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
1. Kreimer AR, Chaturvedi AK. HPV-associated oropharyngeal cancers—are they preventable? Cancer Prev Res (Phila). 2011 Sep;4(9):1346-1349.
2. Centers for Disease Control and Prevention. HPV-associated oropharyngeal cancer rates by race and ethnicity (updated August 2012). Available at: http://www.cdc.gov/cancer/hpv/statistics/headneck.htm. Accessed February 11, 2013.
3. Wu X, Watson M, Wilson R, et al. Human papillomavirus-associated cancers—United States, 2004-2008. MMWR. 2012;61(15):258-261.
4. National Cancer Institute. Oral cancer prevention (PDQ). Updated February 2013. Available at: http://www.cancer.gov/cancertopics/pdq/prevention/oral/HealthProfessional/page1/AllPages/Print. Accessed February 11, 2013.
5. Zandberg DP, Bhargava R, Badin S, Cullen KJ. The role of human papillomavirus in nongenital cancers. CA Cancer J Clin. 2013 Jan;63(1):57-81.
6. Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011 Nov 10;29(32):4294-4301.
7. Gillison ML, Koch WM, Capone RB, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst. 2000 May 3;92(9):709-720.
8. Chaturvedi AK, Engels EA, Anderson WF, Gillison ML. Incidence trends for human papillomavirus–related and –unrelated oral squamous cell carcinomas in the United States. J Clin Oncol. 2008 Feb 1;26(4):612-619.
9. Sano T, Oyama T, Kashiwabara K, Fukuda T, Nakajima T. Expression status of p16 protein is associated with human papillomavirus oncogenic potential in cervical and genital lesions. Am J Pathol. 1998 Dec;153(6):1741-1748.
10. Chung CH, Gillison ML. Human papillomavirus in head and neck cancer: its role in pathogenesis and clinical implications. Clin Cancer Res. 2009 Nov 15;15(22):6758-6762.
11. National Cancer Institute. Head and neck cancers: fact sheet. Reviewed February 2013. Available at: http://www.cancer.gov/cancertopics/factsheet/Sites-Types/head-and-neck/print. Accessed February 11, 2013.
12. National Cancer Institute. Oropharyngeal cancer treatment (PDQ). Updated February 2013. Available at: www.cancer.gov/cancertopics/pdq/treatment/oropharyngeal/HealthProfessional/page1/AllPages/Print. Accessed February 11, 2013.
13. Fakhry C, Westra WH, Li S, et al. Improved survival of patients with human papillomavirus–positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst. 2008 Feb 20;100(4):261-269.
14. Gillison ML, Broutian T, Pickard RK, et al. Prevalence of oral HPV infection in the United States, 2009-2010. JAMA. 2012;307(7):693-703.
15. D’Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007 May 10;356(19):1944-1956.
16. Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010 July 1;363(1):24-35.
17. Posner MR, Lorch JH, Goloubeva O, et al. Survival and human papillomavirus in oropharynx cancer in TAX324: a subset analysis from an international phase III trial. Ann Oncol. 2011 May;22(5):1071-1077.
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.