See the Reponse, p. 409
We read with interest the recent article excluding human papillomavirus (HPV) as a significant contributor in esophageal squamous cell cancers (ESCC), at least in Australia (1). This is in contradistinction to oropharyngeal cancers (OPC) where there is compelling epidemiologic and molecular evidence indicating HPV as the etiology of a subset of cases. Within Australia, there is a changing epidemiology of OPCs. In a recent study of 302 cases, the incidence of HPV-related OPCs increased from 19% in 1987 to 1990, 47% in 2001 to 2005, to 60% in 2005 to 2006 (2). Reports worldwide vary considerably in finding HPV in ESCC: with rates up to 81% (3). The clinical implications of excluding HPV as a major contributor to ESCC are important, particularly as HPV-related cancers have better prognosis and chemoradiation responses than their non-HPV counterparts.
We question whether the...