Undergoing prophylactic childhood tonsillectomy reduced the future risk for tonsil carcinoma diagnosis, according to the results of a study published in Cancer Prevention Research, a journal of the American Association for Cancer Research.
"Oropharyngeal cancers, the majority of which arise in the tonsil and base of the tongue, are increasing in incidence. This increase is due in large part to infection with human papillomavirus [HPV], a sexually transmitted infection. So the question is whether tonsillectomy, a common surgical procedure, reduces risk of these cancers," said Carole Fakhry, MD, MPH, of the Department of Otolaryngology - Head and Neck Surgery at Johns Hopkins School of Medicine.
Decades before HPV-related tonsil cancer was diagnosed and became endemic, childhood tonsillectomy was standard of care to prevent tonsillitis in the United States, Denmark and other developed countries. Since abandoned for this indication, prophylactic tonsillectomy based on societal norms at the time had provided a chance opportunity to examine the effect of this procedure on the future development of of HPV-related oropharyngeal cancer, a current major medical and public health problem.
In this analysis, Fakhry and colleagues used data from the Danish Cancer Registry to estimate the incidence of tonsillectomies and oropharyngeal cancers in Denmark and to determine if tonsillectomy reduced future risk for the disease.
They evaluated more than 3 million Danish patients from the Danish Cancer Registry and found that 90,755 had had a tonsillectomy. Between 1977 and 2012, the incidence of tonsillectomy decreased by 33.8 percent. However, the researchers found that, during this same period, the incidence of oropharyngeal cancer increased significantly.
The researchers found that the absence of palatine lymphoid tissue in the general population reduces the risk of tonsil carcinoma development by 60 percent. In further analyses, they reported that tonsillectomies at younger ages were associated with an even greater reduction (85 percent) in risk for tonsil carcinoma.
"These data do not imply that individuals should have a tonsillectomy to reduce risk of tonsil cancer; oropharyngeal cancers and tonsil cancers are relatively rare," said Fakhry. "If groups at high risk for tonsil cancer could be identified, analogous to BRCA-positive women for breast cancer, then in the context of a clinical trial, a prophylactic tonsillectomy could be evaluated."
Anil Chaturvedi, PhD, an investigator in the Infections and Immunoepidemiology Branch of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, who commented about the study in the accompanying editorial, said, "The study by Fakhry and colleagues provides the first insight into the influenceof childhood tonsillectomy on the risk of oropharyngeal cancers, given the relatively recent and dramatically rising incidence of these types of cancer among young individuals in many countries across the globe. The results of their study are provocative. However, it is too early to consider prophylactic tonsillectomy as a standard means of secondary prevention for oropharyngeal cancers, given the enormous knowledge gaps we have at this point in this field. Primary prevention through HPV vaccination holds the greatest promise at this time.
"The results of this study provide a foundation for future studies to further evaluate the influence of demographic and behavioral factors on oropharyngeal cancers, and develop biomarker-based risk-stratification tools to identify high-risk individuals, and to develop tools for screening and treatment of precancerous lesions," Chaturvedi added.
This study was funded by the Oral Cancer Foundation and the Milton J. Dance Center. Fakhry and Chaturvedi have no conflicts of interest.