Abstract
Human papillomavirus (HPV) infection is associated with oropharyngeal squamous cell carcinoma. International estimates suggest overall oral HPV prevalence is 7.5%, with prevalence of oral HPV types 16 and 18 being 1.6%; prior Australian estimates suggest oral HPV prevalence is 2.3%, with HPV-16 and HPV-18 being 1.3%. To estimate the prevalence of oral HPV infection among Indigenous Australians and to report the prevalence of factors associated with high-risk HPV types (ie, HPV-16 and HPV-18) and HPV types linked with Heck disease (ie, HPV-13 and HPV-32). This cross-sectional study analyzed HPV screening results from saliva samples collected from 1011 Indigenous Australians between February 2018 and January 2019. Data were analyzed from May 2018 to May 2019. Recruitment occurred through Aboriginal Community Controlled Health Organisations in South Australia. Eligibility included identifying as Indigenous, residing in South Australia, and being aged 18 years or older. Saliva samples were collected, with microbial DNA for genotyping extracted. Sociodemographic parameters, health-related behaviors, and sexual history data were collected. Analyses were stratified by sex as well as by HPV types 13 and 32 (Heck disease) and 16 and 18 (high risk of oropharyngeal squamous cell carcinoma). Multivariable analyses were conducted to obtain adjusted odds ratios (ORs). Data were obtained for 910 participants (median [interquartile range] age, 37 [27-51] years); 595 participants (65%) were female and 572 (63%) resided in nonmetropolitan locations. In all, 321 saliva samples (35.3%; 95% CI, 32.2%-38.4%) were positive for oral HPV (106 [33.7%] men; 215 [36.1%] women). The highest prevalence was found for HPV types 13 and 32 (207 [22.7%] total; 60 [19.0%] men; 147 [24.7%] women) followed by HPV types 16 and 18 (30 [3.3%] total; 9 [2.9%] men; 21 [3.5%] women). After multivariable analysis, risk factors associated with HPV types 13 and 32 included nonmetropolitan residential status (OR, 2.06; 95% CI, 1.10-3.88) and not having had a tonsillectomy (OR, 2.74; 95% CI, 1.05-7.16). Among women, having obtained a high school education or less was associated with lower odds of HPV-16 and HPV-18 infection (OR, 0.16; 95% CI, 0.03-0.97). Prevalence of oral HPV infection in a large sample of Indigenous Australians was high, with one-third testing positive. The most prevalent HPV types were those associated with Heck disease. The prevalence of HPV types associated with oropharyngeal squamous cell carcinoma exceeded both Australian and international population-level estimates.
Highlights
Oropharyngeal squamous cell carcinoma (OPSCC) associated with human papillomavirus (HPV) disproportionately affects men and has one of the most rapidly increasing incidences of any cancer in high-income countries.[1]
Risk factors associated with HPV types 13 and 32 included nonmetropolitan residential status (OR, 2.06; 95% CI, 1.10-3.88) and not having had a tonsillectomy (OR, 2.74; 95% CI, 1.05-7.16)
Among women, having obtained a high school education or less was associated with lower odds of HPV-16 and HPV-18 infection (OR, 0.16; 95% CI, 0.03-0.97)
Summary
Oropharyngeal squamous cell carcinoma (OPSCC) associated with human papillomavirus (HPV) disproportionately affects men and has one of the most rapidly increasing incidences of any cancer in high-income countries.[1] The increased incidence is noted among younger cohorts with minimal exposure to smoking and alcohol, the risk factors most commonly associated with OPSCC; the increased HPV incidence may be attributable to oral exposure to infected anogenital sites with changing sexual behaviors.[2,3] Globally, the proportion of OPSCC attributable to HPV has been estimated as 23% to 31%; this varies by setting, regarding exposure to HPV, tobacco, and alcohol.[4,5] In Australia, Hong et al[3] reported a more than 3-fold increase in the percentage of HPV-positive OPSCC in the last 2 decades, from 20% to 63%; HPV-16 is the most common type in HPV-positive OPSCC, HPV-18 plays a role.[6] The 2 types together account for 85% of HPV-positive OPSCC (83% HPV-16; 2% HPV-18).[5] In 2012, the incidence of OPSCC in men overtook that of cervical cancer in women in the United States,[7] and similar findings were observed in the United Kingdom in 2016.8 Australian OPSCC incidence trends are in line with other high-income countries.[3] While these countries have experienced reduced rates of cervical cancer due to successful screening initiatives, the increase in OPSCC remains notable
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