{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T07:03:34Z","timestamp":1792047814373,"version":"4.4.0"},"reference-count":71,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T00:00:00Z","timestamp":1686614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Head and neck squamous cell carcinoma (HNSCC) is a group of malignancies, involving the oral cavity, pharynx, hypopharynx, larynx, nasal cavity, and salivary glands, that together compose the seventh most common cancer diagnosis worldwide. With 890,000 new cases and 450,000 deaths annually per GLOBOCAN estimates, HNSCC accounts for roughly 4.5% of cancer diagnoses and deaths. In the developing world, the incidence of HNSCC is growing with increasing consumption of tobacco (smoked or chewed), alcohol, and areca nut (betel quid). Alcohol and tobacco have a synergistic effect, with the heavy consumption of both increasing HNSCC risk 40-fold. In developed nations, HPV-related HNSCC surpasses tobacco- and alcohol-related disease. HPV-related HNSCC more commonly affects the oropharynx, hypopharynx, and larynx than the oral cavity, and is associated with a significantly longer median survival (130 months vs. 20 months). Discrepancies in etiology as well as disparities in lifestyle choices and access to healthcare may account for the greater incidence and poorer survival of HNSCC among minority and lower-socioeconomic-status communities in developed nations. Pharmacotherapy and counseling together have been shown to be effective in promoting smoking and alcohol cessation. Education on cancer risk and community engagement have reduced areca nut consumption in Asia as well as in diaspora communities. HPV vaccination, starting at age 11\u201312 for both sexes, has been shown to reduce the prevalence of high-risk HPV serologies and prevent pre-cancerous lesions of the cervix, vagina, and vulva. As of 2020, 58.6% of eligible adolescents in the US have received the full two-vaccine series. Increased adoption of vaccination, education on safe sex practices, and routine visual oral screening for high-risk patients would curb growing HNSCC incidence in developed nations.<\/jats:p>","DOI":"10.3390\/medsci11020042","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T02:01:40Z","timestamp":1686708100000},"page":"42","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":643,"title":["Epidemiology, Risk Factors, and Prevention of Head and Neck Squamous Cell Carcinoma"],"prefix":"10.3390","volume":"11","author":[{"given":"Adam","family":"Barsouk","sequence":"first","affiliation":[{"name":"Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Sukumar","family":"Aluru","sequence":"additional","affiliation":[{"name":"Elucid Bioimaging, Boston, MA 02216, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4361-8498","authenticated-orcid":false,"given":"Prashanth","family":"Rawla","sequence":"additional","affiliation":[{"name":"Parrish Medical Center, Titusville, FL 32796, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalyan","family":"Saginala","sequence":"additional","affiliation":[{"name":"Plains Regional Medical Group Internal Medicine, Clovis, NM 88101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Barsouk","sequence":"additional","affiliation":[{"name":"Hematologist-Oncologist, Allegheny Health Network, Pittsburgh, PA 15212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","unstructured":"Ferlay, J., Ervik, M., Lam, F., Colombet, M., Mery, L., Pi\u00f1eros, M., Znaor, A., Soerjomataram, I., and Bray, F. (2020). Global Cancer Observatory: Cancer Today, International Agency for Research on Cancer."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2057178X1770292","DOI":"10.1177\/2057178X17702921","article-title":"Oral cancer in South East Asia","volume":"2","author":"Cheong","year":"2017","journal-title":"Transl. Res. Oral Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1038\/s41415-022-5166-x","article-title":"Reviewing the epidemiology of head and neck cancer: Definitions, trends and risk factors","volume":"233","author":"Gormley","year":"2022","journal-title":"Br. Dent. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1001\/jamaoncol.2016.5688","article-title":"Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life-Years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study Global Burden of Disease Cancer Collaboration","volume":"3","author":"Fitzmaurice","year":"2017","journal-title":"JAMA Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1002\/ijc.32871","article-title":"Global trends in oral and pharyngeal cancer incidence and mortality","volume":"147","author":"Bosetti","year":"2020","journal-title":"Int. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"104551","DOI":"10.1016\/j.oraloncology.2019.104551","article-title":"Global patterns and trends in cancers of the lip, tongue and mouth","volume":"102","author":"Bray","year":"2020","journal-title":"Oral Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1002\/cam4.4539","article-title":"Trends in the incidence of head and neck cancer by subsite between 1993 and 2015 in Japan","volume":"11","author":"Kawakita","year":"2022","journal-title":"Cancer Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.oraloncology.2015.01.002","article-title":"Trends in head and neck cancers in England from 1995 to 2011 and projections up to 2025","volume":"51","author":"Louie","year":"2015","journal-title":"Oral Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1038\/s41415-022-5151-4","article-title":"Head and neck cancer in the UK: What was the stage before COVID-19? UK cancer registries analysis (2011\u20132018)","volume":"233","author":"Creaney","year":"2022","journal-title":"Br. Dent. