Two for the price of one: Prevalence, demographics and treatment implications of multiple HPV mediated Head and Neck Cancers

William Strober, Sachie Shishido, Burton Wood, James S. Lewis, Krystle Kuhs, Robert L. Ferris, Daniel L. Faden

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objectives: HPV mediated head and neck squamous cell carcinoma (HPVmHNSCC) is increasing in prevalence in the United States, as are reports of patients with multiple HPVmHNSCCs. The prevalence, demographics, and treatment implications of this emerging clinical entity are poorly understood. Materials and methods: We performed a multitiered assessment of patients with multiple HPVmHNSCC including: 1. systematic review of the literature, 2. query of the 2017 Surveillance, Epidemiology and End Results (SEER) database and 3. institutional level reporting at two high volume academic centers. Results: Systematic literature review: 13 articles met inclusion criteria (48 patients with multiple HPVmHNSCC). Pooled prevalence rate of multiple HPVmHNSCC was 2.64%. SEER database: 60(0.95%) patients with HPVmHNSCC had two tumors. Patients with multiple HPVmHNSCC were more likely to be younger and present with a lower T and N stage (p < 0.025 for all). The second identified tumor was more likely to be contralateral, found synchronously, of smaller size, and to occur in the tonsil (p < 0.05 for all). Institutional reporting: 17(1.69%) patients with HPVmHNSCC had two primary tumors. Similar to the SEER database, patients with multiple HPVmHNSCC were more likely to present with a low T stage and tonsil location (p < 0.007 for both). Conclusion: Multiple HPVmHNSCCs occur in a subset of HPVmHNSCC cases with distinct characteristics. Thorough interrogation of all oropharyngeal subsites should be performed as part of the initial workup for HPVmHNSCC, with consideration given to contralateral tonsillectomy at the time of surgical resection for HPV mediated tonsil cancers due to the prevalence of contralateral tonsil primaries.

Original languageEnglish
Article number104475
JournalOral Oncology
StatePublished - Jan 2020

Bibliographical note

Publisher Copyright:
© 2019 Elsevier Ltd


  • Epidemiology
  • Head and Neck Cancer
  • Incidence
  • Oropharyngeal neoplasms
  • Papillomavirus infections
  • SEER program
  • Second primary neoplasm
  • Squamous cell carcinoma of head and neck
  • Systematic review

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research


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