title: Human papillomavirus in oral exfoliated cells and risk of head and neck cancer.
abstract: BACKGROUND
  Human papillomavirus (HPV) has been associated with the development of head and neck cancers. In this study, we investigated whether the risk factors for head and neck cancer in relation to HPV infection are different from those in the absence of HPV infection and whether HPV detected in oral exfoliated cells is an independent predictor of head and neck cancer risk.
  
  
  METHODS
  We conducted a case-control study in 201 head and neck cancer case patients and 333 control subjects, frequency matched for age and sex. Oral exfoliated cells and tumor tissue were evaluated for HPV using polymerase chain reaction and DNA sequencing to type HPV. Logistic regression was used to calculate odds ratios (ORs) for head and neck cancer with HPV infection and 95% confidence intervals (CIs), adjusted for age, tobacco use, and alcohol consumption.
  
  
  RESULTS
  Oncogenic, or high-risk (HR), HPV types were detected in oral cells from 22.9% of case patients and 10.8% of control subjects. HPV16 was the most frequently detected type (19% versus 10% of case patients and control subjects, respectively). After adjusting for age, tobacco use, and alcohol consumption, the risk of head and neck cancer was statistically significantly greater in individuals with HPV-HR types (adjusted OR = 2.6, 95% CI = 1.5 to 4.2) but not in individuals with nononcogenic HPV types (adjusted OR = 0.8, 95% CI = 0.4 to 1.7) compared with HPV-negative individuals. Compared with individuals who were HPV-negative and did not use alcohol or tobacco, there was a statistically significant synergistic effect between detection of HPV-HR and heavy alcohol consumption (OR = 18.8, 95% CI = 5.1 to 69.5) but an additive effect between detection of HPV-HR and tobacco use (OR = 5.5, 95% CI = 2.1 to 14.1). HPV-HR types detected in oral exfoliated cells were predictive of HPV-HR types in tumor tissue.
  
  
  CONCLUSIONS
  Infection of oral exfoliated cells with HPV-HR types is a risk factor for head and neck cancer, independent of alcohol and tobacco use, and acts synergistically with alcohol consumption. HPV testing of an oral rinse may be predictive of an HPV-related head and neck cancer.
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City 52242, USA. elaine-smith@uiowa.edu
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Smith
authors.forename: Justine M
authors.initials: JM
authors.lastname: Ritchie
authors.forename: Kurt F
authors.initials: KF
authors.lastname: Summersgill
authors.forename: Henry T
authors.initials: HT
authors.lastname: Hoffman
authors.forename: Dong Hong
authors.initials: DH
authors.lastname: Wang
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Haugen
authors.forename: Lubomir P
authors.initials: LP
authors.lastname: Turek
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000821:virology*; D016022:Case-Control Studies; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D006258:Head and Neck Neoplasms / Q000209:etiology / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000821:virology*; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D014029:Tobacco Use Disorder / Q000150:complications*; D014412:Tumor Virus Infections / Q000150:complications* / Q000821:virology
chemical_list: D004279:DNA, Viral