Head and Neck Cancer in Australia between 1982 and 2005 show increasing incidence of potentially HPV-associated oropharyngeal cancers

Centre for Women's Health, Gender and Society, University of Melbourne, 2/723 Swanston Street, Carlton 3053, Victoria, Australia.
British Journal of Cancer (Impact Factor: 4.84). 02/2011; 104(5):886-91. DOI: 10.1038/sj.bjc.6606091
Source: PubMed


Although tobacco- and alcohol-associated head and neck cancers are declining in the developed world, potentially human papillomavirus (HPV)-associated oropharnygeal cancers are increasing.

We analysed oropharyngeal and oral cavity cancer rates in Australia in 1982–2005. Cancers from the oropharynx (base of tongue, tonsil and other specific oropharyngeal sites) were classified as potentially HPV associated (n=8844); cancers in other oral cavity and oropharyngeal sites not previously associated with HPV were classified as comparison (n=28 379).

In 2000–2005, an average of 219, 159 and 110 cancers of the tonsil, base of tongue and other oropharyngeal sites were diagnosed annually, with incidences of 1.09 (95% CI: 1.03, 1.15), 0.79 (95% CI: 0.74, 0.84) and 0.55 (95% CI: 0.50, 0.59) per 100 000, respectively. An average of 1242 comparison cancers were diagnosed annually (6.17 (95% CI: 6.03, 6.31) per 100 000). In 1982–2005, there were significant annual increases in tonsil (1.39% (95% CI: 0.88, 1.92%)) and base of tongue cancers in males (3.02% (95% CI: 2.27, 3.78%)) and base of tongue cancer in females (3.45% (95% CI: 2.21, 4.70%)). There was a significant decrease in comparison cancers in men (−1.69% (95% CI: −1.96, −1.42%)), but not in females.

Potentially HPV-associated oropharyngeal cancer in Australia is increasing; the impact of HPV vaccination on these cancers should be monitored.

