High‐Risk Human Papillomavirus–Related Oropharyngeal Squamous Cell Carcinoma Among Non‐Indigenous and Indigenous Populations: A Systematic Review

Abstract

Objective To estimate the prevalence of oral high-risk human papillomavirus (hr-HPV) infection and the proportion of hr-HPV–related oropharyngeal squamous cell carcinoma (OPSCC) among Indigenous and non-Indigenous populations. Data Source Electronic database searches of PubMed, PubMed Central, Embase, MEDLINE, Scope, and Google Scholar were conducted for articles published from January 2000 until November 2019. Review Methods Studies were included with a minimum of 100 cases assessing hr-HPV infection in either population samples or oropharyngeal cancer tumor series. The objective was to conduct meta-analyses to calculate the pooled prevalence of oral hr-HPV infection by adjusting for age group or sex in primary studies, the incidence of OPSCC, and the proportion of hr-HPV–related OPSCC in Indigenous people and non-Indigenous/general populations. Results We identified 47 eligible studies from 157 articles for meta-analyses. The pooled prevalence of oral hr-HPV infection was 7.494% (95% CI, 5.699%-9.289%) in a general population, with a higher prevalence among men (10.651%) than women (5.176%). The pooled incidence rate was 13.395 (95% CI, 9.315-17.475) and 7.206 (95% CI, 4.961-9.450) per 100,000 person-years in Indigenous and non-Indigenous populations, respectively. The overall pooled proportion of hr-HPV–related OPSCC was 50.812% (95 CI, 41.656%-59.969%). The highest proportion was in North America (60.221%), while the lowest proportion was in the Asia-Pacific (34.246%). Conclusion Our findings suggest that in the general population, the prevalence of oral hr-HPV infection is lower among females and those in younger age groups. The incidence of OPSCC was higher among Indigenous than non-Indigenous populations, with the proportion being highest in North America.

Natural History of Oral HPV Infection among Indigenous South Australians

“…Analysis began with statistics describing the point prevalence of oral HPV infection, including any type of HPV infection; HPV 13 or 32; HPV16 or 18; and all high-risk HPV (hr-HPV) infections. hr-HPVs were defined as HPV 16,18,26,31,33,35,39,45,51,52,53,56,58,59, 66, 68, 73, and 82; they were assessed at three time points (baseline, 12-months, and 24-months).…”

“…Worldwide, Indigenous populations experience the highest incidence of OPCs due to societal inequality and disparities in health services [ 26 ]. The first peoples of Australia, Aboriginal, and Torres Strait Islanders (hereafter respectfully termed ‘Indigenous’), comprise 3.3% of the total Australian population [ 27 ].…”

“…OPCs have been associated with oral hr-HPV infection and are usually of type 16 [2]. Other high-risk types include 18,26,31,33,35,39,45,51,52,53,56,58,59, 66, 68, 73, and 82 [14,15]. The basic mechanisms of hr-HPV-induced carcinogenesis are that the interactions of the hr-HPV oncoproteins (E6 and E7) with host cellular proteins are involved in the activation or repression of cell cycle progression in carcinogenesis [16].…”