Trends in all-cause five-year mortality after head and neck cancers diagnosed over a period of 33 years. Focus on estimated degree of association with human papillomavirus.

BACKGROUND: Factors influencing survival after head and neck cancer (HNC) include among others stage, age, and sex. More recently, human papillomavirus (HPV) positivity has been described as a favorable prognostic factor in relation to some HNCs. MATERIAL AND METHODS: In this nationwide register-based cohort study of all 20 925 individuals diagnosed with squamous cell carcinoma of the head and neck (HNSCC) in Denmark 1978-2010, we investigate secular trends in all-cause five-year mortality after HNSCC according to the anticipated degree of association with HPV using a Cox proportional hazards model. Furthermore, we examine whether any trend over time differed according to sex, stage, and age at diagnosis. RESULTS: All-cause five-year mortality after HNSCC has decreased over time. The greatest decrease was seen in the last decade (2000-2010) among patients with HNSCC at sites estimated to be strongly associated with HPV, i.e. the base of the tongue and the tonsils, where a 28% decrease per five years (e.g. HRbase of tongue/tonsils=0.72; 95% CI 0.64-0.81) was observed. When examining sex- and age-specific time trends, the decrease in mortality was most pronounced among male patients and patients below 60 years at diagnosis. In contrast, no clear pattern was observed when examining five-year all-cause mortality trends according to stage. CONCLUSION: All-cause five-year mortality after HNSCC has decreased significantly in Denmark from 1978 to 2010, especially for HNSCCs at sites anticipated to be strongly associated with HPV, possibly due to an increasing proportion of HPV-positive HNSCCs.

Burden and incidence of human papillomavirus-associated cancers and precancerous lesions in Denmark.

AIM: The aim of the study was to investigate the incidence of human papillomavirus (HPV)-associated cancers in Denmark between 1978 and 2011, estimate the current absolute annual number (burden) of HPV-associated cancers (HPVaCa) and their precancerous lesions, and assess whether there is socioeconomic inequality in the risk of HPV-associated cancers. METHODS: From four nationwide population-based registries, information was collected on HPVaCa diagnosed during 1978-2011 and age-standardised incidence rate for each site by calendar year and birth cohort was calculated. Furthermore, the current annual burden of HPVaCa and severe precancerous lesions was estimated. Incidence rate ratios and corresponding 95% confidence intervals for HPVaCa were calculated according to socioeconomic status. RESULTS: The age-standardised incidence rate of HPV-associated cancers for the two sexes converged during the study period, and almost identical incidence rates were seen for women and men in the youngest birth cohorts. The current burden of HPV-associated lesions amounted to more than 5000 cases, the vast majority (85%) being severe precancerous lesions. The highest risk for HPV-associated cancers was associated with lower socioeconomic status. CONCLUSIONS THE BURDEN OF HPV-ASSOCIATED CANCERS AMONG MEN WILL LIKELY SURPASS THAT AMONG WOMEN IN THE NEAR FUTURE IF THE INCIDENCE TRENDS CONTINUE AS MANY OF THESE CANCERS AND THEIR PRECANCEROUS LESIONS ARE ASSOCIATED WITH HPV TYPE 16, A SUBSTANTIAL PROPORTION OF CASES ARE, IN THEORY, PREVENTABLE BY THE CURRENTLY AVAILABLE VACCINES.

Prevalence of human papillomavirus in epithelial ovarian cancer tissue. A meta-analysis of observational studies.

OBJECTIVE: The role of human papillomavirus (HPV) in the pathogenesis of ovarian cancer is controversial, and conflicting results have been published. We conducted a systematic review and meta-analysis to estimate the prevalence of HPV in epithelial ovarian cancer tissue. MATERIAL AND METHODS: Observational studies published until 4 March 2013 were identified in PubMed and Embase. We adhered to MOOSE guidelines and included 22 studies (case-control, cross-sectional studies). A pooled estimate of the HPV prevalence with corresponding 95% confidence interval (CI) was calculated based on a random effect model. In a meta-regression analysis we examined the contribution of different factors to heterogeneity. Furthermore, publication bias was evaluated. RESULTS: The pooled HPV prevalence in ovarian cancer tissue was 15.5%, but wide variation was found (0-66.7%). After stratification by geographical region, publication year, tissue type and method of HPV detection, we found that the prevalence of HPV varied most markedly by geographical area, the prevalence being 45.6% (95% CI, 31.0-60.3) in Asia, 18.5% (95% CI, 8.5-28.6) in Eastern Europe, 1.1% (95% CI, -1.6 to 3.8) in Western Europe and zero in North America. A meta-regression analysis revealed that the difference between geographical regions could not be explained by HPV detection method or type of tissue. CONCLUSIONS: Great geographical variation exists in HPV prevalence in ovarian cancer tissue, which is not explained by different HPV detection methods. The results suggest that HPV is unlikely to play an important role in Western European and American women, but cannot reject a role of HPV in other populations.