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Rise of HPV-positive glottic cancer in young patients ‘a significant public health issue’
HPV infection drove a recent increase in glottic carcinoma incidence among individuals aged 30 years and younger, according to results of a retrospective study published in in Annals of Otology, Rhinology & Laryngology.
“Over the past 150 years, vocal cord or glottic cancer has been almost exclusively a disease associated with smoking and almost entirely seen in patients over [age] 40 years,” Steven Zeitels, MD, director of the division of laryngeal surgery at Massachusetts General Hospital, said in a press release. “Today nonsmokers are approaching 50% of the [patients with] glottic cancer, and it is common for them to be diagnosed under the age of 40 [years]. This epidemiologic transformation of vocal cord cancer is a significant public health issue, due to the diagnostic confusion it can create.”
The researchers reviewed the records of 353 patients treated by Zeitels for glottic carcinoma from July 1990 to June 2004 at Massachusetts Eye and Ear Infirmary and July 2004 to June 2018 at Massachusetts General Hospital. The 112 patients treated during the first period included none aged 30 years or younger.
However, the 241 patients diagnosed during the most recent 14-year period included 11 patients aged 30 years or younger — three (one female, two male) between ages 10 and 19 years, three (two female, one male) between ages 20 and 25 years, and five (four female, one male) between ages 26 to 30 years.
Ten of the 11 patients tested positive for high-risk HPV, and only three had a history of smoking, all less than 3 pack-years.
None of the patients had been treated for benign recurrent respiratory papillomatosis, a benign condition caused by low-risk HPV strains, which had been suspected before biopsy due to the patients’ young age and the morphology of the lesions.
One of the 11 patients whose cancer recurred after partial cordectomy at another institution was misdiagnosed with recurrent respiratory papillomatosis and treated with serial cidofovir injections, which dramatically accelerated the growth of the cancer.
The researchers noted that their study reinforces evidence that glottic carcinoma is evolving from a tobacco-induced to an HPV-related disease that can be easily misdiagnosed as recurrent respiratory papillomatosis.
“Benign [recurrent respiratory papillomatosis] of the vocal cords has been a well-known HPV disease for more than a century, and it is very remarkable that there is now an HPV malignancy that looks so similar, creating diagnostic and therapeutic confusion,” Zeitels said. “It should be noted that these HPV-associated vocal-cord carcinomas are not a malignant degeneration of the benign disease.” – by John DeRosier
Disclosures: The Eugene B. Casey Foundation, National Philanthropic Trust and Voice Health Institute funded this study. Zeitels reports equity interest in Endocraft LLC. The other authors report no relevant financial disclosures.