Human Papillomavirus Prevalence in Oropharyngeal Cancer before Vaccine Introduction, United States - Volume 20, Number 5—May 2014 - Emerging Infectious Disease journal - CDC
Volume 20, Number 5—May 2014
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, and the HPV Typing of Cancers Workgroup
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M. Steinau, M. Saraiya, M. Watson, J.L. Cleveland, E.R. Unger); Cedars-Sinai Medical Center, Los Angeles, California, USA (M.T. Goodman); Louisiana State University, New Orleans, Louisiana, USA (E.S. Peters); University of Iowa, Iowa City, Iowa, USA (C.F. Lynch); University of Florida, Gainesville, Florida, USA (E.J. Wilkinson); University of Hawaii, Honolulu, Hawaii, USA (B.Y. Hernandez); Michigan Cancer Surveillance Program, Lansing, Michigan, USA (G. Copeland); Los Angeles Cancer Registry, Los Angeles, California, USA (M.S. Saber, W. Cozen); University of Kentucky, Lexington, Kentucky, USA (C. Hopenhayn); Florida Department of Health, Tallahassee, Florida, USA (Y. Huang); Battelle Memorial Institute, Durham, North Carolina, USA (C. Lyu)
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.