Which statement best describes the relationship between HPV-associated and tobacco-associated cancers in the oropharynx?

• A. All oropharyngeal cancers are HPV-related
• B. Some HPV-unrelated cancers are assumed to be tobacco-related
• C. HPV never relates to oral cancers
• D. Tobacco use has no relation to oral cancers

Answer: (B)

In oropharyngeal cancers, there are two major etiologic pathways: HPV-related and tobacco-related. These pathways are not the same, and a cancer can be driven by one or the other (or, less commonly, by both). HPV-positive tumors tend to occur with little or no tobacco exposure and often have a better prognosis, while HPV-negative tumors are more strongly linked to tobacco use and alcohol. Given that distinction, it’s accurate to say that among HPV-unrelated cancers, tobacco exposure is a common assumed cause. The other statements overgeneralize or contradict the established relationships—for example, not all oropharyngeal cancers are HPV-related, HPV can be involved in some oral cancers, and tobacco use does have a clear association with oral cancers.