HPV linked to rise in oropharyngeal cancer
A new analysis of national data shows human papillomavirus (HPV) might be to blame for the rise of young adults with oropharyngeal cancer. Data indicate an overall 60% increase from 1973 and 2009 in cancers of the base of tongue, tonsils, soft palate, and pharynx in people younger than 45.1
To perform the analysis, a research team used the Surveillance Epidemiology and End Results (SEER) database maintained by the National Cancer Institute to gather information about U.S. adults younger than 45 who had been diagnosed with invasive squamous cell oropharyngeal cancer between 1973 and 2009. The team was led by Farzan Siddiqui, MD, PhD, director of the Head & Neck Radiation Therapy Program in the Department of Radiation Oncology at Henry Ford Hospital in Detroit. Because the SEER database does not record HPV information, the researchers used tumor grade as a surrogate indicator of HPV infection.
Among the study group of more than 1,600 patients, 90% were ages 36-44; 73% were identified as Caucasian. During the 36-year period, most patients (50-65%) underwent surgical resection for their tumors. Patients who had surgery and radiation therapy had the highest five-year survival rate.
Among Caucasians, there was a 113% increase in cancers of the base of tongue, tonsils, soft palate, and pharynx. Among African-Americans, the rate of these cancers declined by 52% during the same period of time.1
What factors might have led to the increase and decline? One factor might lie in sexual practices. Oropharyngeal cancer has been linked to an increase in the number of people who perform oral-genital sex.2 An analysis of the National Survey of Adolescent Males indicates that white males were 2.7 times more likely to engage in oral sexual activity with a female and were 1.4 times more likely to receive oral sex from a female, compared to black males. Compared with white males, black males were 1.35 times more likely to engage in genital-to-genital sex with a female.3
For the current analysis, the five-year survival rate for the study group was 54. African Americans, however, had significantly poor survival rates compared to other races, researchers note.1 Previous research indicates that compared with Caucasians, African Americans are more likely to have an advanced stage of disease at diagnosis and to have inferior outcomes (shorter survival) within the same stage.4
Look for signs
What are the signs and symptoms of oropharyngeal cancer? According to the Centers for Disease Control and Prevention, they might include persistent sore throat, earaches, hoarseness, enlarged lymph nodes, pain when swallowing, and unexplained weight loss. Some persons have no signs or symptoms.
How common is oral HPV? Data indicate about 7% of people in the United States have oral HPV, but only 1% of people have the type of oral HPV that is found in oropharyngeal cancers (HPV type 16). Oral HPV is about three times more common in men than in women.5 There is no Food and Drug Administration-approved test to detect oropharyngeal cancer.
Cancer on the rise
Oropharyngeal squamous cell cancer has attained "epidemic" proportions in the past few years, says Siddiqui. The incidence has increased significantly in the 50- to 60-year-old age group, and this increase has been attributed to the rising rates of HPV infection, which has a sexual mode of transmission, he notes.
"It has been postulated that the sexual revolution of the 1960s and 70s led to increased transmission and infection of high-risk HPV, and people who were probably exposed as teenagers at that time are now presenting with HPV-positive oropharyngeal cancers," says Siddiqui.
Researchers at Henry Ford Hospital were interested in examining what is happening in the people who were born during that time or later, says Siddiqui. The database analysis was carried out to see if the incidence of oropharyngeal cancers is rising in these younger individuals also, he states. Scientists also wanted to see if there is a difference between race and gender in the incidence of these cancers over the past few decades from 1973 to 2009, states Siddiqui.
"These young individuals are in the prime of their lives and in their most productive phases," says Siddiqui. "The diagnosis of cancer is very devastating for them, and they have to undergo cancer therapy and live with the side effects of the cancer therapy — radiation, chemotherapy, surgery — for the rest of their lives."
It remains a mystery why vaccination of men against HPV is not more widely encouraged, says Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta.
"Equally disappointing is our failure to achieve close to 100% vaccination of women by age 26," says Hatcher.
- Siddiqui F, Hall F, Cote M, et al. Oropharyngeal cancer in young adults: an alarming national trend. Int J Radiat Oncol 2013; 87(2):S436.
- D’Souza G, Agrawal Y, Halpern J, et al. Oral sexual behaviors associated with prevalent oral human papillomavirus infection. J Infect Dis 2009; 199:1,263-1,269.
- Gates GJ, Sonenstein FL. Heterosexual genital sexual activity among adolescent males: 1988 and 1995. Fam Plann Perspect 2000; 32:295-297, 304.
- Brawley OW. Oropharyngeal cancer, race, and the human papillomavirus. Cancer Prev Res (Phila). 2009; 2(9):769-772.
- Centers for Disease Control and Prevention. Human papillomavirus (HPV) and Oropharyngeal Cancer. Fact sheet. Accessed at http://1.usa.gov/17jZNsz.