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Andrew G. Sikora, MD, PhD; Luc G. Morris, MD; Erich M. Sturgis, MD, MPH

Arch Otolaryngol Head Neck Surg. 2009;135(4):402-405.

Objective  To test the hypothesis of a bidirectional association of anogenital and oral cavity/pharyngeal human papillomavirus (HPV)-associated cancers in men.

Design  Population-based epidemiological study using the Surveillance, Epidemiology, and End Results cancer database.

Setting  Population-based cancer study involving patients receiving care in the United States.

Participants  The study included 47 308 men 20 years and older with an index oral cavity/pharyngeal or anogenital cancer.

Main Outcome Measure  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.

Conclusion  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.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery, Mount Sinai School of Medicine (Dr Sikora) and New York University School of Medicine (Dr Morris), New York, New York; and Departments of Head and Neck Surgery (Dr Sturgis) and Epidemiology (Dr Sturgis), The University of Texas M. D. Anderson Cancer Center, Houston.

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