Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, MS F-10, 4770 Buford Highway, Atlanta, Ga. 30341, USA.
J Am Dent Assoc. 2011 Aug;142(8):915-24. doi: 10.14219/jada.archive.2011.0298.
Results from studies conducted in the past several years suggest that some oropharyngeal cancers, those of the base of the tongue and the tonsils, are associated with high-risk types of human papillomavirus (HPV). In this article, the authors summarize the available evidence regarding the epidemiology of HPV-associated oropharyngeal cancers in the United States, the available HPV vaccines and the implications of these for dentistry. They also examine the differences in HPV prevalence between cancers of the oral cavity and those of the oropharynx.
The authors searched PubMed, Web of Science, The Cochrane Library and the National Guideline Clearinghouse to identify English-language systematic reviews and meta-analyses focused on HPV-associated oropharyngeal squamous cell cancers published from January 2005 through May 2011.
Molecular and epidemiologic evidence suggest a strong etiologic association of HPV with oropharyngeal cancers. The incidence of oropharyngeal cancers in the United States has increased between 1973 and 2007, whereas that of cancers at other head and neck sites has decreased steadily. Compared with HPV-negative cancers, HPV-positive oropharyngeal cancers are associated with certain sexual behaviors, occur more often among white men and people who do not use tobacco or alcohol, and may occur in a population younger by about four years (median ages, 52-56 years). Despite often having a later stage of diagnosis, people with HPV-positive oropharyngeal cancers have a lower risk of dying or recurrence than do those with HPV-negative cancers. The effectiveness of the HPV vaccine in preventing oropharyngeal cancers is unknown.
Dental health care personnel (DHCP) should be knowledgeable about the role of HPV in carcinogenesis, the association of HPV with oropharyngeal cancers and HPV vaccines, and they should be prompt in referring patients with suggestive symptoms for evaluation. DHCP can play an important role in increasing patients' knowledge about HPV and oropharyngeal cancers.
过去几年的研究结果表明，某些口咽癌（舌根和扁桃体的癌症）与高危型人乳头瘤病毒（HPV）有关。本文作者总结了美国 HPV 相关口咽癌的流行病学、HPV 疫苗以及这些疫苗对牙科的影响的现有证据。他们还研究了口腔癌和口咽癌之间 HPV 流行率的差异。
作者检索了 PubMed、Web of Science、Cochrane 图书馆和国家指南清除中心，以确定 2005 年 1 月至 2011 年 5 月期间发表的针对 HPV 相关口咽鳞状细胞癌的英语系统评价和荟萃分析。
分子和流行病学证据表明 HPV 与口咽癌有很强的病因关联。美国口咽癌的发病率在 1973 年至 2007 年间有所增加，而其他头颈部部位的癌症发病率则稳步下降。与 HPV 阴性癌症相比，HPV 阳性口咽癌与某些性行为有关，在白人男性和不使用烟草或酒精的人群中更为常见，并且可能发生在年龄小约四岁的人群中（中位数年龄，52-56 岁）。尽管 HPV 阳性口咽癌患者的诊断通常处于晚期，但与 HPV 阴性癌症患者相比，他们的死亡或复发风险较低。HPV 疫苗预防口咽癌的有效性尚不清楚。
牙科保健人员（DHCP）应了解 HPV 在致癌作用中的作用、HPV 与口咽癌和 HPV 疫苗的关联，以及应及时转介有可疑症状的患者进行评估。DHCP 可以在提高患者对 HPV 和口咽癌的认识方面发挥重要作用。
