HPV has an affinity for the tissue of the oropharynx, most notably the base of the tongue and the lingual and palatine tonsils.
Surveillance data indicate that incidence of tongue and tonsillar
cancers increased steadily between 1973 and 2007, whereas rates
of cancers at other oral and pharyngeal sites decreased.
from a study published more recently whereby investigators
examined the HPV status of 271 patients with oropharyngeal
cancer from three SEER sites showed that the incidence of HPV-positive cancers increased by 225% during 1988 through 2004;
whereas the incidence of HPV-negative cancers decreased by
50% during the same period as illustrated by Table 4.
Table 4. HPV-positive OPSCCs 225% increase during 1988 to 2004, versus
HPV-negative OPSCCs significant decline by 50%
How is HPV connected to oral and oropharyngeal cancer?
Table 3. Number of HPV-Associated and HPV-Attributable Cancer Cases per Year
Currently the human papillomavirus is the most common sex-
ually transmitted infection (STI) in the United States. “HPV is
so common that nearly all sexually active men and women get
it at some point in their lives.”
15 The Annual Report to the Na-
tion on the Status of Cancer (1975–2009), featuring the burden
and trends in HPV-associated cancers and HPV vaccination
coverage levels provides an update of cancer incidence (new
cases) and mortality (death) rates and trends in the United
States. A special feature section for the 2013 report compiled
by the American Cancer Society (ACS), Centers for Disease
Control and Prevention (CDC), and the North American As-
sociation of Central Cancer Registries (NAACR) highlighted
the burden and trends in HPV-associated cancers.
Cervical cancer is the most common HPV-associated can-
cer among women, and oropharyngeal cancers (cancers of the
back of the throat, including the base of the tongue and tonsils)
are the most common among men as illustrated in Table 3.
Overall prevalence included both low-risk and high-risk HPV
types. Low-risk types of HPV can cause genital warts or other
17 The oncogenic transformation of
HPV to oropharyngeal cancer is related to a persistent infection
with a high-risk strain such as p16. This change in etiology ap-
parent over the last two decades has greatly influenced the de-
mographics of today’s oral and oropharyngeal cancer patient.
The virally transmitted disease is affecting younger patients,
predominantly males who often have never used tobacco prod-
ucts, and the disease lay hidden and dormant for many years.
The global increase in HPV-oropharyngeal cancer has been
tied in with sexual relations, namely oral sex as the most com-
mon transmission vector.
Cancer site Average number of
cancers per year in
sites where HPV is
often found (
by HPV types
by HPV types
Cervix 11,771 91% 10,700 66% 7,800 15% 1,700
Vagina 802 75% 600 55% 400 18% 100
Vulva 3,554 69% 2,400 49% 1,700 14% 500
Penis 1,168 63% 700 48% 600 9% 100
Anus 5,010 91% 4,600 79% 4,000 8% 400
Female 3,260 93% 3,000 80% 2,600 11% 400
Male 1,750 89% 1,600 79% 1,400 4% 100
Rectum 750 91% 700 79% 600 8% 100
Female 513 93% 500 80% 400 11% 100
Male 237 89% 200 79% 200 4% < 100
Oropharynx 15,738 70% 11,000 60% 9,500 6% 900
Female 3, 100 63% 2,000 51% 1,600 10% 300
Male 12,638 72% 9, 100 63% 8,000 4% 600
TOTAL 38,793 30,700 24,600 3,800
aHPV types detected in genotyping study; most were high-risk HPV types known to cause cancer (Saraiya M et al. US assessment of HPV types in cancers; implications for current and 9-valent HPV vaccines.
Journal of the National Cancer Institute 2015; 107;djv086).