Human Papillomavirus Prevalence in Oropharyngeal Cancer Before Vaccine Introduction, United States

Martin Steinau; Mona Saraiya; Marc T. Goodman; Edward S. Peters; Meg Watson; Jennifer L. Cleveland; Charles F. Lynch; Edward J. Wilkinson; Brenda Y. Hernandez; Glen Copeland; Maria S. Saber; Claudia Hopenhayn; Youjie Huang; Wendy Cozen; Christopher Lyu; Elizabeth R. Unger


Emerging Infectious Diseases. 2014;20(5):822-828. 

In This Article

Abstract and Introduction


We conducted a study to determine prevalence of HPV types in oropharyngeal cancers in the United States and establish a prevaccine baseline for monitoring the impact of vaccination. HPV DNA was extracted from tumor tissue samples from patients in whom cancer was diagnosed during 1995–2005. The samples were obtained from cancer registries and Residual Tissue Repository Program sites in the United States. HPV was detected and typed by using PCR reverse line blot assays. Among 557 invasive oropharyngeal squamous cell carcinomas, 72% were positive for HPV and 62% for vaccine types HPV16 or 18. Prevalence of HPV-16/18 was lower in women (53%) than in men (66%), and lower in non-Hispanic Black patients (31%) than in other racial/ethnic groups (68%–80%). Results indicate that vaccines could prevent most oropharyngeal cancers in the United States, but their effect may vary by demographic variables.


Oropharyngeal cancers include malignancies that occur where the oral cavity and pharynx merge, including in the palatine and lingual tonsils, the posterior 1/3 (base) of the tongue, the soft palate, and the posterior pharyngeal wall. Current worldwide incidence has been estimated at ≈85,000 annually,[1] although it varies extensively by geographic region. In the United States, ≈12,000 new oropharyngeal cancers are diagnosed annually;[2] most are classified histologically as squamous cell carcinoma (OPSCC). In addition to tobacco use and alcohol use, infection with human papillomavirus (HPV) has been recognized as an independent risk factor for oropharyngeal cancer.[3–6]

The 2 HPV vaccines approved by the US Food and Drug Administration protect against infection with HPV-16 and HPV-18, which are the high-risk types most frequently associated with cervical cancer. A candidate 9-valent vaccine that includes types in the existing quadrivalent vaccine (HPV types 6, 11, 16, and 18) and 5 additional high-risk types (31, 33, 45, 52, and 58) is in clinical trial. Supported by evidence that existing vaccines effectively reduce oral HPV infections, these formulations may also reduce incidence of oropharyngeal cancers.[7] When monitoring the population-level effect of HPV vaccination on oropharyngeal cancer occurrence in the United States, data on the incidence and type-specific prevalence of this disease are essential. Previously, the prevalence of cases attributable to viral infection and the consequent effects of vaccine programs were approximated from small published studies,[8–13] which estimated HPV to be detected in 37%–60% of OPSCC in North America. Considering the range of prevalence, the heterogeneity of study populations, and differences in sample preparation and HPV detection methods used in these studies, it is not clear that this range of estimates reflects the true scope of HPV-associated OPSCC in the United States. Therefore, the objectives of this study were to determine prevalence of HPV types detected in oropharyngeal cancers in the United States and to establish a prevaccine baseline for monitoring the impact of vaccination.