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"363","DOI":"10.3322\/caac.21565","article-title":"Cancer treatment and survivorship statistics, 2019","volume":"69","author":"Miller","year":"2019","journal-title":"CA Cancer J. Clin."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1038\/s41571-020-0378-y","article-title":"The changing landscape of cancer in the USA\u2014Opportunities for advancing prevention and treatment","volume":"17","author":"Islami","year":"2020","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103569","DOI":"10.1016\/j.critrevonc.2021.103569","article-title":"Neoadjuvant immunotherapy in head and neck cancer: Rationale, current evidence and future perspective","volume":"169","year":"2022","journal-title":"Crit. Rev. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"608772","DOI":"10.3389\/fonc.2020.608772","article-title":"Radiotherapy and Immunotherapy for Head and Neck Cancer: Current Evidence and Challenges","volume":"10","author":"Qian","year":"2021","journal-title":"Front. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1038\/s41571-019-0227-z","article-title":"The changing therapeutic landscape of head and neck cancer","volume":"16","author":"Cramer","year":"2019","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1038\/s41419-019-1769-9","article-title":"Clinical update on head and neck cancer: Molecular biology and ongoing challenges","volume":"10","author":"Alsahafi","year":"2019","journal-title":"Cell Death Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"11612","DOI":"10.1038\/s41598-020-68380-w","article-title":"Disparate survival of late-stage male oropharyngeal cancer in Appalachia","volume":"10","author":"Papenberg","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.oraloncology.2018.12.023","article-title":"Racial and socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States","volume":"89","author":"Gaubatz","year":"2019","journal-title":"Oral Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2473974X211068075","DOI":"10.1177\/2473974X211068075","article-title":"The Impact of COVID-19 on Head and Neck Cancer Treatment: Before and During the Pandemic","volume":"5","author":"Solis","year":"2021","journal-title":"OTO Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1002\/ijc.2910410403","article-title":"Cancer of the larynx\/hypopharynx, tobacco and alcohol: Iarc international case-control study in Turin and Varese (Italy), Zaragoza and Navarra (Spain), Geneva (Switzerland) and Calvados (France)","volume":"41","author":"Tuyns","year":"1988","journal-title":"Int. J. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1038\/bjc.2011.475","article-title":"2. Tobacco-attributable cancer burden in the UK in 2010","volume":"105","author":"Parkin","year":"2011","journal-title":"Br. J. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2983","DOI":"10.1093\/annonc\/mds139","article-title":"Attributable causes of cancer in China","volume":"23","author":"Wang","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1002\/hed.25383","article-title":"Tobacco smoking, alcohol drinking, betel quid chewing, and the risk of head and neck cancer in an East Asian population","volume":"41","author":"Lee","year":"2018","journal-title":"Head Neck"},{"key":"ref_24","first-page":"685","article-title":"Genetic Polymorphisms Of Drug-Metabolizing Enzymes And Susceptibility to Head-And-Neck Squamous-Cell Carcinoma","volume":"80","author":"Morita","year":"1999","journal-title":"J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1158\/1055-9965.EPI-13-0185","article-title":"Single-Nucleotide Polymorphisms in Nucleotide Excision Repair Genes, Cigarette Smoking, and the Risk of Head and Neck Cancer","volume":"22","author":"Wyss","year":"2013","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1093\/aje\/kwt029","article-title":"Cigarette, Cigar, and Pipe Smoking and the Risk of Head and Neck Cancers: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium","volume":"178","author":"Wyss","year":"2013","journal-title":"Am. J. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.canep.2013.03.011","article-title":"Childhood passive smoke exposure is associated with adult head and neck cancer","volume":"37","author":"Troy","year":"2013","journal-title":"Cancer Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1002\/hed.23933","article-title":"Oropharyngeal cancer as a driver of racial outcome disparities in squamous cell carcinoma of the head and neck: 10-year experience at the University of Maryland Greenebaum Cancer Center","volume":"38","author":"Zandberg","year":"2015","journal-title":"Head Neck"},{"key":"ref_29","first-page":"741","article-title":"The role of type of tobacco and type of alcoholic beverage in oral carcinogenesis","volume":"108","author":"Quintana","year":"2003","journal-title":"Int. J. Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/jnci\/djk179","article-title":"Alcohol Drinking in Never Users of Tobacco, Cigarette Smoking in Never Drinkers, and the Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium","volume":"99","author":"Hashibe","year":"2007","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Rumgay, H., Murphy, N., Ferrari, P., and Soerjomataram, I. (2021). Alcohol and Cancer: Epidemiology and Biological Mechanisms. Nutrients, 13.","DOI":"10.3390\/nu13093173"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"609259","DOI":"10.1155\/2011\/609259","article-title":"Bmi-1 Regulates Snail Expression and Promotes Metastasis Ability in Head and Neck Squamous Cancer-Derived ALDH1 Positive Cells","volume":"2011","author":"Yu","year":"2011","journal-title":"J. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Charafeddine, M.A., Olson, S.H., Mukherji, D., Temraz, S.N., Abou-Alfa, G.K., and Shamseddine, A.I. (2017). Proportion of cancer in a Middle eastern country attributable to established risk factors. BMC Cancer, 17.","DOI":"10.1186\/s12885-017-3304-7"},{"key":"ref_34","first-page":"3282","article-title":"Smoking and Drinking in Relation to Oral and Pharyngeal Cancer","volume":"48","author":"Blot","year":"1988","journal-title":"Cancer Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s10552-018-1026-z","article-title":"Racial differences in the relationship between tobacco, alcohol, and the risk of head and neck cancer: Pooled analysis of US studies in the INHANCE Consortium","volume":"29","author":"Voltzke","year":"2018","journal-title":"Cancer Causes Control"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1002\/ijc.28643","article-title":"Betel quid chewing and the risk of oral and oropharyngeal cancers: A meta-analysis with implications for cancer control","volume":"135","author":"Guha","year":"2014","journal-title":"Int. J. Cancer"},{"key":"ref_37","unstructured":"IARC Working Group (1985). Tobacco Habits Other than Smoking, Betel-Quid and Areca-Nut Chewing, and Some Related Nitrosamines. IARC Monogr. Eval. Carcinog. Risk Chem. Hum., 37, 291."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"586","DOI":"10.4269\/ajtmh.2007.77.586","article-title":"Prevalence and Associated Factors of Betel Quid Use in the Solomon Islands: A Hyperendemic Area for Oral and Pharyngeal Cancer","volume":"77","author":"Tovosia","year":"2007","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1080\/13556210120091464","article-title":"Metabolic effects of the consumption of Areca catechu","volume":"7","author":"Boucher","year":"2002","journal-title":"Addict. Biol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/S1470-2045(12)70137-7","article-title":"Global burden of cancers attributable to infections in 2008: A review and synthetic analysis","volume":"13","author":"Ferlay","year":"2012","journal-title":"Lancet Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1002\/hed.24442","article-title":"Clinical characteristics and outcomes of oropharyngeal carcinoma related to high-risk non-human papillomavirus16 viral subtypes","volume":"38","author":"Varier","year":"2016","journal-title":"Head Neck"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1111\/cas.14834","article-title":"Characteristics of B lymphocyte infiltration in HPV + head and neck squamous cell carcinoma","volume":"112","author":"Zhang","year":"2021","journal-title":"Cancer Sci."},{"key":"ref_43","first-page":"166","article-title":"Sexual behaviours and the risk of head and neck cancers: A pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium","volume":"39","author":"Berthiller","year":"2009","journal-title":"Leuk. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"4550","DOI":"10.1200\/JCO.2013.50.3870","article-title":"Worldwide Trends in Incidence Rates for Oral Cavity and Oropharyngeal Cancers","volume":"31","author":"Chaturvedi","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1002\/cncr.30588","article-title":"Human papillomavirus in cervical cancer and oropharyngeal cancer: One cause, two diseases","volume":"123","author":"Berman","year":"2017","journal-title":"Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3322\/caac.21173","article-title":"Cancer statistics for African Americans, 2013","volume":"63","author":"DeSantis","year":"2013","journal-title":"CA Cancer J. Clin."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.humpath.2011.03.009","article-title":"Incidence of human papillomavirus in oropharyngeal squamous cell carcinomas: Now and 50 years ago","volume":"43","author":"Chenevert","year":"2012","journal-title":"Hum. Pathol."},{"key":"ref_48","first-page":"299","article-title":"HPV in oropharyngeal cancer: The basics to know in clinical practice","volume":"34","author":"Elrefaey","year":"2014","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"4294","DOI":"10.1200\/JCO.2011.36.4596","article-title":"Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States","volume":"29","author":"Chaturvedi","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1056\/NEJMoa0912217","article-title":"Human Papillomavirus and Survival of Patients with Oropharyngeal Cancer","volume":"363","author":"Ang","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_51","first-page":"261","article-title":"Improved Survival of Patients with Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma in a Prospective Clinical Trial","volume":"100","author":"Fakhry","year":"2008","journal-title":"Gynecol. Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1038\/s41416-023-02167-4","article-title":"Head and neck cancer patient-derived tumouroid cultures: Opportunities and challenges","volume":"128","author":"Basnayake","year":"2023","journal-title":"Br. J. Cancer"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e012296","DOI":"10.1136\/bmjopen-2016-012296","article-title":"Smoking cessation care among patients with head and neck cancer: A systematic review","volume":"6","author":"McCarter","year":"2016","journal-title":"BMJ Open"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1093\/annonc\/mdz084","article-title":"Head and neck cancer prevention: From primary prevention to impact of clinicians on reducing burden","volume":"30","author":"Hashim","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1080\/17460441.2018.1458090","article-title":"Discovery and development of varenicline for smoking cessation","volume":"13","author":"Jordan","year":"2018","journal-title":"Expert Opin. Drug Discov."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1007\/s11606-020-06454-1","article-title":"Characterizing the Variation of Alcohol Cessation Pharmacotherapy in Primary Care","volume":"36","author":"Bernstein","year":"2021","journal-title":"J. Gen. Intern. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e208279","DOI":"10.1001\/jamanetworkopen.2020.8279","article-title":"Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis","volume":"3","author":"Ray","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"212308","DOI":"10.7573\/dic.212308","article-title":"Practical Outpatient Pharmacotherapy for Alcohol Use Disorder","volume":"7","author":"Kim","year":"2018","journal-title":"Drugs Context"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S1368-8375(03)00039-3","article-title":"Decline of oropharyngeal cancer in Chiangmai province, Thailand, between 1988 and 1999","volume":"39","author":"Reichart","year":"2003","journal-title":"Oral Oncol."},{"key":"ref_60","first-page":"512","article-title":"Intention to quit betel quid: A comparison of betel quid chewers and cigarette smokers","volume":"13","author":"Little","year":"2014","journal-title":"Oral Health Dent. Manag."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"100544","DOI":"10.1016\/j.conctc.2020.100544","article-title":"Rationale and design of a randomized, controlled, superiority trial on areca nut\/betel quid cessation: The Betel Nut Intervention Trial (BENIT)","volume":"17","author":"Paulino","year":"2020","journal-title":"Contemp. Clin. Trials Commun."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1080\/10826084.2021.1892141","article-title":"The Effectiveness of Betel Quid Cessation among Workers through the Adoption of the Five Action Areas of the Ottawa Charter","volume":"56","author":"Tseng","year":"2021","journal-title":"Subst. Use Misuse"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1080\/14728214.2018.1543400","article-title":"An update: Emerging drugs to treat squamous cell carcinomas of the head and neck","volume":"23","author":"Lee","year":"2018","journal-title":"Expert Opin. Emerg. Drugs"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e20151968","DOI":"10.1542\/peds.2015-1968","article-title":"Prevalence of HPV After Introduction of the Vaccination Program in the United States","volume":"137","author":"Markowitz","year":"2016","journal-title":"Pediatrics"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1093\/jnci\/djp534","article-title":"Impact of Human Papillomavirus (HPV)-6\/11\/16\/18 Vaccine on All HPV-Associated Genital Diseases in Young Women","volume":"102","author":"Munoz","year":"2010","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.15585\/mmwr.mm7035a1","article-title":"National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13\u201317 Years\u2014United States, 2020","volume":"70","author":"Pingali","year":"2021","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.1752-7325.2003.tb03485.x","article-title":"Oral Cancer Examinations among Adults at High Risk: Findings from the 1998 National Health Interview Survey","volume":"63","author":"Macek","year":"2007","journal-title":"J. Public Health Dent."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"100","DOI":"10.3322\/caac.21392","article-title":"Cancer screening in the United States, 2017: A review of current American Cancer Society guidelines and current issues in cancer screening","volume":"67","author":"Smith","year":"2017","journal-title":"CA Cancer J. Clin."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2593","DOI":"10.1002\/cncr.28107","article-title":"Incidence and pattern of second primary malignancies in patients with index oropharyngeal cancers versus index nonoropharyngeal head and neck cancers","volume":"119","author":"Gan","year":"2013","journal-title":"Cancer"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1016\/S0140-6736(05)66658-5","article-title":"Effect of screening on oral cancer mortality in Kerala, India: A cluster-randomised controlled trial","volume":"365","author":"Sankaranarayanan","year":"2005","journal-title":"Lancet"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/j.bjorl.2020.12.019","article-title":"Efficacy of non-invasive diagnostic methods in the diagnosis and screening of oral cancer and precancer","volume":"88","author":"Kim","year":"2021","journal-title":"Braz. J. 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