Complex etiology underlies risk and survival in head and neck cancer human papillomavirus,tobacco,and alcohol: A case for multifactor disease

Findings are inconsistent about whether tobacco,alcohol,and human papillomavirus (hpv) are two independent hnc risk factor groups that distinguish an infection-associated cancer from a tobacco/alcohol-associated hnc. we found that cancer in the oral cavity risk was greater in hpv-e6/e7 seropositive/heavy tobacco users (adjusted or = 3.5) than in hpv-seronegative/heavy tobacco users (adjusted or = 1.4); and hpv-seropositive/heavy alcohol users (adjusted or = 9.8) had greater risk than hpv-seronegative/heavy alcohol users (adjusted or = 3.1). in contrast,the risk of oropharyngeal cancer was greater in the hpv-seronegative/heavy tobacco (adjusted or = 11.0) than in hpv-seropositive/ heavy tobacco (adjusted or = 4.7) users and greater in hpv-seronegative/heavy alcohol users (adjusted or = 24.3) compared to hpv-seropositive/heavy alcohol users (adjusted or = 8.5). disease-specific and recurrence-free adjusted survival were significantly worse in oropharyngeal hpv-seronegative cases with no survival differences by hpv status seen in oral cavity cases. the association between tobacco/alcohol,hpv,and tumor site is complex. there appear to be distinct tumor site differences in the combined exposure risks,suggesting that different molecular pathways are involved. copyright © 2012 elaine m. smith et al.