Distinct biomarker and behavioral profiles of human papillomavirus-related oropharynx cancer patients by age

Carole Fakhry, Tim Waterboer, William H. Westra, Lisa M. Rooper, Melina Windon, Tanya Troy, Wayne Koch, Christine G. Gourin, Noemi Bender, Siddhartha Yavvari, Ana P. Kiess, Brett A. Miles, William R. Ryan, Patrick K. Ha, David W. Eisele, Gypsyamber D'Souza

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: HPV-positive oropharynx squamous cell cancer (HPV-OPC) patients were initially described as younger, however incidence has increased among older age-groups. It is unknown why some patients present at a younger age and others at a later age. Methods: Multi-institutional prospective study of HPV-OPC cases (n = 163) and matched controls (n = 345) with detailed behavioral survey, and serum tested for HPV antibodies by fluorescent bead-based technology. Age at diagnosis was used to stratify patients into younger (≤50 years), middle-age (51–65), and older (>65). Results: By age, demographic characteristics were largely similar, but HPV biomarkers and sexual acts differed. Younger cases were more likely to be HPV16-positive than older cases (100% vs 77%, p = 0.009). Similarly, younger cases were more likely to be HPV16 E6 or E7 seropositive (100% vs 82%, p = 0.03). Younger cases had a higher number of oral sex partners per year, a marker of sexual intensity (sex-years, p = 0.003), but a similar number of lifetime oral sex partners (measure of cumulative sexual exposure), compared to older cases. While sex-years were higher for younger cases and controls, cases had significantly higher sex-years than matched controls in each age-group (p < 0.001). Younger patients were also more likely to perform oral sex at sexual debut, and were younger at sexual debut (each p < 0.03). Conclusions: Younger, middle-age and older HPV-OPC have distinct biomarker and behavioral profiles. Younger HPV-OPC cases have higher intensity of sexual exposure than older cases and controls, which may in part explain earlier disease onset. The distribution of HPV16-positive tumors among HPV-OPC differs by age group.

Original languageEnglish (US)
Article number104522
JournalOral Oncology
StatePublished - Feb 2020


  • Age
  • HPV
  • Oropharynx cancer

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research


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