Tonsillectomy and Risk of Oropharyngeal Cancer: Implications for Research and Prevention

Abstract

The association of tonsillectomy, a common surgical procedure involving the removal of a majority of the palatine tonsillar tissue, with risk of tonsil cancer specifically or oropharyngeal cancers overall is not known. In this issue of Cancer Prevention Research, Fakhry and colleagues conduct an analysis within the Danish Cancer Registry and show that tonsillectomies were associated with significantly reduced risk of tonsil cancer, but were unrelated to risk of base of tongue cancers. This editorial discusses the implications of the results by Fakhry and colleagues for key prevailing questions in the field related to risk, rising incidence, secondary prevention, and treatment of oropharyngeal cancers.

HPV-Related Oropharynx Cancer in the United Kingdom: An Evolution in the Understanding of Disease Etiology

“…However, this contrasts with the more modest increase in incidence of other smoking-related head and neck malignancies, such as laryngeal cancer, [25] ( Figure 3) and suggests that another risk factor, in addition to HPV and smoking, may contribute to the increased overall incidence of OPSCC. Prior tonsillectomy appears to reduce risk of tonsillar carcinoma, [26,27] but while the current UK tonsillectomy rate is approximately 75% lower than in the 1950s, [28] the absence of a disproportionate increase in OPSCCs specifically involving the tonsils, in our results and other published data, [25] suggests this is not a major contributory factor to the increasing incidence of OPSCC. The observed increases in ASR among the different subsites (non-HPV OPSCC, mouth, and laryngeal) may reflect the degree of exposure of specific anatomical sites to individual carcinogens, including alcohol and tobacco smoke.…”

Tonsillectomy as a Prevention Strategy in the Light of Increasing Incidence of Oropharyngeal Cancer – a Research of Current Literature

“…In view of the increase in (HPV-positive) OCA, especially TCA, the question arises as to whether this can be explained in the context of the decreasing number of tonsillectomies internationally (10). This study aimed to clarify the potential of TE to prevent carcinogenesis in the tonsils or even in the entire oropharynx (3,11). According to our research, only three population-based studies (7-9) with a focus on this subject have been published (Table I).…”

“…This development, which has been well documented in many European countries and in North America in the last five decades, can also be observed in Germany (1, 2). The incidence of oropharyngeal cancer (OCA), especially tonsil cancer (TCA) has been increasing in the last decades (3,4); the stationary case numbers are also steadily increasing in Germany for both entities (Figure 1). Since a carcinoma manifestation is not possible on an organ that no longer exists, the question arises whether TE is justified as a "carcinoma prophylaxis" to avoid TCA/OCA.…”

Previous tonsillectomy modifies odds of tonsil and base of tongue cancer

“…Recently, the possibility of prophylactic tonsillectomy as a method of secondary OPSCC prevention has been considered ( Chaturvedi, 2015 ; Fakhry et al , 2015 ). Although we demonstrate a reduction in overall risk of OPSCC cancer associated with tonsillectomy, our study was not designed to address this question.…”

“…Vaccination against high-risk HPV types has the potential to serve as a safer and more effective method of primary prevention of OPSCC than tonsillectomy ( D'Souza and Dempsey, 2011 ). Nonetheless, when considered along with other covariates such as sexual history, smoking status, and age, a history of tonsillectomy may play a role in risk stratification ( Chaturvedi, 2015 ; Fakhry et al , 2015 ).…”