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A new national report on cancer incidence trends1 presents data of relevance for dentists and the public. First, the report provides encouraging long-term data on declining death rates for several common cancer types, but it also presents significant data on the increasing incidence rates of human papillomavirus (HPV)-associated cancers of the oropharynx, including the base of the tongue and tonsils. The report, published in the Journal of the National Cancer Institute, was widely publicized online and was prepared as part of an annual collaboration by the American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute, and the North American Association of Central Cancer Registries.

The new publication is titled the “Annual Report to the Nation on the Status of Cancer, 1975-2009.” Among the Annual Report’s primary findings on HPV-associated oropharyngeal cancer:

  • From 2005 to 2009, incidence rates were four times higher among men than women (8.2 versus 1.8 cases per 100,000 persons, respectively), with the highest incidence rates found in white and black men (8.5 and 7.9 cases per 100,000 persons). 
  • Incidence rates of HPV-associated oropharyngeal cancer increased among white men (3.9%) and women (1.7%) over the same time period. 
  • Of the 13,446 new HPV-associated cancer cases among men in 2009, 78.2% were HPV-associated cancers of the oropharynx. 
  • Although cervical cancer remains the primary HPV-associated cancer among women, comprising 53.4% of U.S. cancer cases in 2009, 11.6% of HPV-associated oropharyngeal cancers also occurred in women.

Exposure to human papillomavirus occurs commonly through sexual contact, and oncogenic HPV types have been increasingly shown to be associated with squamous cell cancers of the oropharynx. Over 90 percent of HPV-positive oropharyngeal cancers are associated with HPV-16 and HPV-18, two oncogenic HPV types that are commonly associated with cervical cancer and other anogenital cancers.2 HPV-associated oropharyngeal cancers typically develop near the base of the tongue and in the tonsils. Based on the available data, it has been estimated that the incidence of HPV-positive oropharyngeal cancers could surpass the number of HPV-associated cervical cancers in the U.S. by 2020.3

To reduce the incidence of cancer and other complications associated with HPV, the CDC recommends
HPV vaccination for pre-teen girls and boys, and for women and men up to age 26 who have not been vaccinated previously. Regarding HPV vaccination, the Annual Report indicates that “no data are available on [their] efficacy for prevention of HPV-associated cancers or lesions of the oropharynx. Because HPV 16 is responsible for the majority of HPV-associated cancers, the vaccines likely protect against these outcomes.”

The new Annual Report adds to a growing body of evidence on the increasing incidence of HPV-associated oropharyngeal cancer, particularly among men, who accounted for over 10,500 new cases of HPV-associated oropharyngeal cancer in 2009. HPV-related cancers have also been found to be more common in persons with a higher lifetime number of sex partners (vaginal and oral).2 Dentists should be aware of the increasing incidence of HPV-associated oropharyngeal cancer in these patient populations. Adult patients should also be provided with hard-tissue and soft-tissue examinations, including lymph node examination, following completion of the patient’s health history and risk assessment.

For more information, clinicians are encouraged to consult the ADA Council on Scientific Affairs’ Statement on Human Papillomavirus and Squamous Cell Cancers of the Oropharynx,4 which was updated in November 2012 and presents an overview of initially suggestive symptoms of HPV-related oropharyngeal cancer, including persistent sore throat, pain and dysphagia.

Footnotes

1. Jemal A, Simard EP, Dorell C, Noone AM, Markowitz LE, Kohler B, Eheman C, Saraiya M, Bandi P, Saslow D, Cronin KA, Watson M, Schiffman M, Henley SJ, Schymura MJ, Anderson RN, Yankey D, and Edwards BK. Annual Report to the Nation on the Status of Cancer, 1975–2009, Featuring the Burden and Trends in HPV-Associated Cancers and HPV Vaccination Coverage Levels. Journal of the National Cancer Institute; Published online Jan. 7, 2013. Available at: “http://jnci.oxfordjournals.org/content/early/2013/01/03/jnci.djs491.full.pdf+html”.

2. Cleveland JL, Junger ML, Saraiya M, et al. The connection between human papillomavirus and oropharyngeal squamous cell carcinomas. Implications for dentistry. J Am Dent Ass 2011;142(8):915-924.

3. Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011; 29: 4294–4230.

4. ADA Council on Scientific Affairs. Statement on Human Papillomavirus and Squamous Cell Cancers of the Oropharynx (adopted November 2012). Available at: “http://www.ada.org/1749.aspx”. Accessed January 14, 2013.

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