The Rise of HPV-Positive Oropharyngeal Cancers in the United States

摘要

Abstract This perspective highlights a study that reports an increasing proportion of human papillomavirus-positive oropharyngeal cancer among blacks in recent calendar periods. The results are discussed in the context of other studies which evaluated racial differences in the distribution of human papillomavirus-positive oropharyngeal cancer and survival. In recent decades the incidence of oropharyngeal cancers in the United States has steadily risen, whereas the incidence of other head and neck cancers has significantly decreased (1). These epidemiologic patterns are attributed to an increased prevalence of oral human papillomavirus (HPV) infection since the sexual revolution and a concomitant decrease in tobacco use. In the United States, HPV-positive oropharyngeal cancer (HPV-OPC) has significantly risen among whites, 50 to 59 year-olds, and males (2). Although less noticeable, a trend of increased HPV-OPC has also been observed among blacks. In a Surveillance Epidemiology and End Results (SEER) subana-lysis restricted to blacks, a nonsignificant increase in HPV-OPC from 0% in 1984 to 1989 to approximately 25% in 1995 to 1999 (P = 0.11) was reported (2). HPV tumor status was determined using multiple validated methods (Inno-lipa, E6 and E7 mRNA, HPV16 rt-PCR, and in situ hybridization). Interestingly, in the latest report of U.S. cancer incidence, oropharyngeal cancer overall (independent of HPV tumor status) was significantly decreasing among blacks (3). The SEER analysis of oropharyngeal cancer incidence did not provide trends among blacks after 1999, which is the time period most relevant to the current "epidemic" of HPV-OPC in the United States (1,4). Until this can be performed at a population level, Zandberg and colleagues (5) provide single-institution estimates for changes in incidence of HPV-OPC among blacks. They reported nonsignificant increases in HPV-OPC among blacks from 1992 to 2007, from 0% to 17.7% (n = 17), with 25% of tumors tested in the calendar years 2000 to 2003 being HPV-positive.