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Available from: Jane Hocking, Jan 22, 2014
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    • "Human papillomavirus (HPV) causes a significant proportion of oropharyngeal cancers, most commonly in the lingual and palatine tonsils or base of tongue. There has been an increase in oropharyngeal cancer incidence in younger individuals and the proportion of these tumours associated with HPV continues to rise [1]. Specific genotypes of HPV identified as high-risk [2] have been shown to be more likely to cause malignancy due to modulation of two important tumor suppressors, p53 and Rb by the HPV oncoproteins, E6 and E7 [3]. "
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    ABSTRACT: Background Human papillomavirus (HPV) is a causative agent in oropharyngeal squamous cell carcinoma. The natural history of oral HPV in HIV-positive men who have sex with men (MSM) is unclear. Methods Detection of oral human papillomavirus in 173 HIV-positive MSM using oral rinse samples 3 years apart was investigated. HPV DNA was detected by polymerase chain reaction, and genotyped by Roche Linear Array. Results Of 173 men tested in 2010, 30 had at least one HPV genotype (17%, 95% CI: 12–23), 15 at least one hr-HPV (9%, 95% CI: 5–14) and 8 had HPV 16 (5%, 95% CI: 2–9) detected. In 2013, 33 had at least one HPV genotype (19%, 95% CI: 14–26), 20 had at least one hr-HPV (12%, 95% CI: 7–17) and 7 had HPV 16 (4%, 95% CI: 2–8) detected. Of 30 men at baseline (2010) with any HPV detected, 14 (47%, 95% CI: 28–66) had at least one persistent genotype. Of the 15 men in 2010 with high risk (hr-) HPV, 6 men (40%, 95% CI: 16–68) had at least one persistent hr-HPV genotype. The incidence rate of detection of at least one new HPV genotype was 4.8 per 100 person years (95% CI: 3.1–7.0), of at least one hr-HPV genotype was 3.2 per 100 person years (95% CI: 1.8–5.1) and of HPV 16 was 0.8 per 100 person years (95% CI: 0.2–2.0). The clearance rate was 14.9 per 100 person years (95% CI: 8.2–24.2) for any HPV, 18.2 per 100 person years (95% CI: 8.2–32.7) for hr-HPV and 17.4 per 100 person years (95% CI: 5.0–38.8) for HPV-16. Persistent HPV detection was associated with duration of HIV (OR 1.13 (per additional year), 95% CI: 1.00–1.26) and tonsillectomy (OR 8.17, 95% CI: 1.30–51.40). Conclusion The same oral HPV genotype was detected again after 3 years in nearly half of HIV-positive men who have sex with men.
    Full-text · Article · Jul 2014 · PLoS ONE
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    • "As such, some public health professionals and researchers profile the ethical debate of the exclusion of boys in a vaccination program from which they could reap additional health benefits. In recent decades, data suggest that incidence rates for HPV-related anal and oropharynx cancer, affecting both sexes, have been increasing in many countries, including the US [2], and Australia [3,4] and markedly in 50–69 year-old males in New Zealand [5]. Vaccinating males as well as females will confer more benefit than vaccinating females only, but the extent of the incremental benefit will critically depend on coverage in females. "
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    ABSTRACT: Background: Similar to many developed countries, vaccination against human papillomavirus (HPV) is provided only to girls in New Zealand and coverage is relatively low (47% in school-aged girls for dose 3). Some jurisdictions have already extended HPV vaccination to school-aged boys. Thus, exploration of the cost-utility of adding boys' vaccination is relevant. We modeled the incremental health gain and costs for extending the current girls-only program to boys, intensifying the current girls-only program to achieve 73% coverage, and extension of the intensive program to boys. Methods: A Markov macro-simulation model, which accounted for herd immunity, was developed for an annual cohort of 12-year-olds in 2011 and included the future health states of: cervical cancer, pre-cancer (CIN I to III), genital warts, and three other HPV-related cancers. In each state, health sector costs, including additional health costs from extra life, and quality-adjusted life-years (QALYs) were accumulated. The model included New Zealand data on cancer incidence and survival, and other cause mortality (all by sex, age, ethnicity and deprivation). Results: At an assumed local willingness-to-pay threshold of US$29,600, vaccination of 12-year-old boys to achieve the current coverage for girls would not be cost-effective, at US$61,400/QALY gained (95% UI $29,700 to $112,000; OECD purchasing power parities) compared to the current girls-only program, with an assumed vaccine cost of US$59 (NZ$113). This was dominated though by the intensified girls-only program; US$17,400/QALY gained (95% UI: dominant to $46,100). Adding boys to this intensified program was also not cost-effective; US$128,000/QALY gained, 95% UI: $61,900 to $247,000).Vaccination of boys was not found to be cost-effective, even for additional scenarios with very low vaccine or program administration costs - only when combined vaccine and administration costs were NZ$125 or lower per dose was vaccination of boys cost-effective. Conclusions: These results suggest that adding boys to the girls-only HPV vaccination program in New Zealand is highly unlikely to be cost-effective. In order for vaccination of males to become cost-effective in New Zealand, vaccine would need to be supplied at very low prices and administration costs would need to be minimised.
    Full-text · Article · Jun 2014 · BMC Infectious Diseases
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    • "HPV is detected in approximately 25% of all HNSCCs (Kreimer et al. 2005), and the majority of these HPV-associated HNSCCs are oropharyngeal (tonsillar and base of the tongue) squamous cell cancers (Lajer and Buchwald 2011). HPV has also been detected in a smaller subset of laryngeal (24%) and oral (23%) cancers (Kreimer et al. 2005; Hobbs et al. 2006; Hocking et al. 2011). "
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    ABSTRACT: More than four decades have elapsed since the initial hypothesis of a possible role of human papilloma virus (HPV) in the genesis of human cancers was postulated. It is now apparent that different types of HPVs are responsible for sizable proportion of human cancers. Till date, 180 HPV genotypes, numbered sequentially, have been cloned from clinical lesions worldwide. It is common knowledge that HPV infection accounts for almost 100% of cervical cancers, and that HPV is responsible for 5.2% of all cancers including 25% of head and neck cancers. Presently, research on identification of host micro RNAs as master regulators in the process of carcinogenesis would be a tool for therapeutics in this arena. 1 Introduction HPV is a member of Papillomaviridae family of viruses, which are so far implicated for causing epithelial warts, mostly benign in nature. However, this particular viral entity has shot into prominence due to its increasingly distinct association in the causation of human maladies of grave nature, cf. cervical and oropharyngeal squamous cell carcinomas. Interestingly enough, this association is accompanied by a silver lining in the form of explorable therapeutic options that may pave the path for fruitful research and subsequent deployment in clinical medicine. In the ensuing paragraphs, the various aspects of the aforesaid shall be elucidated further.
    Full-text · Chapter · May 2014
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