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
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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.
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