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Volume 16, Number 11—November 2010

Oropharyngeal Cancer Epidemic and Human Papillomavirus

Torbjörn Ramqvist and Tina DalianisComments to Author 
Author affiliations: Karolinska Institutet, Stockholm, Sweden (T. Ramqvist, T. Dalianis); Swedish Institute for Infectious Disease Control, Solna, Sweden (T. Dalianis)

Main Article

Figure 1

Survival rates for patients with human papillomavirus (HPV)–positive tonsillar cancer compared with those for patients with HPV-negative cancer. Circles indicate patients who died of tonsillar cancer during the follow-up period; plus signs indicate patients who were removed from the study for other reasons (e.g., died from a cause other than tonsillar cancer, left the country); p<0.0005. Data from Lindquist et al. (13), with permission of Elsevier (

Figure 1. Survival rates for patients with human papillomavirus (HPV)–positive tonsillar cancer compared with those for patients with HPV-negative cancer. Circles indicate patients who died of tonsillar cancer during the follow-up period; plus signs indicate patients who were removed from the study for other reasons (e.g., died from a cause other than tonsillar cancer, left the country); p<0.0005. Data from Lindquist et al. (13), with permission of Elsevier (

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  1. Villa  LL, Costa  RL, Petta  CA, Andrade  RP, Ault  KA, Giuliano  AR, Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol. 2005;6:2718. DOIPubMedGoogle Scholar
  2. Muñoz  N, Kjaer  SK, Sigurdsson  K, Iversen  OE, Hernandez-Avila  M, Wheeler  CM, Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. J Natl Cancer Inst. 2010;102:32539. DOIPubMedGoogle Scholar
  3. Zur Hausen  H. Infections causing human cancer. Weinheim (Germany): Wiley-VCH Verlag; 2006. p. 145–243.
  4. Syrjänen  S. Human papillomavirus (HPV) in head and neck cancer. J Clin Virol. 2005;32(Suppl 1):S5966. DOIPubMedGoogle Scholar
  5. Parkin  DM, Bray  F, Ferlay  J, Pisani  P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74108. DOIPubMedGoogle Scholar
  6. Licitra  L, Bernier  J, Grandi  C, Merlano  M, Bruzzi  P, Lefebvre  JL. Cancer of the oropharynx. Crit Rev Oncol Hematol. 2002;41:10722. DOIPubMedGoogle Scholar
  7. Gillison  ML, Koch  WM, Capone  RB, Spafford  M, Westra  WH, Wu  L, Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst. 2000;92:70920. DOIPubMedGoogle Scholar
  8. Mellin  H, Friesland  S, Lewensohn  R, Dalianis  T, Munck-Wikland  E. Human papillomavirus (HPV) DNA in tonsillar cancer: clinical correlates, risk of relapse, and survival. Int J Cancer. 2000;89:3004. DOIPubMedGoogle Scholar
  9. Dahlstrand  HM, Dalianis  T. Presence and influence of human papillomaviruses (HPV) in tonsillar cancer. Adv Cancer Res. 2005;93:5989. DOIPubMedGoogle Scholar
  10. World Health Organization. IARC monographs on the evaluation of carcinogenic risk to humans. Volume 90. Human papillomaviruses. Lyon (France): International Agency for Research on Cancer; 2007.
  11. Sturgis  EM, Cinciripini  PM. Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus–associated cancers? Cancer. 2007;110:142935. DOIPubMedGoogle Scholar
