Myth:Decreased smoking rates have had no impact on incidence of head and neck squamous cell carcinoma (HNSCC)

Fact:Between1974 to 1999, there was a decrease in oral cavity, laryngeal, and hypopharyngeal cancers in the United States. This was largely attributed to a decreasing incidence in smoking. Notably, there wasno significant differencein the incidence of nasopharyngeal cancers and there has been anincreasein the incidence oforopharyngeal squamous cell carcinoma(OPSCC). Theincreasein OPSCC has been attributed to thehuman papilloma virus(HPV).

Myth:与人类乳头瘤病毒疫苗接种的发展ncidence of HPV-positive OPSCC is declining

Fact:The incidence of HPV-positive OPSCC isrising. There has been an astounding increase of228%of OPSCC in the United States between 1988 and 2004. It is estimated that HPV-associated OPSCC comprises about70%of cases of OPSCC. Furthermore, between 2002 and 2012, the rate of HPV-related oropharyngeal cancer increased by2.5%per year (p value< .0001). The rising rate of HPV-positive HNSCC extends beyond the United States, with the literature showing that the incidence of HPV-positive cancers is alsogrowing in Korea. In fact, HPV-associated OPSCC isestimatedto surpass cervical cancer as the most common HPV-related cancer in the next year.

Myth:The incidence of HPV-positive cancers is similar between males and females

Fact:Men are 2.8 to 5 timesmorelikelythan womento haveHPV-positive OPSCC. Thediscrepancybetween men and women is thought to be in part related tosexual behaviorvariation. Men were found to havemorelifetime oral and vaginal sexual partners, which has been associated with the development of OPSCC. The variation in incidence of HPV-positive OPSCC between men and women could also be attributed to the lagging HPV vaccination recommendations for men. TheHPV vaccination was approvedfor girls in 2006, however it was not approved for boys until 2009.

Myth:Smokeless tobacco does not carry an increased risk of development of HNSCC

Fact:Smokeless tobacco does carry an increased risk of development of HNSCC. The incidence of HNSCC associated with smokeless tobacco varies based on regional prevalence of smokeless tobacco use. InIndia, more than50%of oral cancers in men and women were attributed to the use ofsmokeless tobacco products. A multicenter case control study from India showed that there is anincreasein hypopharyngeal cancers in never smokers but not laryngeal cancers. InSudan and the US、68%和4%oral cancers in men were attributed to smokeless tobacco use, respectively. Another study assessingbetel quid usefrom Pakistan showed a similar increase in risk of oral cancer even after adjusting for tobacco smoking.

Myth:Alcohol does not have an independent impact on the risk of developing HNSCC

Fact:Alcohol does have an independent effect on the risk of developing HNSCC. Alcohol consumed at high frequency (greater than or equal to three drinks per day) is associated with a2-fold increasein the likelihood of developing head and neck cancer compared to never drinkers. There is amultiplicative effectofalcohol and tobacco useon development of HNSCC. People who consume 84g/day of ethanol and 10 cigarettes per day are at a 35-foldincreased riskof developing HNSCC compared to never drinkers and never smokers.