The Growing Epidemic of HPV-Positive Oropharyngeal Carcinoma

Abstract and Introduction

Abstract

While the rate of head and neck cancer has decreased in recent decades, the prevalence of oropharynx cancer has dramatically increased due to human papillomavirus (HPV)–related oropharyngeal cancer. Three of 4 newly diagnosed oropharyngeal carcinomas are HPV-positive, and by 2020 it is projected that the prevalence of this disease will overtake that of HPV-related cervical cancer. Recognized in recent years as a malignant entity distinct from HPV-negative oropharyngeal carcinoma, HPV-positive oropharyngeal cancer is associated with younger age at diagnosis, oral sexual behavior as a primary risk factor, nonspecific presentation, and improved treatment response compared with HPV-negative disease. Early recognition and referral for definitive treatment are paramount in decreasing morbidity and mortality, as well as improving the quality of life of these patients. Primary care providers are in an ideal position to improve patient outcomes through early recognition and referral, as well as coordination of comprehensive care of patients with this potentially devastating disease. Awareness of risk factors, a high index of suspicion, counseling patients and parents on the importance of vaccination against HPV, and coordinated care between primary care providers and specialists are vital to achieving improved outcomes for patients with this increasingly prevalent cancer.

Introduction

Oropharynx cancer has been increasing at an epidemic rate over the past several decades, with a prevalence in the United States that has increased 225% from 1988 to 2004.^[1] This meteoric rise is exclusively a result of human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma (OPSCC). According to recent data, 3 of 4 newly diagnosed oropharyngeal carcinomas are HPV-positive (HPV+); if current trends continue, HPV+ OPSCC prevalence is expected to overtake that of cervical cancer by the year 2020.^[2,3] HPV+ OPSCC has been recognized as a malignant process distinct from HPV-negative (HPV−) OPSCC, with its own epidemiology, tumor biology, presentation, response to treatment, and prognosis.

Because of its rapidly increasing prevalence and often nonspecific presentation, timely diagnosis and treatment of HPV+ OPSCC requires a high index of suspicion from primary care providers, who are commonly the first point of professional contact for patients with symptoms of HPV+ OPSCC. Awareness of the epidemiology, risk factors, and presentation of these tumors is crucial to producing improved outcomes through rapid referral for diagnosis and definitive treatment of these tumors, as well as maintaining the patient's quality of life. The objective of this article is to increase awareness of HPV+ OPSCC among primary care providers and emphasize the importance of early detection of these tumors in decreasing morbidity and mortality for these patients.