Oropharyngeal human papillomavirus and head and neck cancer

Head and Neck Squamous Cell Cancer (HNSCC) encompasses a diverse group of tumors originating from the squamous epithelium of the aerodigestive tract. Over the last four decades, an unexpected epidemiological pattern has emerged that suggests evolving risk factor exposures may be altering the epidemiology of HNSCC. The incidence of oropharyngeal squamous cell carcinoma (OPC) has increased, while the incidence of tumors arising from nonoropharyngeal subsites has decreased. The increase in OPC has been attributed to human papillomavirus (HPV), a common sexually transmitted infection, while declines in heavy tobacco and alcohol use are thought to have resulted in reductions in the incidence of nonoropharyngeal HPV-negative HNSCC. Perhaps the most clinically relevant feature of HPV-positive OPC (HPV-OPC) is the therapeutic responsiveness and prognostic advantage conferred by HPV-positive tumor status. In light of the emergence of HPV-OPC as a distinct subtype of HNSCC with a significantly more favorable prognostic profile, ongoing investigations of HPV-OPC represent efforts to refine the diagnostic, prognostic, and therapeutic approaches for HPV-positive disease.