While specific population-wide screening for oral cancer is not recommended by the National Institutes of Health, improving rates of oral cancer examination by primary care clinicians and dentists—currently about 20%—might improve early-stage detection.22 Despite research, no test equivalent to the Pap test is available for OPC; idiosyncrasies associated with the disease, such as the difficulty of obtaining cells from deep within the tonsils where tumors originate, may make such a test impractical for widespread use.1,23 The available HPV vaccines are effective against HPV serotypes 16 and 18 and are expected to have vaccine efficacy against OPC. The relationship with sexual behaviors and the disproportionate representation of men affected by HPV-positive OPC supports current recommendations to vaccinate both boys and girls to protect against HPV-16–associated cancers.1,15,24 Whether HPV vaccination can play a role in primary prevention of oropharyngeal cancer remains an open question, but one that warrants investigation.1,14


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References

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18. Semrau R, Duerbaum H, Temming S, et al. Prognostic impact of human papillomavirus status, survivin, and epidermal growth factor receptor expression on survival in patients treated with radiochemotherapy for very advanced nonresectable oropharyngeal cancer.  Head Neck. 2012;Oct 5 doi: 10.1002/hed.23126 [Epub ahead of print].

19. Argiris A, Heron DE, Smith RP, et al. Induction docetaxel, cisplatin, and cetuximab followed by concurrent radiotherapy, cisplatin, and cetuximab and maintenance cetuximab in patients with locally advanced head and neck cancer. J Clin Oncol. 2010 Dec 20;28(36):5294-5300.

20. Fury MG, Lee NY, Sherman E, et al. A phase 2 study of bevacizumab with cisplatin plus intensity-modulated radiation therapy for stage III/IVB head and neck squamous cell cancer. Cancer. 2012 Oct 15;118(20):5008-5014.

21. O’Sullivan B, Huang SH, Siu LL, et al. Deintensification candidate subgroups in human papillomavirus-related oropharyngeal cancer according to minimal risk of distant metastasis. J Clin Oncol. 2013 feb 10;31(5):543-550.

22. National Cancer Institute. Oral cancer screening (PDQ). Updated May 17, 2012. Available at: http://www.cancer.gov/cancertopics/pdq/screening/oral/HealthProfessional/page2/AllPages. Accessed February 11, 2013.

23. Fakhry C, Rosenthal BT, Clark DP, et al. Associations between oral HPV16 infection and cytopathology: evaluation of an of an oropharyngeal “Pap-test equivalent” in high-risk populations. Cancer Prev Res (Phila). 2011 Sep;4 (9):1378-1384.

24. Dunne EF, Markowitz LE, Chesson H, et al. Recommendations on the use of quadrivalent human  papillomavirus vaccine in males—Advisory Committee on Immunization Practices (ACIP), 2011. MMWR. 2011;60(50):1705-1708.