Trends in head and neck cancer incidence in relation to smoking

Though the overall incidence of head and neck cancers has fallen in the United States, the rate of oropharyngeal (chiefly, tonsil and base of tongue) cancers is stagnant and appears to be rising is certain populations and these trends are likely due to oncogenic human papillomavirus (HPV) infection.

A review published in the October 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, finds an increasing trend in the incidence of oropharyngeal cancers, particularly among men under 45 years old, for which HPV infection is the likely cause.

Cancers of the head and neck, which include cancers of the larynx, nasal passages/nose, oral cavity, pharynx, and salivary glands, account for three percent of all newly diagnosed cancers in the U.S. Men are three times more likely to be diagnosed with these cancers than women. Of the estimated 45,000 new cases of head and neck cancers expected this year, approximately 10,000 are cancers of the pharynx (chiefly the oropharynx). Though the prognosis for these cancers is excellent when caught early, more than half of them are identified in advanced stages, when the prognosis is far worse, making prevention critical to saving lives.

In their review, Erich M. Sturgis, M.D., M.P.H. and Paul Cinciripini, Ph.D. of The University of Texas M. D. Anderson Cancer Center in Houston, conclude that the stagnate incidence rates of oropharyngeal cancers, particularly cancers of the tonsil and base of tongue, in the face of declines in tobacco use, the principal cause of head and neck cancers, are likely explained by rising prevalence of oropharyngeal exposure to an oncogenic virus. They say the literature points to exposure to HPV especially strain 16 as having the strongest association to oropharyngeal cancers. However, the authors suggest that a recently approved HPV vaccine may ultimately have a significant impact on the incidence of oropharyngeal tumors.

While the cervical cancer and dysplasia prevention policy of HPV16/18 vaccination of young women and adolescent females are commended, we fear that vaccination programs limited to females will only delay the potential benefit in prevention of HPV16/18 associated oropharyngeal cancers, which typically occur in men, conclude the authors.

The authors encourage the rapid study of the efficacy and safety of these vaccines in males and, if successful, the recommendation of vaccination of young adult and adolescent males.

Article: Trends in Head and Neck Cancer Incidence in Relation to Smoking Prevalence: An Emerging Epidemic of Human Papillomavirus-Associated Cancers, Erich M. Sturgis, M.D., M.P.H., and Paul M. Cinciripini, CANCER; Published Online: August 27, 2007 (DOI: 10.1002/cncr. 22963); Print Issue Date: October 1, 2007.