Certain head and neck cancers that are positive for high-risk types of human papillomavirus (HPV) have a better prognosis and may need less aggressive treatment.
To help ensure that patients with these cancers are accurately diagnosed and effectively treated, the College of American Pathologists (CAP) today released its newest evidence-based practice guideline, "Human Papillomavirus (HPV) Testing in Head and Neck Carcinomas," NOW AVAILABLE IN EARLY ONLINE RELEASE IN ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE.
The guideline comes at a much-needed time. HPV-positive head and neck cancer is on the rise in the U.S., with the greatest increase among middle-aged Caucasian men. In the United States and Canada, high-risk HPV causes approximately 70% of cancers of the oropharynx (those involving the middle of the throat, the base of the tongue, and the tonsils), according to the National Cancer Institute.
"Accurate HPV assessment in head and neck cancers is becoming critical," said guideline co-chair William C. Faquin, MD, PhD, FCAP, a pathologist at Massachusetts General Hospital, Boston. "It is also important to know when testing is not indicated, and this new guideline provides that guidance."
An interdisciplinary, expert panel of pathologists, surgeons, radiation oncologists, medical oncologists, patients, and patient advocates developed the guideline, which recommends accurate assessments of a patient’s high-risk HPV status, directly or by surrogate markers.
"Because today's cancer care is increasingly multidisciplinary, a diversity of disciplines of the members for this expert panel was critical. This provides strength to the recommendations," said project co-chair, James S. Lewis, Jr., MD, FCAP, a pathologist at Vanderbilt University Medical Center in Nashville, Tenn.
Based on a screening of 2,200 peer-reviewed articles and a review of evidence from 492 studies, the panel issued 14 final recommendations in the guideline. Notably:
"HPV-associated carcinomas of the oropharynx are different biologically and clinically, and this impacts the patient's treatment plan," said panelist and surgical oncologist James Rocco, MD, PhD, The Ohio State University Wexner Cancer Center, Columbus, Ohio. "We have many tools in the cancer-fighting arsenal, and this guideline will help inform the entire treatment team on which tools to use and when."
Panelist and Stanford University radiation oncologist Beth Beadle, MD, concurs. "Management of these patients can involve a combination of radiation, chemotherapy, and/or surgery. By better tailoring the treatment to the specific pathology of each patient's cancer, we can achieve better results and help minimize side effects," she said. Many clinical trials aimed at tailoring treatment for HPV-positive OPSCCs are underway.
The CAP Pathology and Laboratory Quality Center develops evidence-based guidelines and consensus statements related to the practice of pathology and laboratory medicine. Through this work, the CAP and its members continually improve the quality of diagnostic medicine and patient outcomes.
As the world's largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. For more information, READ THE CAP ANNUAL REPORT at CAP.ORG
1. Lewis JS Jr, Beadle B, Bishop JA, et al. Human papillomavirus testing in head and neck carcinomas: guideline from the College of American Pathologists [published online December 18, 2017]. Arch Pathol Lab Med. doi: 10.5858/ARPA.2017-0286-CP
CAP guideline details HPV testing in head and neck cancers. Appl Rad Oncol.