has been recognized in the past 10 years as a distinct disease entity. These cancers are associated with oral HPV infection and sexual behavior (a surrogate for oral HPV exposure), although HPV-OSCC is diagnosed in many people who have a modest number of lifetime sexual partners. Individuals with HPV-OSCC, when compared to those with HPV-negative tumors, tend to be white, male, non-smokers and non-drinkers. 4 Patients with HPV-OSCC have significantly better prognosis than those with HPV-negative Corresponding Authors. Carole Fakhry and Gypsyamber D'Souza, 615 N Wolfe St. E6132, Baltimore, MD

HPV positive oropharyngeal cancer: risky sexual behavior

“…In our research we identify 15 articles focused on HPV associated oropharyngeal cancer and sexual behavior as a risk factor 1,3,9,[11][12][13][14][15][16][17][18][19][20][21][22] . One article studied the knowledge of HPV and its association with oropharyngeal cancer in a high-risk population 16 .…”

“…The other affirms that the HPV has influence in the oropharyngeal cancer depending on its viral load and stage and that's not determined by demographic or behavioral factors 14 . The other ten articles affirm the HPV can be used as sexual behavior marker 9,[11][12][13][17][18][19][20][21][22] , but each article used a different aspect of sexual behavior to establish that.…”

“…The many aspects of sexual behavior used to determine if it can be used as a marker was number of sexual partners 3,16,17,19,21,22 , practicing oral-genital sex 18,20 , number of oral-genital sex partners 3,11,12,22 , practicing oral-anal sex 20 , age of first sexual interaction 16,17 , age of first oral-genital sexual interaction 17 , perception of risk of sexually transmitted disease (16) and marital status 9 .…”

Deubiquitination and stabilization of programmed cell death ligand 1 by ubiquitin‐specific peptidase 9, X‐linked in oral squamous cell carcinoma

“…However, the mechanisms regulating the high expression of USP9X in OSCC are unclear. There are several classically activated pathways in OSCC, including hypoxia, human papillomavirus (HPV) infection, and Notch pathways 24, 25, 26. HIF‐1α overexpression has been associated with tumor cell growth and survival in head and neck tumors.…”

Oral cancer: Overall immunity

“…These are complex issues that patients consider very important. 4 No assumptions about HPV infection should be made.…”