An increasing incidence of HPV-related oropharyngeal cancer has been reported predominantly among younger patients. Our objective was to update these results using United States cancer registry data with an emphasis on age-specific secular trends.
Data from 18 Surveillance, Epidemiology, and End results (SEER) program registries (2000-2012) were queried to compare secular changes in age-adjusted and age-specific incidence, and survival trends in oropharyngeal squamous cell carcinoma (OPSCC) with selected tobacco-related cancers (larynx, oral cavity, hypopharynx, lung) and HPV-related cancer (anus), by age, sex, and race-ethnicity.
In total, 40,264 patients with OPSCC were included in this study. Significant increases in the age-adjusted incidence of OPSCC were observed during the study period for both younger adults aged 45 to 64 and elderly patients aged 65 or older, with similar annual percentage changes observed in both groups. These changes were driven predominantly by cancers in white men. Concomitantly, the incidence of tobacco-associated head and neck cancers and lung cancers decreased or were stable across these age groups, whereas the incidence of anal cancer markedly increased. Further, improved overall and cause specific survival over time were also observed for both younger and elderly patients with OPSCC. However, despite these improved relative outcomes, absolute cause specific survival remained worse for those over 65 in comparison to younger patients.
The incidence of OPSCC is increasing among elderly patients in the United States, likely driven by HPV-associated malignancies. Given the unique challenges related to treatment of elderly patients, their limited enrollment in clinical trials, and the aging United States population, clinical studies investigating improved therapeutic strategies for elderly patients with HPV-positive OPSCC are imperative.