Oral human papillomavirus (HPV) is a sexually transmitted infection that is etiologically responsible for the recent global increase in incidence of oropharyngeal cancer (OPC). The natural history of the progression from infection to cancer is not fully understood.
Current evidence indicates that HPV-driven OPC is preceded by oral infection with oncogenic HPV types, most commonly HPV16, by an estimated 10-30 years. Oral HPV infection is relatively rare, and is associated with sexual behaviors, male sex, and tobacco smoking. Although most infections are rapidly cleared, persistent infection is observed in some individuals, with increased risk among men and smokers. In a subset of individuals, oral HPV infection progresses to cancer. HPV-driven OPCs are frequently, but not always, characterized by integration of viral DNA into the host genome. Overexpression of HPV oncoproteins E6 and E7 with resultant disruption of p53 and Rb pathways is observed, among other genomic alterations that are still under investigation.
Future research to better characterize HPV-driven oncogenesis will carry important implications for the prevention, screening, diagnosis, and treatment of HPV-OPC.