Human Papillomavirus-Associated Head and Neck Cancer

Juan C. Nogues, BS; Scott Fassas, MD; Collin Mulcahy, MD; Philip E. Zapanta, MD


J Am Board Fam Med. 2021;34(4):832-837. 

In This Article


OPSCC has historically been a disease affecting older male smokers. As the rates of tobacco consumption have declined in the United States, there has been a decreased incidence of many head and neck cancers. HPV-related head and neck cancers, however, have not followed this overall trend, with multiple sources demonstrating a rise in incidence over the last 2 decades.[4–6] Specifically, the percentage of HPV-related cancers has jumped from 41%, before 2000, to 72% between 2005 and 2009 (Figure 2).[7] While previous literature estimated the incidence of HPV-related OPSCC would surpass HPV-related cervical cancer by 2020,[8,9] data collected by the Centers for Disease Control and Prevention (CDC) have suggested that the total incidence has already surpassed HPV-related cervical cancer well before this time frame.[2]

Figure 2.

Human Papillomavirus (HPV) Prevalence Among Patients With Oropharyngeal Cancer as Reported in A Systematic Review and Meta-Analysis of Studies Published Between 1966 and 2010.7

While marijuana exposure has been shown to be an independent risk factor for the development of HPV-positive head and neck cancer,[10] the primary reason for the increase in OPSCC is related to an overall rise in high-risk sexual practices. More than 90% of oral HPV infections are related to sexual activity, with oral sex being the largest predisposing factor.[11,12] Furthermore, patients impacted by HPV-positive OPSCC are generally younger than their HPV-negative counterparts and overwhelmingly white males—typically between the ages of 40 and 55.[13]