Since the 1980s, physicians who treat a subset of head and neck cancer patients have seen an increasing number of patients who don’t fit the typical profile seen prior to this time. Instead of older men with a history of hard drinking and smoking, there has been a steady increase in the incidence of oropharyngeal cancers in younger patients—younger white men in particular—with little or no history of drinking or smoking.
Explore this issue:November 2012
What has emerged over the past 15 years is a distinct subgroup of head and neck cancers caused by the human papillomavirus (HPV), according to Edward S. Peters, DMD, associate professor of epidemiology at the School of Public Health at Louisiana State University’s Health Sciences Center in New Orleans. He emphasized the need to recognize the changing profile of patients in this subgroup of head and neck cancers. “We should be more astute and vigilant in examining, for example, young patients with complaints of soreness in their throat or on the back of their tongue for possible lesions,” he said.
Dr. Peters and his colleagues found recent evidence of the increased incidence of HPV-associated head and neck cancers and the changing profile of these patients in a study published earlier this year that looked at the incidence of HPV-associated head and neck cancers by age and ethnicity in the United States from 1995 to 2005 (PLoS ONE. 2012;7(3):e32657). The study found that although non HPV-associated head and neck cancers significantly declined during this time, there was a significant increase in HPV-associated head and neck cancers, with the greatest increase in white males between 45 and 54 years of age.
Other epidemiological data confirm this. The most recent report, published in August, found that up to 80 percent of oropharyngeal cancers are now caused by HPV and that these cancers are more likely, when compared with non-HPV-related head and neck cancers, to occur in whites (93 percent versus 82 percent in non-whites), never drinker/never smokers (16 percent versus 7 percent), those with a younger median age at cancer diagnosis (54 versus 60 years), and patients who have had more than six oral sexual partners over a lifetime (46 percent versus 20 percent) (Otolaryngol Clin North Am. 2012;45:739-764).
History of Oral HPV
Although the increased incidence of HPV-associated oropharyngeal cancer is now well established, the actual number of people with HPV infection who will develop oropharyngeal cancers is quite small based on what is known about the natural history of HPV infection in anogenital cancers. “Most people will have a genital infection in their lifetime,” said Gypsyamber D’Souza, PhD, assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore. “Most people get infected within a few years of becoming sexually active, and most people clear those infections within a year of being infected,” she said.