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ASCO 2013: No Increased Risk of Oral HPV Infections Reported in Long-term Partners of Patients with HPV-positive Oropharyngeal Cancers

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Key Points

  • The majority of oropharyngeal cancers in the United States are now caused by HPV infection and the incidence of oral HPV-positive oropharyngeal cancers is increasing significantly.
  • Oral HPV prevalence is not more common among spouses or long-term partners of HPV-related oropharyngeal cancer patients than people in the general population, according to preliminary results of a pilot study (HOTSPOT) presented at the 2013 ASCO Annual Meeting.
  • More couples research is needed among young adults to better understand oral HPV transmission.

Spouses and long-term partners of patients diagnosed with human papillomavirus (HPV)-positive oropharyngeal cancer were no more likely to test positive for oral HPV infection than people in the general population and have a low risk of HPV-related oropharyngeal cancer, according to the Human Oral Papillomavirus Transmission in Partners over Time (HOTSPOT) study.

“Patients with HPV-positive oropharyngeal cancers and their spouses often worry about oral HPV transmission and wonder about the spouses’ cancer risk. These findings provide assurance that prevalence of oral HPV infection is not increased among partners, and their risk of HPV-related oropharyngeal cancer remains low,” said the study’s lead study author Gypsyamber D’Souza, PhD, MPH, MS, an Associate Professor of Epidemiology at Johns Hopkins University in Baltimore, who presented the results at the 2013 ASCO Annual Meeting (Abstract CRA6031). “Couples who have been together for several years have likely already shared whatever infections they have and no changes in their physical intimacy are needed.”

Dr. D'Souza said that the majority of oropharyngeal cancers in the United States are now caused by HPV infection and the incidence of oral HPV-positive oropharyngeal cancers is increasing significantly. Although HPV infection is responsible for thousands of cases of cancer of the oropharynx, cervix, and other sites every year, the overwhelming majority of individuals with the infection will not get cancer.

HOTSPOT Study Details

The HOTSPOT study included 166 individuals with HPV-positive oropharyngeal cancer and 94 spouses/partners. The patients with oropharyngeal cancer were predominantly male, white, non-Hispanic, had performed oral sex, and had a median age of 56 years. The partners were predominantly female, white, non-Hispanic, and had a median age of 53. Slightly more than half of the patients (51%) and the partners (54%) had never smoked. “Spouses were significantly less likely than cases to have more than 10 lifetime oral sex partners (11% vs 39%, P < .001),” the researchers reported.

Oral HPV DNA was collected through a 30-second mouth rinse and gargle at diagnosis and again 1 year later. The oral rinse samples were tested for 36 different subtypes of HPV, including HPV16, the type responsible for most HPV-positive oropharyngeal cancer cases, as well as a variety of other cancers.

No Oropharyngeal Cancers in Partners

Dr. D’Souza stressed that HOTSPOT is a pilot study and the results should be considered preliminary. HPV DNA was detected in 65% of patients with HPV-positive oropharyngeal cancer at diagnosis, but following treatment for cancer, only 6% of those patients still had oral HPV infection 1 year later. The overall prevalence of oral HPV among partners was 6.5%. The prevalence among the 88 female partners was 5%, which is comparable to the prevalence among women in the general population (4% based on previously published data). The prevalence among the six male partners assessed in this study was also similar to that among men in the general population, though higher than in the female population.

HPV16, the subtype responsible for most cases of HPV-positive oropharyngeal cancer, was detected in 54% of patients with HPV-positive oropharyngeal cancer, but in only 2.3% of female partners and in none of the male partners. The sample size for male partners, however, was small, including only six men.

“We did a detailed oral cancer screen, which was a visual oral examination by a head and neck surgeon, in a subset of about two-thirds of our spouses. There were no oropharyngeal precancers or cancers detected in our spouses. When we asked about their cancer history, none of our spouses had oropharyngeal cancer, although three of our cases reported a previous partner who had oropharyngeal cancer,” Dr. D’Souza said.

“Taken together, these results were very reassuring that oral HPV prevalence is not more common among these spouses of HPV-related oropharyngeal cancer patients than people in the general population,” Dr. D’Souza said. “This suggests these partners have been exposed in the past, but have effectively cleared these infections.”

Cervical Cancer Connection

“We did have one partner in our study who had cervical cancer and two partners who had a cervical precancer. We also had two cases who had had a previous partner who had had cervical cancer,” Dr. D’Souza continued. “This supports the transmission of HPV to the mouth from oral sex, and having cervical cancer and cervical precancer suggests a long-term cervical HPV infection. Oral sex with someone who has a genital HPV infection is known to be a risk factor for transmission of HPV to the mouth and this supports that transmission.”

Researchers emphasized that to better understand oral HPV transmission, more couples research is needed among young adults.

This research was supported by the Johns Hopkins Innovation Fund, Richard Gelb Cancer Prevention Award. Dr. D’Souza, reported research funding from Merck.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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