Abstract
PURPOSE OF REVIEW: The incidence of human papillomavirus (HPV)-positive oropharyngeal cancer has increased to epidemic-like proportions in the United States and other industrialized nations. However, geographical variations are notable across the world. While significant progress has been made in the understanding of this disease with respect to its etiology, underlying biology, and pathogenesis, numerous uncertainties persist. The purpose of this review is to thus present some of the controversies and questions surrounding this disease focusing on its unique epidemiology. A selected series of critical points were presented related to the epidemiology, pathogenesis, and diagnosis of HPV-positive oropharyngeal cancer. Interpretive viewpoints were provided after a comprehensive review of the literature. RECENT FINDINGS: HPV is now estimated to cause approximately 70% of oropharyngeal cancers in the United States and other developed countries. However, in developing countries, the incidence of HPV-positive oropharyngeal cancer is significantly lower. Data has also established that HPV-positive and HPV-negative oropharyngeal cancer represents distinct entities that generally originate in different settings. Since HPV-positive oropharyngeal cancer is increasingly being recognized as a sexually transmitted disease with unique modes of transmission, the epidemiological implications are of practical relevance. The resultant geographical variation in incidence rates among countries across the world is thus believed to be due to differing lifestyles and sexual norms. Although there is currently no role for screening, efforts to promote general awareness particularly among high-risk groups should be prioritized. The development of a novel staging system specific for patients with HPV-positive oropharyngeal cancer also has important ramifications with respect to treatment. HPV-positive oropharyngeal cancer is increasingly recognized as a public health problem with a unique worldwide geographical distribution. As the etiology of this disease is increasingly elucidated, efforts to promote awareness and education are warranted.