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Warts are annoying on the skin but can be deadly on mucosal surfaces. Human papillomavirus (HPV) infection has a well-established role in cervical carcinoma, and its association with oropharyngeal carcinoma (OPC) has also been suggested. Researchers conducted a hospital-based, epidemiologic study in patients with newly diagnosed OPC to look at such an association.
The investigators collected demographic information and determined HPV infection status in 100 patients with OPC and 200 age- and sex-matched healthy controls. Most patients (86%) were male. Family history of cancer (especially squamous-cell carcinoma of the head and neck), a personal history of oral papillomas, poor long-term oral hygiene, consumption of 15 or more alcoholic drinks per week for more than 14 years, and a smoking history of more than 20 pack-years were all associated with OPC. In a multivariate analysis, the following factors were also significantly associated with OPC: having had more than 26 lifetime vaginal-sex partners or more than 6 lifetime oral-sex partners and presence of serum antibodies to HPV-16b L1 capsid protein. Of 60 patients with available frozen tissue samples, 72% had HPV-16 DNA in tumor cell nuclei. Neither high tobacco use nor high alcohol use was an additive factor in HPV-induced OPC. The authors speculate that alcohol- and tobacco-induced OPC may follow a different pathway than HPV-16–induced disease.
D’Souza G et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 2007 May 10; 356:1944-56.
Comment
The incidence of tonsillar and base-of-the-tongue cancers has been increasing since 1973. Understanding the contributing factors beyond the well-established ones of heavy alcohol and tobacco use is important. Warts have been implicated in oral cancer, and this epidemiologic and virologic investigation confirms an association between such cancers and HPV. The number of sexual partners appears to increase the odds of having an oral HPV-16 infection. Because most patients with this disease are males, protection during oral-genital sex is not straightforward. With a vaccine now available and effective in preventing HPV-16–associated cervical carcinoma, seeing whether the vaccine also decreases the incidence of oral and pharyngeal carcinoma will be interesting.