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Human papilloma virus (HPV) causes cancer at genital, oral, and anal sites. Although there is a higher reported prevalence of all HPV-related cancer in women, the prevalence of oropharyngeal squamous cell carcinoma (OPSCC) is about four times greater in men.
Using data from the National Health and Nutrition Examination, investigators found that the incidence of OPSCC has increased in men by 2.89% annually from 2002 to 2012, while increasing only 0.57% annually in women, and has exceeded the incidence of cervical cancer in women. The prevalence of oral HPV in men rose to 11.5%, equating to 11 million infected men nationwide, while the prevalence in women was 3.2%, equating to 3.2 million women; the prevalence of strains causing most cancers was higher in men by an even greater proportion.
Prevalence peaks in men were bimodal in the age groups of 30 to 39 and 50 to 54 years. Non-Hispanic black men had the highest prevalence overall prevalence and highest prevalence of high-risk infection. Other risk factors for overall and high-risk infection included cigarette and marijuana use (previous marijuana use in men, current use in women) and sexual practices in men and women, including having had many lifetime or recent sex partners. There was high concurrence between oral and genital infection and presence of high-risk infection in both men and women. The prevalence of high-risk infection was greatest (22.2%) in men with 2 or more same sex, oral sex partners.
Sonawane K et al. Oral human papillomavirus infection: Differences in prevalence between sexes and concordance with genital human papillomavirus infection, NHANES 2011 to 2014. Ann Intern Med 2017 Oct 17; [e-pub]. (http://dx.doi.org/10.7326/M17-1363)
Gravitt PE.Unraveling the Epidemiology of oral human papillomavirus infection. Ann Intern Med 2017 Oct 17; [e-pub]. (http://dx.doi.org/10.7326/M17-2628)
Comment
These are very strong data showing increasing prevalence of oral human HPV, especially among men, with resultant development of OPSCC. The authors appropriately raise the issue of health policy changes to try to prevent infection and oropharyngeal cancer in men. One policy change that might be evaluated, as suggested by an editorial, is vaccination of middle-aged men.