Purpose Previous studies examining the association of body mass index (BMI) with risk of and survival from head and neck squamous cell carcinoma (HNSCC) have been inconsistent, although an inverse association has been noted for obesity and risk of HNSCC in several studies. Previous studies have not examined whether these associations differ by human papillomavirus (HPV) status. Methods We utilized the resources of a population-based case-control study of HNSCC from the greater Boston area (959 cases and 1208 controls were eligible for this analysis). Anthropometric history was collected through personal interviews and HPV status was assessed using serology. We analyzed the association between BMI (assessed 5 years prior to disease incidence) and disease risk and survival using logistic regression and Cox proportional hazards regression, respectively. Results After adjusting for known risk factors, the association between obesity and overall risk of HNSCC was not significant (OR=0.79, 95% CI: 0.60-1.04). However, obesity (BMI≥30 kg/m2) was inversely associated with HNSCC risk among HPV seronegative cases (OR=0.48, 95% CI: 0.32-0.70), but not among HPV seropositive cases (OR=0.91, 95% CI: 0.68-1.21). BMI was not associated with survival overall or by HPV status. However, being overweight (BMI:25-29.9 kg/m2) was associated with longer survival among HPV seropositive smokers (HR=0.48, 95%CI:0.31-0.74). Conclusions Our findings are consistent with previous observations that obesity is inversely associated with the risk of HNSCC; however this association appears to be confined to HPV seronegative cases. Overall obesity was not associated with HNSCC survival overall or by HPV status. Impact Obesity is associated with risk of non-HPV HNSCC, but not HPV HNSCC.

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