Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States

Abstract

A B S T R A C T PurposeRecent increases in incidence and survival of oropharyngeal cancers in the United States have been attributed to human papillomavirus (HPV) infection, but empirical evidence is lacking. Patients and MethodsHPV status was determined for all 271 oropharyngeal cancers collected by the three population-based cancer registries in the Surveillance, Epidemiology, and End Results (SEER) Residual Tissue Repositories Program by using polymerase chain reaction and genotyping (Inno-LiPA), HPV16 viral load, and HPV16 mRNA expression. Trends in HPV prevalence across four calendar periods were estimated by using logistic regression. Observed HPV prevalence was reweighted to all oropharyngeal cancers within the cancer registries to account for nonrandom selection and to calculate incidence trends. Survival of HPV-positive and HPV-negative patients was compared by using Kaplan-Meier and multivariable Cox regression analyses. ResultsHPV prevalence in oropharyngeal cancers significantly increased over calendar time regardless of HPV detection assay (P trend Ͻ .05). For example, HPV prevalence by Inno-LiPA increased from 16.3% during 1984 to 1989 to 71.7% during 2000 to 2004. Median survival was significantly longer for HPV-positive than for HPV-negative patients (131 v 20 months; log-rank P Ͻ .001; adjusted hazard ratio, 0.31; 95% CI, 0.21 to 0.46). Survival significantly increased across calendar periods for HPV-positive (P ϭ .003) but not for HPV-negative patients (P ϭ .18). Population-level incidence of HPV-positive oropharyngeal cancers increased by 225% (95% CI, 208% to 242%) from 1988 to 2004 (from 0.8 per 100,000 to 2.6 per 100,000), and incidence for HPV-negative cancers declined by 50% (95% CI, 47% to 53%; from 2.0 per 100,000 to 1.0 per 100,000). If recent incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020. ConclusionIncreases in the population-level incidence and survival of oropharyngeal cancers in the United States since 1984 are caused by HPV infection.

Trends of oral cavity, oropharyngeal and laryngeal cancer incidence in Scotland (1975–2012) – A socioeconomic perspective

“…This difference in incidence rates could be explained in part by the greater prevalence of HPV among men compared to women [5,11,18].…”

“…Global incidence rates of oropharyngeal cancer (OPC) are rising, particularly in economically developed countries such as Canada, United States, Japan, Switzerland, Australia, England and parts of Eastern Europe [3][4][5][6][7]. Rates of oral cavity cancer (OCC) are also rising among men and women in some European countries, stabilising in certain Asian countries and decreasing in Canada and USA [4,8].…”

Time trends in the prevalence of HPV in oropharyngeal squamous cell carcinomas in northern Spain (1990–2009)

“…Still, this prevalence is among the lowest reported thus far in the literature. [6][7][8][9][10][11][12] Only two HPV studies from Spain have been published, one including patients from Barcelona, Granada and Seville, 7 and another on 15 patients from Oviedo. 19 Both studies reported a presence of HPV type 16 in 13.5% of the cases.…”

Human Papillomavirus Status and the Risk of Cerebrovascular Events Following Radiation Therapy for Head and Neck Cancer

“…Significant epidemiological and scientific data suggest that human papillomavirus (HPV) may be a significant risk factor for CVEs after RT: HPV infection is common and has been estimated at up to 11% to 12% worldwide, and oncogenic HPV has been recognized as a primary risk factor for the development of HNCA 5, 6, 7. Currently, well over one third of all HNCAs are linked to HPV, with oropharyngeal cancers testing positive in >70% of new cases alone 8.…”