title: Bidirectional association of anogenital and oral cavity/pharyngeal carcinomas in men.
abstract: OBJECTIVE
  To test the hypothesis of a bidirectional association of anogenital and oral cavity/pharyngeal human papillomavirus (HPV)-associated cancers in men.
  
  
  METHODS
  Population-based epidemiological study using the Surveillance, Epidemiology, and End Results cancer database.
  
  
  METHODS
  Population-based cancer study involving patients receiving care in the United States.
  
  
  METHODS
  The study included 47,308 men 20 years and older with an index oral cavity/pharyngeal or anogenital cancer.
  
  
  METHODS
  Second primary HPV-associated cancers (anogenital or oral cavity/pharyngeal) or HPV-unrelated cancers (prostate, bladder, or colon).
  
  
  RESULTS
  The standardized incidence ratio (SIR) was elevated for both anogenital cancer following oral cavity/pharyngeal cancer (SIR, 1.9; 95% confidence interval [CI], 1.2-2.7) and oral cavity/pharyngeal cancer following anogenital cancer (SIR, 3.0; 95% CI, 2.1-4.2). The increase in SIR was most pronounced for tonsillar cancer following anal cancer (SIR, 8.4; 95% CI, 2.7-19.6). The risk of second primary HPV-associated cancers did not vary significantly by age, race, year of diagnosis, or geographic location but was greater among never-married men, particularly for anal cancer following oral cavity/pharyngeal cancer (SIR, 6.5; 95% CI,1.8-16.7 in never-married men, but SIR, 1.6; 95% CI, 0.7-3.1 in ever-married men) and for tonsillar cancer following anogenital cancer (SIR, 13.0; 95% CI, 3.5-33.2 in never-married men, but SIR, 3.8; 95% CI, 1.0-9.7 in ever-married men). Other than a slightly increased risk of tongue cancer following colon cancer (SIR, 1.3; 95% CI, 1.1-1.6), there was no increased risk of oral cavity/pharyngeal or anogenital cancer following HPV-unrelated cancers or vice versa.
  
  
  CONCLUSIONS
  The association between index and second primary anogenital and oral cavity/pharyngeal cancers, strongest in never-married men, supports the influence of sexual behavior on the risk of HPV-associated head and neck cancers.
authors.affiliation: Department of Otolaryngology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1189, New York, NY 10029, USA. agsikora@gmail.com
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Sikora
authors.forename: Luc G
authors.initials: LG
authors.lastname: Morris
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology* / Q000821:virology; D002281:Carcinoma, Basosquamous / Q000453:epidemiology / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000821:virology; D005834:Genital Neoplasms, Male / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D008297:Male; D017533:Marital Status; D009062:Mouth Neoplasms / Q000453:epidemiology* / Q000821:virology; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000821:virology; D030361:Papillomavirus Infections / Q000453:epidemiology; D010610:Pharyngeal Neoplasms / Q000453:epidemiology* / Q000821:virology; D018426:SEER Program