(ChemotherapyAdvisor) – Among U.S. men and women aged 14 to 69 years, the prevalence of oral human papillomavirus (HPV) infection is 6.9% and is 3-fold more common among men, the first population-based study to examine the epidemiology of infection among both genders has found. Results were published in JAMA online January 26 to coincide with the study’s presentation at the Multidisciplinary Head and Neck Cancer Symposium.
Maura L. Gillison, MD, PhD, of The Ohio State University Comprehensive Cancer Center, Columbus, OH, and colleagues conducted the cross-sectional study within the US National Health and Nutrition Examination Survey, 2009–2010. Participants (n=5,579) provided a 30-second oral rinse and gargle with mouthwash. DNA purified from oral exfoliated cells was evaluated to detect HPV subtypes.
Among this population, oral HPV infection prevalence was 6.9% (95% CI, 5.7%–8.3%). Of the 37 HPV types evaluated, the most prevalent was HPV-16 (1.0%), which corresponds to an estimated 2.13 million infected individuals. At least 90% of HPV-positive oropharyngeal squamous cell carcinomas (OSCC) are associated with high-risk HPV-16, the investigators noted, “and oral infection confers an approximate 50-fold increase in risk for HPV-positive OSCC.”
A first peak in prevalence was observed among those 30 to 34 years of age (7.3%) and a second higher peak among those ages 60 to 64 years (11.4%). Prevalence of HPV was higher among current smokers and heavy alcohol drinkers and among former and current marijuana users.
Men had a significantly higher prevalence than women for overall oral HPV infection (10.1% vs. 3.6%); this 3-fold higher prevalence likely explains the 3-fold higher rates for HPV-positive OSCC among men, Dr. Gillison noted. She said it is not yet known whether men are more prone to getting HPV infection or, once infected, HPV is more likely to persist.
“Our data provide evidence that oral HPV infection is predominantly sexually transmitted,” the investigators wrote. Among individuals who reported ever having had sex (7.5%) vs. not (0.9%), oral HPV prevalence was more than 8-fold higher and increased with lifetime or recent number of partners for any kind of sex, vaginal sex, or oral sex (P<.001 for trend).
“Studies to evaluate ability of HPV vaccines to prevent oral HPV infection would further inform potential benefits of HPV vaccination among men,” Dr. Gillison said during a press conference. “This study is the first step toward development of prevention and screening strategies for this type of cancer,” she added.
On October 25, 2011, the Advisory Committee on Immunization Practices recommended HPV vaccination for boys ages 11 and 12 years.
In an accompanying editorial, Hans P. Schlecht, MD, MMSc, of Drexel University College of Medicine, Philadelphia, PA, wrote that “clinicians should encourage their patients who engage in oral sex to use barrier protection.”
The Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Head and Neck Society, the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Society of Nuclear Medicine.
“Oral Human Papillomavirus Infection,” Journal of the American Medical Association