An epidemic of oropharyngeal squamous cell carcinoma (OSCC) due to human papillomavirus (HPV) infection and aspects of treatment and prevention.

In Europe and the US the incidence of oropharyngeal squamous cell carcinoma (OSCC), where tonsillar and tongue base cancer dominate, has increased and we propose this is due to an epidemic of human papillomavirus (HPV) infection. We base our hypothesis on two main findings. Firstly, in the past decade numerous reports have shown the presence of HPV in OSCC, and that HPV-positive OSCC has a significantly better response to therapy than HPV-negative OSCC. As a consequence of these findings, the International Agency for Research against Cancer (IARC) has acknowledged HPV, in addition to smoking and alcohol, as a risk factor for OSCC. Secondly, we and others have demonstrated a considerable and significant increase in the proportion of HPV-positive tonsillar and tongue base cancer/OSCC in recent decades. In conclusion, we suggest that the increased incidence of OSCC is due to an HPV epidemic. In addition, since patients with HPV-positive OSCC have a better response to therapy than those with HPV-negative OSCC, we put forward that it is important to individualize therapy on the basis of HPV status and other markers in order to obtain optimal survival with the least side-effects. Finally, we suggest that the possibility to vaccinate against HPV-positive OSCC should be examined.