While the incidence of smoking-related oral squamous cell carcinoma has decreased in many parts of the world, cases of human papilloma virus (HPV) positive oropharyngeal cancer (OPSCC) have greatly increased. Otolaryngologists are finding that the majority of their patients are male and a lot younger in age than their counterparts. This “new” head and neck cancer patient differs in several ways from the “traditional” head and neck cancer patients who were older, had significant tobacco and alcohol exposure, and potential tumours throughout the upper aerodigestive tract. The significance of this global trend suggests that more attention needs to be paid to the phenomena here in the Middle East.
Dr Marilene Wang, Professor, Chief of Otolaryngology, UCLA Department of Head and Neck Surgery, will be discussing the increasing incidence of young cancer patients who are non-smokers, but happen to be HPV positive and how these cases should be managed in the Middle East at the 11th Middle East Update in Otolaryngology Conference & Exhibition – Head and Neck Surgery (ME-OTO) from the 20-22 April 2014 at the Madinat Jumeirah Arena, Dubai, UAE.
According to Dr Wang, “Currently, the most common head and neck cancer patients are younger, primarily male, and have no or relatively minimal exposures to tobacco and alcohol. Yet, they often have histories of notable increased sexual encounters. Although HPV positive OPSCC demonstrates an alarming increasing incidence, this is balanced by a significant response to treatment regardless of advanced stage.
“Cases of OPSCC associated with HPV have increased 225% in the US from 1988-2004. HPV infection is ubiquitous, as up to 85% of adults may have an HPV infection at some point from any of the over 120 subtypes. Only a small percentage of these subtypes develop malignancy and these are primarily related to the HPV-16 subtype. There is also an increased risk of OPSSC in husbands of women with cervical cancer and in situ cancer.”
The majority of epidemiological studies on HPV positive OPSCC have been done in the Western hemisphere, where there is a documented rise in the incidence of both HPV infection and HPV positive OPSCC. The impact of HPV in other parts of the world is less clear.
“A recent study from Turkey did document an increase in the incidence of HPV positive OPSCC between 1996 and 2011, from 33% to 70% (Dural et al. Asian Pac J Cancer Prev. 2013; 14(10):6065-8). Further studies will need to be done to determine the incidence of HPV-positive OPCC in the Middle East,” says Dr Wang.
“Vaccination against HPV is recommended for adolescents and young adults, boys and girls, ages 9 -25, ideally prior to onset of sexual activity. This commonly utilized vaccine provides protection against the 4 strains of HPV most associated with cervical and OPSCC, including HPV-16. However, there is no evidence to support efficacy of the vaccine to treat HPV-related cancers,” concludes Dr Wang.