to about 85% of head and neck cancers many of which are oropharyngeal squamous cell carcinomas (OPSCC) and within the last five decades there has been a 225% increase in the (OPSCC) cases caused by HPV infection (Tumban, 2019). Today the relationship between HPV and oropharyngeal cancer is well established (Kline, et al., 2018). Over the past 30 years, the incidence of oropharyngeal cancer cases has been increasing worldwide (You, et al., 2019) – a trend that is attributed to the HPV epidemic. Some estimates predict that by 2020 the incidence of HPV-positive (OPSCC) will exceed that of cervical cancer and that by 2030, about 50% of all head and neck cancers will be HPV-related (Wagner & Villa, 2017). Currently, in the U.S., 70 to 80% of oropharyngeal squamous cell carcinoma cases are HPV- related (Sanyaolu, et al., 2019). Table 4 provides a brief summary of oral cancer in general, including the most common symptoms. Prevalence, incidence, and at-risk populations The incidence of HPV-related oral cancers is steadily rising globally (Van-Heerden, et al., 2017). Some cancers of the oropharynx (back of throat, including the base of the tongue and tonsils) have been linked with HPV (Sanyaolu, et al., 2019). Worldwide, the incidence of HPV-related oropharyngeal cancers is increasing, while the incidence of oropharyngeal cancers related to other causes (alcohol, tobacco) is falling (You, et al., 2019; Ducatman, 2018). Between 2001-2018 229,264 adult males and 55,108 females were diagnosed with HPV-related oropharyngeal squamous cell carcinoma (OPSCC) (Guo, et al., 2022). White, Non-Hispanics get these cancers more often than Hispanics, and men get them more frequently than women although the incidence or oropharyngeal cancer is increasing among white, non-Hispanic women (Lechner,
Table 4: Oral Cancer Brief • Most oral cancers begin in the squamous cells that line the moist surfaces inside the head and neck. • Use of tobacco and/or alcohol and the presence of HPV infection are important risk factors. • Traditional symptoms include: ○ Lump or sore in the mouth that does not heal within 2 weeks. ○ A sore throat that does not go away. ○ Difficulty swallowing. ○ A change or hoarseness in the voice. ○ A tonsil that is swollen but painless. Tonsils on both sides should be about the same size. ○ A painless lump on the outside of the neck which has been present for two weeks. ○ During protrusion the tongue deviates to one side. Note . Adapted from American Dental Association. Cancer (Head and Neck) Department of Scientific Information, Evidence Synthesis and Translation Research, ADA Science and Research Institute, LLC. Last updated: September 30, 2022; Oral Cancer Foundation. HPV / Oral Cancer Facts. © 2022. https// oralcancerfoundation.org>understanding>hpv… et al., 2022). Calculations of the incidence of HPV-related (OPSCC) can be made based upon its occurrence per 1,000,000 people and can reflect specific periods of time for comparison. During the period of 2014-2018 the incidence of (OPSCC) was lower in males aged 20-44 (11.4 per 1,000,000) than compared to that of 2002-2006 which was (12.8 per 1,000,000 (Guo, et al., 2022). compared to the profile of traditional oral cancer patients, HPV-positive patients tend to be younger, of higher socioeconomic status and level of education, with lower lifetime use of tobacco and alcohol (Ducatman, 2018; Kline, et al., 2017). Table 5 offers a comparison of the characteristics and demographics of persons with HPV-related oropharyngeal cancer and persons with non-HPV-related oropharyngeal cancer.
Table 5: Oropharyngeal Cancer Patient Characteristics by HPV Status HPV-Positive Cancer
HPV-Negative Cancer All head and neck sites
Anatomical site
Oropharynx Younger age
Age
Older age: Most common in the seventh decade
Prevalence peaks: 30 to 34 years and 60 to 64 years Incidence is higher: 45 to 59 years
Sex
4:1 male to female ratio
3:1 male to female ratio
Race
White
Black
Patient characteristics
Multiple sex partners and/or anogenital sex partners (average of 8 to 10 partners; more than 4 oral sex partners) Nonsmoker
Tobacco use: Cigarettes, chewing tobacco, or snuff
Low to moderate alcohol use
Moderate to heavy alcohol use
Middle to upper SES
Low SES
Incidence
Increasing Decreasing Note . Adapted from Tillman Randi. The important role dental professionals play in educating patients about HPV prevention. Dentistry IQ. March 22, 2019. https://www.dentistryiq.comoral-cancer>article>the...; Kreimer Aimee R., Chaturvedi Anil K and Alemany Laia. Summary from an international cancer seminar focused on human papillomavirus (HPV-positive oropharynx cancer, convened by scientists at IARC and NCI. Oral Oncology. 108 (2020) 104736. https://www.sciencedirect.com>science>article>pii orhttps://doi.org/10.1016/j.oraloncology; Riddell IV James, Brouwer Andrew, Walline Heather M. Oral human papillomavirus prevalence, persistence and risk-factors in HIV-positive and HIV negative adults. Tumour Virus Research. April 20, 2022. https://www.sciencedirect.com>science>article>pii; Lechner Matt, Liu Jacklyn, Masterson Liam and Fenton, Tim R. HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nat Rev Clin Oncol 19, 306-327 (2022). https://www.nature.com>...>reviewarticles; Gorphe Philppe, Calsse Marion, Ammari Samy, et.al. Patterns of disease events and causes of death in patients with HPV-positive versus HPV-negative oropharyngeal carcinoma. Radiotherapy and Oncology. 168 (January 2022) 40-45. https://www.sciencedirect.com>science>article>pii
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