• Carole Fakhry, Tim Waterboer, William H Westra, Lisa M Rooper, Melina Windon, Tanya Troy, Wayne Koch, Christine G Gourin, Noemi Bender, Siddhartha Yavvari, Ana P Kiess, Brett A Miles, William R Ryan, Patrick K Ha, David W Eisele, and Gypsyamber D'Souza.
• Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, United States. Electronic address: cfakhry@jhmi.edu.
• Oral Oncol. 2020 Feb 1; 101: 104522.

BackgroundHPV-positive oropharynx squamous cell cancer (HPV-OPC) patients were initially described as younger, however incidence has increased among older age-groups. It is unknown why some patients present at a younger age and others at a later age.MethodsMulti-institutional prospective study of HPV-OPC cases (n = 163) and matched controls (n = 345) with detailed behavioral survey, and serum tested for HPV antibodies by fluorescent bead-based technology. Age at diagnosis was used to stratify patients into younger (≤50 years), middle-age (51-65), and older (>65).ResultsBy age, demographic characteristics were largely similar, but HPV biomarkers and sexual acts differed. Younger cases were more likely to be HPV16-positive than older cases (100% vs 77%, p = 0.009). Similarly, younger cases were more likely to be HPV16 E6 or E7 seropositive (100% vs 82%, p = 0.03). Younger cases had a higher number of oral sex partners per year, a marker of sexual intensity (sex-years, p = 0.003), but a similar number of lifetime oral sex partners (measure of cumulative sexual exposure), compared to older cases. While sex-years were higher for younger cases and controls, cases had significantly higher sex-years than matched controls in each age-group (p < 0.001). Younger patients were also more likely to perform oral sex at sexual debut, and were younger at sexual debut (each p < 0.03).ConclusionsYounger, middle-age and older HPV-OPC have distinct biomarker and behavioral profiles. Younger HPV-OPC cases have higher intensity of sexual exposure than older cases and controls, which may in part explain earlier disease onset. The distribution of HPV16-positive tumors among HPV-OPC differs by age group.Copyright © 2019. Published by Elsevier Ltd.

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