Human Papillomavirus-Associated Head and Neck Cancer

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

Disclosures

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

In This Article

Abstract and Introduction

Abstract

Oropharyngeal squamous cell carcinoma (OPSCC) has historically been attributable to tobacco and alcohol exposure and saw a decline in incidence after societal norms shifted away from smoking. In recent decades, this disease has had a re-emergence due to human papillomavirus (HPV) infection, now surpassing cervical cancer as the number 1 cause of HPV-related cancer in the United States. HPV-positive OPSCC differs from HPV-negative disease in epidemiology, prognosis, treatment, and prevention. Additionally, there is a deficit in awareness of the causal relationship between HPV and OPSCC. This, coupled with low vaccination rates, puts primary care providers in a unique position to play a vital role in prevention and early diagnosis. In this review, we highlight the epidemiology, screening, patient presentation, diagnosis, prognosis, and prevention of HPV-positive OPSCC, with a focus on the primary care provider's role.

Introduction

Oropharyngeal squamous cell carcinoma (OPSCC) has historically been attributable to tobacco exposure, seeing a decline in incidence in the 1980s (Figure 1)[1] after societal norms shifted away from smoking. However, in recent decades this disease has had a re-emergence due to human papillomavirus (HPV) infection, now surpassing cervical cancer as the number 1 cause of HPV-related cancer in the United States.[2] Compared with HPV-negative OPSCC, the disease course of HPV-positive OPSCC portends a more favorable prognosis, with significantly increased progression free survival.[3] This is particularly true when appropriate therapy is provided early, highlighting the importance of early detection and treatment to reduce the morbidity associated with late-stage interventions. Although treatment interventions are improving, the majority of these cases are attributable to HPV 16, 18, 31, and 33; all infections preventable by vaccination.

Figure 1.

SEER Age-Adjusted Trends in Oral Cavity and Pharynx Cancer, 1975 to 2017.1 Results from cancer incidence data from population-based cancer registries covering approximately 34.6% of the US population.

This puts primary care providers (PCPs) in a unique position to play a vital role in prevention, screening, and early diagnosis. In this review, we highlight the epidemiology, screening, patient presentation, diagnosis, prognosis, and prevention of HPV-positive OPSCC, with a PCP-focused approach.

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