The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population

  • A.C. Nichols The University of Western Ontario, London Regional Cancer Program, Lawson Health Research Institute
  • D.A. Palma London Regional Cancer Program, Lawson Health Research Institute, The University of Western Ontario
  • S.S. Dhaliwal The University of Western Ontario
  • S. Tan The University of Western Ontario
  • J. Theuer The University of Western Ontario
  • W. Chow The University of Western Ontario
  • C. Rajakumar The University of Western Ontario
  • S. Um The University of Western Ontario
  • N. Mundi The University of Western Ontario
  • S. Berk The University of Western Ontario
  • R. Zhou The University of Western Ontario
  • J. Basmaji The University of Western Ontario
  • G. Rizzo The University of Western Ontario
  • J.H. Franklin The University of Western Ontario, London Regional Cancer Program
  • K. Fung The University of Western Ontario, London Regional Cancer Program
  • K. Kwan The University of Western Ontario
  • B. Wehrli The University of Western Ontario
  • M.I. Salvadori The University of Western Ontario
  • E. Winquist The University of Western Ontario, London Regional Cancer Program
  • S. Ernst The University of Western Ontario, London Regional Cancer Program
  • S. Kuruvilla The University of Western Ontario, London Regional Cancer Program
  • N. Read The University of Western Ontario, London Regional Cancer Program
  • V. Venkatesan The University of Western Ontario, London Regional Cancer Program
  • B. Todorovic London Regional Cancer Program, The University of Western Ontario
  • J.A. Hammond London Regional Cancer Program, The University of Western Ontario
  • J. Koropatnick London Regional Cancer Program, Lawson Health Research Institute, The University of Western Ontario,
  • J.S. Mymryk The University of Western Ontario, London Regional Cancer Program, Lawson Health Research Institute,
  • J. Yoo The University of Western Ontario, London Regional Cancer Program
  • J.W. Barrett The University of Western Ontario, London Regional Cancer Program, Lawson Health Research Institute
Keywords: Human papillomavirus, oropharyngeal cancer, epidemiology, HNSCC

Abstract

Background

Sexually transmitted infection with the human papillomavirus (hpv) is responsible for a significant burden of human cancers involving the cervix, anogenital tract, and oropharynx. Studies in the United States and Europe have demonstrated an alarming increase in the frequency of hpv-positive oropharyngeal cancer, but the same direct evidence does not exist in Canada.

Methods

Using the London Health Sciences Centre pathology database, we identified tonsillar cancers diagnosed between 1993 and 2011. Real-time polymerase chain reaction was then used on pre-treatment primary-site biopsy samples to test for dna from the high-risk hpv types 16 and 18. The study cohort was divided into three time periods: 1993–1999, 2000–2005, and 2006–2011.

Results

Of 160 tumour samples identified, 91 (57%) were positive for hpv 16. The total number of tonsillar cancers significantly increased from 1993–1999 to 2006–2011 (32 vs. 68), and the proportion of cases that were hpv-positive substantially increased (25% vs. 62%, p < 0.002). Those changes were associated with a marked improvement in 5-year overall survival (39% in 1993–1999 vs. 84% in 2006–2011, p < 0.001). When all factors were included in a multivariable model, only hpv status predicted treatment outcome.

Interpretation

The present study is the first to provide direct evidence that hpv-related oropharyngeal cancer is increasing in incidence in a Canadian population. Given the long lag time between hpv infection and clinically apparent malignancy, oropharyngeal cancer will be a significant clinical problem for the foreseeable future despite vaccination efforts.


Author Biographies

A.C. Nichols, The University of Western Ontario, London Regional Cancer Program, Lawson Health Research Institute

Assistant Professor, Department of Otolaryngology Head and Neck Surgery

D.A. Palma, London Regional Cancer Program, Lawson Health Research Institute, The University of Western Ontario
Department of Oncology
S.S. Dhaliwal, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
S. Tan, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
J. Theuer, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
W. Chow, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
C. Rajakumar, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
S. Um, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
N. Mundi, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
S. Berk, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
R. Zhou, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
J. Basmaji, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
G. Rizzo, The University of Western Ontario
Department of Otolaryngology Head and Neck Surgery
J.H. Franklin, The University of Western Ontario, London Regional Cancer Program
Department of Otolaryngology Head and Neck Surgery, Department of Oncology
K. Fung, The University of Western Ontario, London Regional Cancer Program
Department of Otolaryngology Head and Neck Surgery, Department of Oncology
K. Kwan, The University of Western Ontario
Department of Pathology
B. Wehrli, The University of Western Ontario
Department of Pathology
M.I. Salvadori, The University of Western Ontario
Department of Paediatrics, Infectious Disease
Division
E. Winquist, The University of Western Ontario, London Regional Cancer Program

Department of Oncology

S. Ernst, The University of Western Ontario, London Regional Cancer Program
Department of Oncology
S. Kuruvilla, The University of Western Ontario, London Regional Cancer Program
Department of Oncology
N. Read, The University of Western Ontario, London Regional Cancer Program
Department of Oncology
V. Venkatesan, The University of Western Ontario, London Regional Cancer Program
Department of Oncology
B. Todorovic, London Regional Cancer Program, The University of Western Ontario
Department of Microbiology and Immunology
J.A. Hammond, London Regional Cancer Program, The University of Western Ontario
Department of Oncology
J. Koropatnick, London Regional Cancer Program, Lawson Health Research Institute, The University of Western Ontario,
Department of Oncology, Department of Microbiology and Immunology
J.S. Mymryk, The University of Western Ontario, London Regional Cancer Program, Lawson Health Research Institute,
Department of Otolaryngology Head and Neck Surgery, Department of Oncology, Department of Microbiology and Immunology
J. Yoo, The University of Western Ontario, London Regional Cancer Program
Department of Otolaryngology Head and Neck Surgery, Department of Oncology
J.W. Barrett, The University of Western Ontario, London Regional Cancer Program, Lawson Health Research Institute
Department of Otolaryngology Head and Neck Surgery, Department of Oncology
How to Cite
Nichols, A., Palma, D., Dhaliwal, S., Tan, S., Theuer, J., Chow, W., Rajakumar, C., Um, S., Mundi, N., Berk, S., Zhou, R., Basmaji, J., Rizzo, G., Franklin, J., Fung, K., Kwan, K., Wehrli, B., Salvadori, M., Winquist, E., Ernst, S., Kuruvilla, S., Read, N., Venkatesan, V., Todorovic, B., Hammond, J., Koropatnick, J., Mymryk, J., Yoo, J., & Barrett, J. (1). The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population. Current Oncology, 20(4), 212-219. https://doi.org/10.3747/co.20.1375
Section
Translational Research