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HPV-16 and Oropharyngeal Cancer

HPV-16 infection was shown to be an independent risk factor for oropharyngeal squamous-cell carcinoma.

Although alcohol and tobacco use have long been recognized as major risk factors for oropharyngeal squamous-cell carcinoma, recent work has produced molecular evidence supporting a major role for human papillomavirus (HPV). Now, investigators in Baltimore have performed a case-control study to evaluate the strength of this association.

The researchers enrolled 100 patients with newly diagnosed oropharyngeal squamous-cell carcinoma from a longitudinal cohort study and 200 age- and sex-matched cancer-free controls from an outpatient otolaryngology clinical population. Most (86%) of the cancer patients were men.

Significant risk factors for cancer included history of squamous-cell carcinoma of the head or neck in a first-degree relative, poor oral hygiene, heavy tobacco or alcohol use, regular marijuana use, high lifetime number of vaginal-sex or oral-sex partners, serologic evidence of HPV type 16 infection, and presence of an oral HPV-16 infection. In an analysis restricted to patients with HPV-16–positive tumors, the association of sexual behaviors with cancer was strengthened and — contrary to findings in patients with HPV-16–negative tumors — was unaffected by alcohol and tobacco use. Multivariate analysis revealed that 55% of the oropharyngeal cancers (95% confidence interval, 45–63) were attributable to HPV-16 exposure alone. Of 60 fresh-frozen tumor specimens available from the 100 cancer patients, 35 (58%) were HPV-16–positive.

Comment: These data strongly support an independent role for HPV-16 in the pathogenesis of oropharyngeal squamous-cell carcinoma. Although the incidence of such cancers is much lower than that of cervical cancer, the present findings provide an additional reason for HPV vaccination. This potential benefit should be factored into cost-benefit analyses of HPV vaccine use for both girls and boys.

— Richard T. Ellison III, MD

Published in Journal Watch Infectious Diseases May 9, 2007

Citation(s):

D’Souza G et al. Case–control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 2007 May 10; 356:1944-56.

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