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Abstract
HPV-positive oropharyngeal squamous cell carcinoma (HPV-OSCC) is associated with oral sexual behaviors. The sharp rise in incidence of HPV-OSCC in the USA has been attributed to changes in sexual norms over the past five decades, with lower age at sexual debut and higher numbers of sexual partners per individual. In addition, variations in HPV-OSCC prevalence by race, age cohort and gender may be attributable to differences in oral sexual behaviors among these groups. Oral HPV infection is the putative precursor to HPV-OSCC. Risk factors for oral HPV incidence, prevalence, clearance and persistence are crucial to understanding how, and in whom, oral HPV infection progresses to malignancy. Future investigation should focus on elucidating the natural history of oral HPV infection persistence and malignant transformation, developing effective screening tools and exploring opportunities for prevention such as vaccination and public health education.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.
No writing assistance was utilized in the production of this manuscript.
Human papillomavirus (HPV) is etiologically responsible for a rising proportion of head and neck squamous cell carcinomas (HNSCCs), primarily tumors arising in the oropharynx. Approximately 80% of oropharyngeal squamous cell carcinomas are HPV-positive. HPV-positive HNSCC is epidemiologically and molecularly distinct from HPV-negative disease.
Oral sexual behaviors are associated with HPV-positive HNSCC (HPV-HNSCC).
The epidemiology of HPV-HNSCC, which affects mostly middle-aged individuals, whites and men, can partially be explained by variations in oral sexual behavior by age cohort, race and gender.
Oral HPV infection is the putative precursor to HPV-HNSCC. Elucidating risk factors for incident, prevalence and persistent oral HPV infection is important to our understanding of the natural history of progression from infection to malignancy.
Risk factors for incident and prevalent oral HPV infection include sexual behaviors, cigarette smoking, male gender, older age and immune deficiency.
Persistent oral HPV infection is hypothesized to increase risk for progression to cancer. Risk factors for persistent oral HPV infection are poorly understood, but may include cigarette smoking, male gender and older age. Sexual behaviors have not been found to increase risk for persistent infection.
The psychosocial needs of patients with HPV-HNSCC are likely distinct from the needs of patients with HPV-negative disease due to the sexually transmitted nature of HPV-HNSCC, but this has not been well studied.
Counseling for patients with HPV-HNSCC should acknowledge the potential psychosocial impact of the diagnosis, and frankly address what is known and unknown about oral HPV transmission.
There are no evidence-based screening methods available for oral HPV infection or HPV-related head and neck cancer.
The efficacy of HPV vaccination in preventing oral HPV infection is unknown, but preliminary studies indicate that vaccination may be a viable prevention strategy.