Small Study Investigates Rise of Glottic Carcinoma in Young Adults and HPV Infection
An increase in the diagnosis of glottic carcinoma in young adults may be due in part to infection with strains of human papillomavirus (HPV). Investigators from Massachusetts General Hospital (MGH) described finding HPV infection in all tested samples of glottic carcinoma from 10 patients diagnosed at age 30 or under, most of whom were nonsmokers. Their report was published by Bayan et al in the Annals of Otology, Rhinology & Laryngology.
“Over the past 150 years … glottic cancer has been almost exclusively a disease associated with smoking and almost entirely seen in patients over 40 years old,” said senior study author Steven Zeitels, MD, Director of the MGH Division of Laryngeal Surgery. “Today, nonsmokers are approaching 50% of [patients with] glottic cancer, and it is common for them to be diagnosed under the age of 40. This epidemiologic transformation of [glottic cancer] is a significant public health issue, due to the diagnostic confusion it can create.”
The researchers noted that the increase in glottic cancer diagnosis appears to mimic an earlier increase in the diagnosis of throat cancer, which has been associated with infections by high-risk strains of HPV. After initially attributing incidents of glottic cancer in nonsmokers—which they began to see about 15 years ago—to increased travel and exposure to infectious diseases, Dr. Zeitels and his colleagues decided to investigate whether HPV infection might explain the diagnosis in younger nonsmokers.
Study Methods
Researchers examined the records of patients treated by Dr. Zeitels from July 1990 to June 2004 at Massachusetts Eye and Ear Infirmary and between July 2004 and June 2018 at MGH. Of 353 patients treated for glottic cancer during the entire period, none of the 112 treated from 1990 to mid-2004 were age 30 or younger, but 11 of the 241 patients treated from 2004 to 2018 were 30 or younger. Three of these younger patients were aged 10 to 19, and only 3 of the 11 were smokers. (All 3 smokers had less than 3 pack-years.) Analysis of tissue samples from the tumors of 10 of the 11 younger patients revealed high-risk strains of HPV in all of them.
The authors noted that these high-risk, HPV-associated glottic cancers greatly resemble recurrent respiratory papillomatosis (RRP), a benign condition caused by common, low-risk strains of HPV
“Benign RRP of the vocal cords has been a well-known HPV disease for more than a century, and it is very remarkable that there is now an HPV malignancy that looks so similar, creating diagnostic and therapeutic confusion,” said Dr. Zeitels, who is also the Eugene B. Casey Professor of Laryngeal Surgery at Harvard Medical School. “It should be noted that these HPV-associated vocal-cord carcinomas are not a malignant degeneration of the benign disease."
“Large-scale studies are now needed to determine the pace of the increase in glottic cancer among nonsmokers, the incidence of high-risk HPV in these cancers, and changes in the age and genders of those affected,” Dr. Zeitels concluded.
Disclosure: The study authors' full disclosures can be found at journals.sagepub.com.
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