News
HPV-Related Oral Cancer Incidence Spikes Sharply
Major Finding: Between 1988 and 2004, the incidence of HPV-positive oropharyngeal cancers increased 225%.
The prevalence of oral human papillomavirus is nearly three times higher in men than in women, according to data from more than 5,000 individuals in the United States.
The findings were simultaneously published online in JAMA and presented at the Multidisciplinary Head and Neck Cancer Symposium in Phoenix on Jan. 26 (JAMA 2012;307: [doi: 10.1001/jama.2012/101]).
Dr. Maura Gillison
Oral HPV infection causes a subset of oropharyngeal squamous cell carcinoma (OSCC) that has increased in several countries, including the United States, over the past 3 decades, said Dr. Maura L. Gillison of the Ohio State University, Columbus, and her colleagues. "HPV has been directly implicated as the underlying cause," they noted. However, the epidemiology of OSCC has not been well studied.
The researchers conducted a cross-sectional study of HPV infection as part the National Health and Nutrition Examination Survey (NHANES) for 2009-2010. The study population included 5,579 men and women aged 14-69 years who were tested for HPV at mobile centers.
Overall, the prevalence of any HPV infection was 6.9%, and the prevalence of HPV type 16 (the type associated with OSCC) was 1%. The prevalence of any HPV infection was significantly higher in men than in women (10.1% vs. 3.6%, P less than .001). The peak prevalence of oral HPV occurred in people aged 30-34 years (7.3%) and 60-64 years (11.4%).
Infection in either gender was significantly more common in those with a history of any sexual contact (7.5%), compared with those who had no history of sexual contact (0.9%). The risk of infection also increased significantly as the number of sex partners for any type of sex increased. "One in five individuals with more than 20 lifetime sexual partners was infected," the researchers said.
Univariate associations between risk of oral HPV infection and alcohol and marijuana use did not remain significant in a multivariate analysis. However, cigarette smoking remained independently associated with an increased risk of oral HPV infection. The risk significantly increased with the number of cigarettes smoked daily for both men and women, but this trend was stronger in women.
In a multivariate analysis, age, gender, number of sexual partners, and number of cigarettes smoked daily remained independently associated with an increased risk of oral HPV infection.
"Our data provide evidence that oral HPV infection is predominantly sexually transmitted," the researchers said. Although HPV-positive OSCC has been associated with oral sex in particular, this study could not associate infection with a particular sexual behavior, they added.
The findings were limited by the emphasis on Alpha-papillomaviruses only, which likely underestimates the prevalence of oral HPV infection, the researchers said. But the findings suggest that vaccine trials to test the efficacy of the current HPV vaccine against oral HPV may be warranted. "Such trials could inform ongoing discussions regarding the benefits of HPV vaccination for males, given the higher prevalence of oral HPV infection demonstrated here as well as higher incidence of HPV-positive OSCC among men," they said.
The Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Society for Radiation Oncology.
Study sponsors included the Ohio State University Comprehensive Cancer Center and the National Cancer Institute. Dr. Gillison has served as a consultant to study sponsor Merck and to GlaxoSmithKline.
The incidence of HPV-positive oropharyngeal cancers increased 225% – from 0.8/100,000 to 2.8/100,000 – between 1988 and 2004, according to a presentation by Dr. Gillison at the annual meeting of the American Society of Clinical Oncology in June 2011. Click here for a report on the earlier findings.