1. Author : Updated : HPV Associated Oropharyngeal Cancer Benjamin L. Judson, M.D. 10/19/2013 333 Cedar Street New Haven, Connecticut 06510

2. Author : Updated : No conflict of interest. Benjamin L. Judson, M.D. 10/19/2013

3. 2. Types 6 and 11 –Recurrent respiratory papillomatosis Types 16 and 18 –Previously no role in head & neck HPV in the Head & Neck

4. 3. Head & Neck Cancer Cancer Facts and Figures 2011, American Cancer Society

5. 4. Oropharynx -tonsils -base of tongue Larynx Nasopharynx Hypopharynx Oral Cavity

6. 5. Smoking Prevalence: 1965 - 2005

7. 6. Different Incidence Chaturvedi AK, et al. J Clin Oncol 2008; 26: 612–19. Oropharynx Oral Cavity, Larynx, Nasopharynx, Hypopharynx

8. 7. Chaturvedi A K et al. JCO 2011;29:4294-4301 Increase in HPV Associated Oropharyngeal Cancer

9. 8. Pytynia KB et al. Oral Oncol. 2014 Jan 21.

10. 9. Oropharynx -tonsils -base of tongue Larynx Nasopharynx Hypopharynx Oral Cavity

11. 10. Changing Face of Head and Neck Cancer Sturgis EM, Cinciripini PM. Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus-associated cancers? Cancer. 2007 Oct 1;110(7):1429-35. Review.

12. 11. Risk increases with number of lifetime –vaginal-sex partners (26 or more) –oral-sex partners (6 or more) Different Risk Factors D’Souza et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 2007; 356:1944–1956. Sikora AG et al. Bidirectional association of anogenital and oral cavity/pharyngeal carcinomas in men. Arch Otolaryngol Head Neck Surg. 2009 135(4):402-5.

13. 12. Smaller primary tumor Different Presentation Straetmans JM et al. Laryngoscope. 2009 Oct;119:1951-7. Gillison ML et al. JNCI. 2008;100(4):261-269. Bulky/cystic nodal metastasis

14. 13. Trans oral vizualization is limited: Different Presentation

15. 14. Different Histology Basaloid poorly differentiated P16 +HPV +

16. 15. Different Survival Ang KK et al. N Engl J Med 2010;363:24-35

17. 16. Different Risk with Tobacco Exposure Ang KK et al. N Engl J Med 2010;363:24-35

18. 17. HPV is causing an epidemic of oropharynx cancer Affects men more than women Risk of HPV causing oropharynx cancer surpassing that of cervical cancer Conclusion

19. 18. Thank you!