  12. Hammarstedt  L, Lindquist  D, Dahlstrand  H, Romanitan  M, Dahlgren  LO, Joneberg  J, Human papillomavirus as a risk factor for the increase in incidence of tonsillar cancer. Int J Cancer. 2006;119:26203. DOIPubMedGoogle Scholar
  13. Lindquist  D, Romanitan  M, Hammarstedt  L, Nasman  A, Dahlstrand  H, Lindholm  J, Human papillomavirus is a favourable prognostic factor in tonsillar cancer and its oncogenic role is supported by the expression of E6 and E7. Mol Oncol. 2007;1:3505. DOIPubMedGoogle Scholar
  14. Mellin  H, Dahlgren  L, Munck-Wikland  E, Lindholm  J, Rabbani  H, Kalantari  M, Human papillomavirus type 16 is episomal and a high viral load may be correlated to better prognosis in tonsillar cancer. Int J Cancer. 2002;102:1528. DOIPubMedGoogle Scholar
  15. Gillison  ML, Chaturvedi  AK, Lowy  DR. HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer. 2008;113(Suppl):303646. DOIPubMedGoogle Scholar
  16. Ang  KK, Harris  J, Wheeler  R, Weber  R, Rosenthal  DI, Nguyen-Tan  PF, Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363:2435. DOIPubMedGoogle Scholar
  17. Marur  S, D’Souza  G, Westra  WH, Forastiere  AA. HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncol. 2010;11:7819.Medline DOIPubMedGoogle Scholar
  18. Näsman  A, Attner  P, Hammarstedt  L, Du  J, Eriksson  M, Giraud  G, Incidence of human papillomavirus (HPV) positive tonsillar carcinoma in Stockholm, Sweden: an epidemic of viral-induced carcinoma? Int J Cancer. 2009;125:3626. DOIPubMedGoogle Scholar
  19. Attner  P, Du  J, Nasman  A, Hammarstedt  L, Ramqvist  T, Lindholm  J, The role of human papillomavirus in the increased incidence of base of tongue cancer. Int J Cancer. 2010;126:287984.PubMedGoogle Scholar
  20. Clavel  C, Masure  M, Bory  JP, Putaud  I, Mangeonjean  C, Lorenzato  M, Hybrid Capture II-based human papillomavirus detection, a sensitive test to detect in routine high-grade cervical lesions: a preliminary study on 1518 women. Br J Cancer. 1999;80:130611. DOIPubMedGoogle Scholar
  21. de Roda Husman  AM, Walboomers  JM, van den Brule  AJ, Meijer  CJ, Snijders  PJ. The use of general primers GP5 and GP6 elongated at their 3′ ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. J Gen Virol. 1995;76:105762. DOIPubMedGoogle Scholar
  22. Tieben  LM, ter Schegget  J, Minnaar  RP, Bouwes Bavinck  JN, Berkhout  RJ, Vermeer  BJ, Detection of cutaneous and genital HPV types in clinical samples by PCR using consensus primers. J Virol Methods. 1993;42:26579. DOIPubMedGoogle Scholar
  23. van den Brule  AJ, Pol  R, Fransen-Daalmeijer  N, Schouls  LM, Meijer  CJ, Snijders  PJ. GP5+/6+ PCR followed by reverse line blot analysis enables rapid and high-throughput identification of human papillomavirus genotypes. J Clin Microbiol. 2002;40:77987. DOIPubMedGoogle Scholar
  24. Gravitt  PE, Peyton  CL, Apple  RJ, Wheeler  CM. Genotyping of 27 human papillomavirus types by using L1 consensus PCR products by a single-hybridization, reverse line blot detection method. J Clin Microbiol. 1998;36:30207.PubMedGoogle Scholar
  25. Schmitt  M, Bravo  IG, Snijders  PJ, Gissmann  L, Pawlita  M, Waterboer  T. Bead-based multiplex genotyping of human papillomaviruses. J Clin Microbiol. 2006;44:50412. DOIPubMedGoogle Scholar
  26. Mellin Dahlstrand  H, Lindquist  D, Bjornestal  L, Ohlsson  A, Dalianis  T, Munck-Wikland  E, P16(INK4a) correlates to human papillomavirus presence, response to radiotherapy and clinical outcome in tonsillar carcinoma. Anticancer Res. 2005;25(6C):437583.PubMedGoogle Scholar
