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Clinical Implications of Human Papillomavirus in Head and Neck Cancers

Carole Fakhry, Maura L. Gillison

From the Departments of Viral Oncology, Aerodigestive Malignancy, and Cancer Prevention and Control, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and the Departments of Epidemiology and Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Address reprint requests to Maura L. Gillison, MD, PhD, Cancer Research Building I, Room G91, 1650 Orleans St, Baltimore, MD 21231; e-mail: gillima{at}jhmi.edu

Human papillomavirus (HPV) is now recognized to play a role in the pathogenesis of a subset of head and neck squamous cell carcinomas (HNSCCs), particularly those that arise from the lingual and palatine tonsils within the oropharynx. High-risk HPV16 is identified in the overwhelming majority of HPV-positive tumors, which have molecular-genetic alterations indicative of viral oncogene function. Measures of HPV exposure, including sexual behaviors, seropositivity to HPV16, and oral, high-risk HPV infection, are associated with increased risk for oropharyngeal cancer. HPV infection may be altering the demographics of HNSCC patients, as these patients tend to be younger, nonsmokers, and nondrinkers. There is sufficient evidence to conclude that a diagnosis of HPV-positive HNSCC has significant prognostic implications; these patients have at least half the risk of death from HNSCC when compared with the HPV-negative patient. The HPV etiology of these tumors may have future clinical implications for the diagnosis, therapy, screening, and prevention of HNSCC.

Supported in part by National Institute for Dental and Craniofacial Research Grant No. DE016631-02.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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