Is High-Risk Sexual Behavior a Risk Factor for Oropharyngeal Cancer?

Gunnar Wichmann; Jasmin Rudolph; Sylvia Henger; Christoph Engel; Kerstin Wirkner; John Ross Wenning; Samira Zeynalova; Susanne Wiegand; Markus Loeffler; Theresa Wald; Andreas Dietz

doi:10.3390/cancers15133356

Is High-Risk Sexual Behavior a Risk Factor for Oropharyngeal Cancer?

Cancers (Basel). 2023 Jun 26;15(13):3356. doi: 10.3390/cancers15133356.

Authors

Gunnar Wichmann^{1

2}, Jasmin Rudolph¹, Sylvia Henger^{2

3}, Christoph Engel^{2

3}, Kerstin Wirkner², John Ross Wenning¹, Samira Zeynalova^{2

3}, Susanne Wiegand¹, Markus Loeffler^{2

3}, Theresa Wald¹, Andreas Dietz^{1

2}

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany.
² LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany.
³ Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University, Härtelstr. 16-18, 04107 Leipzig, Germany.

Abstract

(1) Background: Several lines of evidence established a link between high-risk (HR) sexual behavior (SB), the persistence of human papillomavirus (HPV) DNA in saliva, and the presence of oncogenic HR-HPV subtypes in oropharyngeal squamous cell carcinoma (OPSCC). A highly influential case-control study by D'Souza et al. comparing OPSCC patients and ENT patients with benign diseases (hospital controls) established HR-SB as a putative etiological risk factor for OPSCC. Aiming to replicate their findings in a nested case-control study of OPSCC patients and propensity score (PS)-matched unaffected controls from a large population-based German cohort study, we here demonstrate discrepant findings regarding HR-SB in OPSCC. (2) Methods: According to the main risk factors for HNSCC (age, sex, tobacco smoking, and alcohol consumption) PS-matched healthy controls invited from the population-based cohort study LIFE and HNSCC (including OPSCC) patients underwent interviews, using AUDIT and Fagerström, as well as questionnaires asking for SB categories as published. Afterwards, by newly calculating PSs for the same four risk factors, we matched each OPSCC patient with two healthy controls and compared responses utilizing chi-squared tests and logistic regression. (3) Results: The HNSCC patients and controls showed significant differences in sex distribution, chronologic age, tobacco-smoking history (pack years), and alcohol dependence (based on AUDIT score). However, PS-matching decreased the differences between OPSCC patients and controls substantially. Despite confirming that OPSCC patients were more likely to self-report their first sexual intercourse before age 18, we found no association between OPSCC and HR-SB, neither for practicing oral-sex, having an increased number of oral- or vaginal-sex partners, nor for having casual sex or having any sexually transmitted disease. (4) Conclusions: Our data, by showing a low prevalence of HR-SB in OPSCC patients, confirm findings from other European studies that differ substantially from North American case-control studies. HR-SB alone may not add excess risk for developing OPSCC.

Keywords: head and neck cancer (HNC); head and neck squamous cell carcinoma (HNSCC); human papillomavirus (HPV); oropharyngeal squamous cell carcinoma (OPSCC); sexual behavior (SB).

Grants and funding

This research was funded by grants from the Leipzig Research Center for Civilization Diseases (LIFE); grant sponsor, University Leipzig; grant numbers, LIFE-006 B7 and LIFE-007 D9; grant sponsor for LIFE, the European Union, the European Fund for Regional Development (EFRE), and the Free State of Saxony.