In UK, rise in oropharyngeal cancers not solely driven by HPV

Abstract

A recently published study from the United Kingdom demonstrated that the rise in the incidence of oropharyngeal squamous cell carcinoma (OPSCC) was not solely related to an increase in the incidence of human papillomavirus (HPV)- positive disease because the percentage of HPV-positive and HPV-negative cases remained the same during the study period.1 Terry Jones, MD, professor of head and neck surgery in the department of molecular and clinical cancer medicine at the University of Liverpool in the United Kingdom, notes that because multiple factors besides HPV infection can cause OPSCC, the data should be considered by public health officials when developing disease prevention strategies. Among the other factors contributing to OPSCC are smoking and alcohol consumption. OPSCC is the most common form of head and neck cancer, and its incidence has been increasing throughout the developed world since the 1990s, Dr. Jones says. Several studies have suggested that the increase is due to the rise in HPV-related disease, but Dr. Jones and his colleagues wanted to further investigate whether that was the case in the United Kingdom. A large, multidisciplinary team comprised of researchers from major head and neck cancer centers in the United Kingdom determined the HPV status of archival tumor tissue from 1602 patients who had been diagnosed with OPSCC between 2002 and 2011. Each sample was analyzed using 3 validated commercial tests for HPV, and results were obtained for samples from 1474 patients. The prevalence of HPV infection among these samples was 51.8%. When considered by year of disease diagnosis, the percentage of samples testing positive for HPV remained static at approximately 50%. As a result, researchers were surprised to learn that, although the overall incidence of OPSCC rose each year, the percentage of cases attributable to HPV did not change. HPV-negative disease is rising in parallel to HPV-positive OPSCC, Dr. Jones says, adding that this information contrasts with trends reported elsewhere in the developed world. For that reason, he concludes that the underlying causes of the increase in OPSCC incidence must be analyzed in a population-specific manner. He adds that the evidence points to the need for a genderneutral HPV vaccination policy, and that alcohol consumption could be driving the increase in HPV-negative disease, although that hypothesis has yet to be proven. One difference between the United Kingdom and the United States is that, although the magnitude of the increase in rates of HPV-positive OPSCC is very similar between the countries, the percentage of HPV-negative disease declined in the United States whereas it rose in the United Kingdom during the study period. As a result, researchers have concluded that risk factor exposures may vary substantially between the 2 countries.