This article objectively summarizes published scientific research. Original research citation in footer.

JoAnn Gurenlian, RDH, MS, PhD, AAFAAOM, FADHA
November 7, 2025

The epidemiology of oropharyngeal squamous cell carcinoma (OPSCC) has changed significantly, marked by a rise in HPV-positive cases and a decline in HPV-negative cases. Notably, HPV-positive patients had a 58% reduction in the risk of death compared to HPV-negative patients.

In 2018, the Centers for Disease Control and Prevention reported that OPSCC had become the most common HPV-associated cancer in the United States, surpassing cervical cancer.

In 2012, the National Comprehensive Cancer Network recommended HPV testing for all newly diagnosed cases of oropharyngeal squamous cell carcinoma (OPSCC), recognizing HPV status as an independent prognostic factor.  

In 2018, the eighth edition of the American Joint Committee on Cancer Staging Manual incorporated HPV status into the staging criteria for OPSCC. 

Prior to 2018, studies reported that HPV testing rates remained suboptimal following the NCCN recommendation, particularly among underserved and minority populations. This study analyzed HPV testing rates from 2013 to 2021, examining sociodemographic and clinical factors, as well as factors associated with a higher likelihood of not receiving HPV testing.

A retrospective cohort study of 135,756 individuals diagnosed with OPSCC from 2013 to 2021 was conducted using the National Cancer Database. The outcome variable was HPV testing status, that is, tested versus not tested. HPV testing status coded as not applicable occurred in 54 patients, and these data were excluded from the study. 

Results reported for the time frame of 2013 to 2017 included a total of 70,911 patients who were diagnosed with OPSCC. Of these individuals, 50,494 (71.2%) were tested for HPV while 20,417 (28.8%) were not tested or had an unknown testing status. 

From 2018 to 2021, a total of 64,845 patients were diagnosed with OPSCC; 60,184 (92.8%) tested positive for HPV and 4,661 (7.2%) were not tested for HPV or had an unknown status. 

HPV testing rates increased from 2013 to 2017; however, testing rates plateaued from 2018 to 2021. HPV testing rates increased annually by 6.8% from 2013 to 2017 and by only 1.2% from 2018 to 2021. 

Within both time frames of evaluation higher proportions of Black patients and uninsured patients were not tested compared with patients of all other races or insurance types. Patients living in underserved areas and corresponding lowest educational attainment or lowest median income had higher proportions of patients not tested for HPV.  

Furthermore, community cancer program settings had the highest proportions of patients not tested in comparison to academic or research programs. 

This study of trends in HPV testing among patients with OPSCC is the first of its kind. Results highlighted substantial socioeconomic and clinical disparities in HPV testing.   

The authors recommend that bias training and interventions be performed to address structural racism and reduce racial disparities in HPV testing for OPSCC. Further, improving patient education, facilitating communication, and increasing health literacy can assist in addressing HPV testing disparities.  

In addition, policy changes and health insurance reform were recommended, as health insurance may be inaccessible to those who are unemployed or cannot afford insurance. Also, using an academic and community collaboration model at community cancer centers may increase adherence to quality measures.  

Suboptimal HPV testing is concerning, especially as the incidence of OPSCC continues to rise in the U.S. and current staging guidelines require HPV status. The authors recommend further research to validate these findings, identify barriers to HPV testing, and develop targeted interventions to improve its utilization in OPSCC cases. 

To read more, access the research article here.

This article summarizes the findings of the research article “Trends in Human Papillomavirus Testing Among Patients With Oropharyngeal Cancer” by Katie M. Carlson, MPH, Nana-Hawwa Abdul-Rahman, MS, Rebecca A. Deek, PhD, MS, et al, published in JAMA Network Open on July 29, 2025 (DOI: 10.1001/jamanetworkopen.2025.23917). 

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JoAnn Gurenlian, RDH, MS, PhD, AAFAAOM, FADHA is the ADHA Director of Education, Research & Advocacy, professor emerita in the Department of Dental Hygiene at Idaho State University, and former president of the American Dental Hygienists’ Association, 1990-1991.