Risk of Oral HPV Infections and OSCC Linked to Cumulative Exposure to Oral Sexual Activity

What is the epidemiology of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OSCC)?

Background: Although the twin traditional factors of alcohol and tobacco consumption account for the majority of head and neck squamous cell carcinomas (HNSCC), HPV is now recognized as the etiologic factor driving carcinogenesis for the majority of HNSCCs of the oropharynx in North America and Europe. It is expected that the incidence of HPV-related OSCC in the United States will surpass the incidence of cervical cancer by 2020.

Study design: Systematic review of articles pertaining to the epidemiology of HPV-related OSCC.

Setting: MEDLINE/PubMed from the year 2000 onward.

Synopsis: HPV-related OSCC patients were on average younger, more commonly male, and had a higher socioeconomic status compared to HPV-unrelated OSCC patients. The odds of HPV-related HNSCC increase with a higher number of oral sex partners and joint years of marijuana use. Furthermore, although increased tobacco and alcohol consumption were not associated with increasing odds of HPV-related HNSCC, higher tobacco and alcohol exposure were independently associated with increasing strength of association with HPV-unrelated HNSCC. There was strong evidence to show that HPV tumor status is an independent marker of favorable prognosis for OSCC, with an improved response to treatment and survival. Patients with HPV-positive tumor status had higher overall survival (OS) and progression-free survival at two years compared to HPV-negative patients. Despite a favorable initial response to therapy, up to 30% of HPV-related HNSCC patients experienced recurrence. It is too early to predict the definitive impact of HPV vaccination initiatives on HPV-related OSCC incidence. Future efforts at secondary prevention will require identification of characteristics that place individuals at high risk of developing HPV-related OSCC.

Bottom line: Emerging evidence shows that the demographic profile of groups at risk of oral HPV infections and OSCC is linked to cumulative exposure to oral sexual activity; however, HPV-related OSCC epidemiology continues to evolve.

Citation: Gooi Z, Chan JY, Fakhry C. The epidemiology of the human papillomavirus related to oropharyngeal head and neck cancer. Laryngoscope. 2016;126:894-900.