title: Contribution of human papilloma virus to the incidence of squamous cell carcinoma of the head and neck in a European population with high smoking prevalence.
abstract: BACKGROUND
  Increases in incidence of oropharyngeal squamous cell carcinoma (OPSCC) in countries with falling tobacco use have been attributed to a growing role of human papilloma virus (HPV) in the carcinogenesis. Trends of HPV prevalence in populations with persistently high portions of smokers are poorly characterised.
  
  
  METHODS
  Registry data from East Germany were used to determine incidence trends between 1998 and 2011. Data from patients treated at the Charité University Medicine Berlin between 2004 and 2013 (cohort 1, N=436) were used for estimation of trends in HPV prevalence, smoking and survival. HPV prevalence was prospectively confirmed in cohort 2 (N=213) comprising all primary HNSCC cases at the Charité in 2013.
  
  
  RESULTS
  Between 1998 and 2011 incidence of both OPSCC and non-OPSCC increased. An increase in HPV prevalence (% of HPV+ cases in 2004-2006 versus 2012-2013: 27% versus 59%, P=0.0004) accompanied by a moderate decrease in the portion of current smokers was observed in OPSCC but not in non-OPSCC. The change in disease epidemiology in OPSCC was associated with significant improvement in overall survival. Increased HPV prevalence in OPSCC (48%) compared to non-OPSCC (11%) was confirmed in cohort 2.
  
  
  CONCLUSIONS
  Despite clear differences to the United States in terms of tobacco use, the increase in OPSCC incidence in a European population was also mainly attributed to HPV, and the HPV status significantly affected prognosis. For clinical trial design it is important to consider the large group of smokers within HPV-induced OPSCC.
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Radiooncology and Radiotherapy, Charité University Medicine, Berlin, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Berlin, Germany. Electronic address: ingeborg.tinhofer@charite.de.
authors.forename: I
authors.initials: I
authors.lastname: Tinhofer
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Jöhrens
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Berlin, Germany; Department of Hematology and Medical Oncology, Charité University Medicine, Berlin, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Keilholz
authors.affiliation: Department of Gynecology, Charité University Medicine, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Kaufmann
authors.affiliation: Institute of Pathology, Charité University Medicine, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Lehmann
authors.affiliation: Institute of Pathology, University Hospital Heidelberg and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Weichert
authors.affiliation: Institute of Pathology, University Hospital Heidelberg and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Stenzinger
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Radiooncology and Radiotherapy, Charité University Medicine, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Stromberger
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Hematology and Medical Oncology, Charité University Medicine, Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Klinghammer
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Otorhinolaryngology, Charité University Medicine, Berlin, Germany.
authors.forename: E-T
authors.initials: ET
authors.lastname: Becker
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Otorhinolaryngology, Charité University Medicine, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Dommerich
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Otorhinolaryngology, Charité University Medicine, Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Stölzel
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Otorhinolaryngology, Charité University Medicine, Berlin, Germany.
authors.forename: V M
authors.initials: VM
authors.lastname: Hofmann
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Hematology and Medical Oncology, Charité University Medicine, Berlin, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Hildebrandt
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Radiooncology and Radiotherapy, Charité University Medicine, Berlin, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Moser
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Oral and Maxillofacial Surgery, Charité University Medicine, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Ervens
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Otorhinolaryngology, Charité University Medicine, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Böttcher
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Otorhinolaryngology, Charité University Medicine, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Albers
authors.affiliation: Common Tumor Registry of the Federal States of Berlin, Brandenburg, Mecklenburg-Western Pomerania, Saxony-Anhalt, Saxony and Thuringia, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Stabenow
authors.affiliation: Tumorzentrum Berlin e.V., Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Reinecke
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Radiooncology and Radiotherapy, Charité University Medicine, Berlin, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Berlin, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Budach
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Oral and Maxillofacial Surgery, Charité University Medicine, Berlin, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Hoffmeister
authors.affiliation: Charité Comprehensive Cancer Center, Working Group for Head and Neck Cancer, Berlin, Germany; Department of Oral and Maxillofacial Surgery, Charité University Medicine, Berlin, Germany.
authors.forename: J D
authors.initials: JD
authors.lastname: Raguse
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D006801:Humans; D015994:Incidence; D008297:Male; D027383:Papillomaviridae / Q000302:isolation & purification*; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Head and neck cancer; Human papilloma virus; Prevalence trends