Increase in head and neck cancer in younger patients due to human papillomavirus (HPV)

• While tobacco related head and neck cancers are decreasing, HPV-related ones are increasing.
• HPV (+) cancer patients are typically younger (40 s–50 s), white, and have not used tobacco.
• HPV (+) cancer typically presents in the oropharynx and responds better to treatment.
• P16 stain is a reliable test for HPV recommended in all oropharyngeal cancers.
• HPV infection risk may be lowered with vaccination prior to becoming sexually active.

SummaryThe face of head and neck cancer has changed dramatically over the past 30 years. There has been a steady decline in the number of tobacco and alcohol related squamous cell carcinomas over the past 30 years, but and increasing incidence of human papillomavirus (HPV) related cancers. Some estimates suggest that 70–90% of new oropharyngeal cancers have evidence of HPV.These patients have different demographic patterns, in that they are more likely to be younger, white adults in their 40 s and 50 s who are never smokers or have reduced tobacco exposure. Studies have shown that a higher number of lifetime oral sex partners (>5) and a higher number of lifetime vaginal sex partners (>25) have been associated with increased risk of HPV positive head and neck cancer. People can also reduce their risk of HPV linked head and neck cancer by receiving the HPV vaccine series prior to becoming sexually active.Recent evidence suggests HPV related head and neck cancers present with different symptoms than those caused by tobacco. The most popular test for HPV status is the p16 immunohistochemical stain because it is cheap, simple, and studies have shown it to have comparable sensitivity and specificity to the previous standards. It is widely recommended that all cancers of the oropharynx be tested for the presence of HPV, and some recommend it for all head and neck cancers.Overall 2-year and 5-year survival for HPV positive head and neck cancer is significantly greater than for HPV negative cancers, likely due to HPV positive cancers being more responsive to treatment.