Male predominance (3:1), heavy tobacco and alcohol use, and onset in late middle age describe a typical patient. The median age at diagnosis ranges from 55 to 67 years, depending on the site, with nasopharynx and tonsil cancer diagnosed at a younger age and oral cavity and larynx cancer diagnosed at an older age.

A relatively new phenomenon of younger patients without the characteristic history of alcohol and tobacco use has been associated with infection with human papillomavirus (HPV). Identification of this population has prognostic implications in that their risk of death from the cancer is 60% to 80% less than that of those who are HPV negative."*

Dr. Harlan Pinto** : Chapter 2, section 6 : "Carcinomas of the Head and Neck" in Handbook of Cancer Chemotherapy edited by Roland T. Skeel, 7th. edition, 2007.***

I was fascinated by the final sentence of the quote from Dr. Pinto above. I am a person with basal tongue squamous cell carcinoma T2~T3N2M0 who has never smoked (okay, some pot in the 1960's, a little), and has never liked, or been able to tolerate, alchohol (okay, a few drunken binges in the early 60's in college).

However, as much as I would like to "grasp at straws" (hi Steph:), I was 63 when diagnosed, and consider it very unlikely, though not impossible, I could have HPV.

My questions :

1. Is Dr. Pinto's statement reflective of medical research consensus outside the US ? To what extent is the dramatic mortality reduction he mentions occurring. ? When Dr. Pinto says "younger" : can anyone expand this topic further ?

2. What is the test for HPV for males : is it expensive and/or complex ?

-There is no doubt that there is a relationship between hpv and H&N cancer in non-smokers. H&N squamous cancers associated with smoking are most common in the 6th and 7th decade. H&N scc in non-smokers is more commonly seen in younger people. I know of no good evidence to support an assertion that hpv-associated H&N cancers carry a better prognosis, all other things being equal, However, younger patients without the comorbidities that old smokers have do have a better prognosis. But that's patient, not disease, factors.

-There is a woman on the ACOR H&N Cancer listserve who will disagree with you. Her husband was treated at Johns Hopkins in Maryland, USA and there they do test H&N cancer patients for HPV. According to that lady, the docs there feel that HPV caused H&N cancers respond better to treatments.

My own RO at MD Anderson has told me that most of the tongue cancers that they have seen that are positive for HPV are base of tongue.

That's two major cancer centers who do tests in people's mouths, Steph. I'm sure there are more.

This is why I went to MDA where there is an entire department of oncologists dedicated to H&N cancers. They are much more aware of things than a generalist.