The Growing Epidemic of HPV-Positive Oropharyngeal Carcinoma: A Clinical Review for Primary Care Providers

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. (J Am Board Fam Med 2015;28: 498 -503.)

Assessment of human papillomavirus awareness in association with head and neck cancer at a screening event

“…We can partially explain this observation by highlighting that insurance status is not a good indicator of whether patients are receiving effective health education, and clinicians may not adequately discuss HPV and HNC with their patients. A recent clinical review advocated for PCPs to increase their own awareness of HPV‐related HNC, which would improve their ability to effectively counsel their patients . Even among dentists, there still exists a gap in HPV knowledge .…”

HPV positive oropharyngeal cancer: risky sexual behavior

“…In our research we identify 15 articles focused on HPV associated oropharyngeal cancer and sexual behavior as a risk factor 1,3,9,[11][12][13][14][15][16][17][18][19][20][21][22] . One article studied the knowledge of HPV and its association with oropharyngeal cancer in a high-risk population 16 .…”

“…The other affirms that the HPV has influence in the oropharyngeal cancer depending on its viral load and stage and that's not determined by demographic or behavioral factors 14 . The other ten articles affirm the HPV can be used as sexual behavior marker 9,[11][12][13][17][18][19][20][21][22] , but each article used a different aspect of sexual behavior to establish that.…”

Radon exposure and oropharyngeal cancer risk

“…Overall HPV prevalence in oropharyngeal cancer increased significantly from 40.5% before 2000, to 64.3% between 2000 and 2004, and 72.2% between 2005 and 2009 (p < .001) [29]. It is projected that by 2020 the prevalence of this disease will overtake that of HPV-related cervical cancer [30], so we can't avoid including such a risk factor in this review.…”