  27. Singhi  AD, Westra  WH. Comparison of human papillomavirus in situ hybridization and p16 immunohistochemistry in the detection of human papillomavirus–associated head and neck cancer based on a prospective clinical experience. Cancer. 2010;116:216673.MedlinePubMedGoogle Scholar
  28. Koskinen  WJ, Chen  RW, Leivo  I, Makitie  A, Back  L, Kontio  R, Prevalence and physical status of human papillomavirus in squamous cell carcinomas of the head and neck. Int J Cancer. 2003;107:4016. DOIPubMedGoogle Scholar
  29. Mellin  H, Friesland  S, Auer  G, Dalianis  T, Munck-Wikland  E. Human papillomavirus and DNA ploidy in tonsillar cancer—correlation to prognosis. Anticancer Res. 2003;23(3C):28218.PubMedGoogle Scholar
  30. Dahlgren  L, Mellin  H, Wangsa  D, Heselmeyer-Haddad  K, Bjornestal  L, Lindholm  J, Comparative genomic hybridization analysis of tonsillar cancer reveals a different pattern of genomic imbalances in human papillomavirus–positive and –negative tumors. Int J Cancer. 2003;107:2449. DOIPubMedGoogle Scholar
  31. Braakhuis  BJ, Visser  O, Leemans  CR. Oral and oropharyngeal cancer in the Netherlands between 1989 and 2006: increasing incidence, but not in young adults. Oral Oncol. 2009;45:e859. DOIPubMedGoogle Scholar
  32. Conway  DI, Stockton  DL, Warnakulasuriya  KA, Ogden  G, Macpherson  LM. Incidence of oral and oropharyngeal cancer in United Kingdom (1990–1999)—recent trends and regional variation. Oral Oncol. 2006;42:58692. DOIPubMedGoogle Scholar
  33. Robinson  KL, Macfarlane  GJ. Oropharyngeal cancer incidence and mortality in Scotland: are rates still increasing? Oral Oncol. 2003;39:316. DOIPubMedGoogle Scholar
  34. Hammarstedt  L, Dahlstrand  H, Lindquist  D, Onelov  L, Ryott  M, Luo  J, The incidence of tonsillar cancer in Sweden is increasing. Acta Otolaryngol. 2007;127:98892. DOIPubMedGoogle Scholar
  35. Chaturvedi  AK, Engels  EA, Anderson  WF, Gillison  ML. Incidence trends for human papillomavirus–related and –unrelated oral squamous cell carcinomas in the United States. J Clin Oncol. 2008;26:6129. DOIPubMedGoogle Scholar
  36. Syrjänen  S. HPV infections and tonsillar carcinoma. J Clin Pathol. 2004;57:44955. DOIPubMedGoogle Scholar
  37. Anaya-Saavedra  G, Ramirez-Amador  V, Irigoyen-Camacho  ME, Garcia-Cuellar  CM, Guido-Jimenez  M, Mendez-Martinez  R, High association of human papillomavirus infection with oral cancer: a case–control study. Arch Med Res. 2008;39:18997. DOIPubMedGoogle Scholar
  38. D’Souza  G, Agrawal  Y, Halpern  J, Bodison  S, Gillison  ML. Oral sexual behaviors associated with prevalent oral human papillomavirus infection. J Infect Dis. 2009;199:12639. DOIPubMedGoogle Scholar
  39. Spanos  WC, Nowicki  P, Lee  DW, Hoover  A, Hostager  B, Gupta  A, Immune response during therapy with cisplatin or radiation for human papillomavirus–related head and neck cancer. Arch Otolaryngol Head Neck Surg. 2009;135:113746. DOIPubMedGoogle Scholar
  40. Chesson  HW, Ekwueme  DU, Saraiya  M, Markowitz  LE. Cost-effectiveness of human papillomavirus vaccination in the United States. Emerg Infect Dis. 2008;14:24451. DOIPubMedGoogle Scholar

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