Tonsillectomy and Incidence of Oropharyngeal Cancers

Abstract

Background: Rising incidence of oropharyngeal cancers in numerous countries since the 1970s has been attributed to increased oral human papillomavirus (HPV) exposure. However, the contribution of coincidental declines in the surgical removal of the tonsils (tonsillectomy) is unknown. We quantified the association of tonsillectomy with risk of tonsillar, other oropharyngeal, and other head and neck cancers and the contribution of declines in tonsillectomies to cancer incidence trends.Methods: We conducted a nation-wide cohort study in Sweden (1970Sweden ( -2009. Tonsillectomies (N ¼ 225,718) were identified through national patient registers, which were linked with the cancer register. Cancer incidence in the tonsillectomy cohort was compared with Sweden's general population through standardized incidence ratios (SIR).Results: Tonsillectomies were associated with reduced risk of tonsil cancers [SIRs 1þ years post-tonsillectomy ¼ 0.31; 95% confidence interval (CI), 0.08-0.79 and 5þ years post-tonsillectomy ¼ 0.17; 95% CI, 0.02-0.62], but unrelated to other oro-

Screening for human papillomavirus‐driven oropharyngeal cancer: Considerations for feasibility and strategies for research

“…44,45 While tonsillectomy was associated with decreased odds of tonsillar cancer, increased odds of cancer of the base of the tongue were reported. For example, in women with cervical precancer, excision of the cervical transformation zone nearly eliminates risk of progression to cervical cancer.…”

“…Indeed, retrospective data have suggested that tonsillectomy (removal of the relevant lymphoid tissue and associated epithelium) reduces the risk of OPC. 44,45 While tonsillectomy was associated with decreased odds of tonsillar cancer, increased odds of cancer of the base of the tongue were reported. 46 In addition, tonsillectomy has its own inherent risks (life-threatening or catastrophic bleeding), and therefore optimizing the ability to predict the patient's risk of developing HPVdriven OPC becomes paramount, as does demonstrating that the benefits outweigh the harms (including considerations of quality of life and cost-effectiveness).…”

Current Role of Surgery in the Management of Oropharyngeal Cancer

“…Studies looking at the Swedish and Danish cancer registries found that tonsillectomy significantly reduced the risk of developing tonsillar carcinoma. 41,42 A more recent study looking at the North Carolina Central Cancer Registry examined the effect of prior tonsillectomy on the incidence of oropharyngealc arcinomaby subsite. 43 This group found that tonsillectomy was associated with a two-fold increase in the risk of base-of-tongue carcinoma (odds ratio, 1.95; 95% CI, 1.25 to 3.06; P = .003), particularly when tonsillectomy was performed at a young age.…”

Childhood tonsillectomy alters the primary distribution of HPV‐related oropharyngeal squamous cell carcinoma

“…A nation‐wide study from Sweden (1970‐2009) observed that tonsillectomies (N = 225 718) were associated with reduced risk of tonsil cancers (standardized incidence ratios [SIRs] 1+ years post‐tonsillectomy = 0.31; 95% CI = 0.08‐0.79 and 5+ years post‐tonsillectomy = 0.17; 95% CI = 0.02‐0.62), but unrelated to other oropharyngeal or other head and neck cancers (SIRs 1+ years post‐tonsillectomy = 1.61; 95% CI = 0.77‐2.95 and 0.92; 95% CI = 0.64‐1.27, respectively) . The authors did not believe tonsillectomies should be considered as a secondary prevention strategy for tonsil cancers or other oropharyngeal cancers at this time.…”

“…Some of the reasons were that: tonsillectomies did not alter risk of non‐tonsil oropharyngeal cancers, and the mortality due to tonsillectomy outnumbers the incidence of oropharynx cancers. Other obstacles were inadequate risk stratification for the identification of high‐risk individuals, inadequate identification and location of premalignant lesions, and lack of low‐morbidity, cost‐effective treatments for premalignant lesions …”