The recent rise in HPV-related oropharyngeal squamous cell carcinoma is well described. There has been a significant shift from tobacco-driven to virus-driven cancers at this anatomical site. This retrospective study analysed US tumour registry data over a long period (1973–2009) and aimed to investigate the changing epidemiology of this cancer. Over 21,000 cases were included, with similar numbers of tonsillar and tongue-base tumours. Over the period of the study, the incidence of oropharyngeal SCC in younger (≤55 years) patients more than doubled. This was not the case in older patients, where rates remained relatively constant. This occurred despite the substantial decrease in tobacco consumption over the same period. Similarly, the incidence in male patients more than doubled whilst the rate in females did not significantly change. The authors hypothesise that this is due to differences in oral sex practices and the risks entailed. In concluding, the authors point out without further qualification that HPV vaccination is indicated in both boys and girls, highlighting the high efficacy of the vaccines available against the relevant viral subtypes. In contrast, UK policy of selective immunisation of only girls is justified by the association with cervical cancer, and certainly influenced by cost pressures. Even setting aside the obvious benefits of herd immunity in sexually-transmitted diseases, the epidemiology of HPV-related oropharyngeal SCC justifies the vaccination of boys against this virus in itself. 

Trends in the incidence of oropharyngeal cancers in the United States.
Enomoto LM, Bann DV, Hollenbeak CS, Goldenberg D.
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Thomas Jacques

Royal National Throat, Nose and Ear Hospital, London, UK.

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