Obesity and head and neck cancer risk and survival by human papillomavirus serology

Purpose: Previous studies examining the association of body mass index (BMI) with risk of and survival from head and neck squamous cell carcinoma (HNSCC) have been inconsistent, although an inverse association has been noted for obesity and risk of HNSCC in several studies. Previous studies have not examined whether these associations differ by human papillomavirus (HPV) status. Methods: We utilized the resources of a population-based case–control study of HNSCC from the greater Boston area (959 cases and 1,208 controls were eligible for this analysis). Anthropometric history was collected through personal interviews, and HPV status was assessed using serology. We analyzed the association between BMI (assessed 5 years prior to disease incidence) and disease risk and survival using logistic regression and Cox proportional hazards regression, respectively. Results: After adjusting for known risk factors, the association between obesity and overall risk of HNSCC was not significant (OR 0.79, 95 % CI 0.60–1.04). However, obesity (BMI ≥30 kg/m²) was inversely associated with HNSCC risk among HPV-seronegative cases (OR 0.48, 95 % CI 0.32–0.70), but not among HPV-seropositive cases (OR 0.91, 95 % CI 0.68–1.21). BMI was not associated with survival overall or by HPV status. However, being overweight (BMI 25–29.9 kg/m²) was associated with longer survival among HPV-seropositive smokers (HR 0.48, 95 % CI 0.31–0.74). Conclusions: Our findings are consistent with previous observations that obesity is inversely associated with the risk of HNSCC; however, this association appears to be confined to HPV-seronegative cases. Overall, obesity was not associated with HNSCC survival overall or by HPV status. Impact: Obesity is associated with risk of non-HPV HNSCC, but not HPV HNSCC.