HPV and oropharyngeal cancer: what the CDC counts, what the CDC recommends about the vaccine, and what ADA policy asks the dentist to do

What it says#

Start with the CDC's arithmetic, because it is the part most often repeated wrongly. The CDC distinguishes two things. An HPV-associated cancer is a specific cellular type of cancer diagnosed in a part of the body where HPV is often found, counted from registries; an HPV-attributable cancer is a cancer that is probably caused by HPV, estimated by multiplying the associated count by a genotyping-derived percentage. Cancer registries do not routinely collect data on whether HPV is in the cancer tissue, so the second number is an estimate built on the first.

On the page dated December 3, 2025, using registry data for 2018 to 2022 covering 100% of the United States population, the CDC reports about 49,908 new cases a year in sites where HPV is often found, 27,081 among females and 22,827 among males, and states that HPV causes about 39,300 of them. Site by site: cervix 12,287 cases at 91%, or 11,100; vagina 889 at 75%, or 700; vulva 4,370 at 69%, or 3,000; penis 1,429 at 63%, or 900; anus 8,348 at 91%, or 7,600; and oropharynx 22,585 at 70%, or 16,000. The oropharyngeal split by sex is 18,776 cases in males with 13,600 attributable and 3,809 in females with 2,400. The CDC's own summary sentence is that cervical cancer is the most common HPV-associated cancer among women and oropharyngeal cancers, the back of the throat including the base of the tongue and tonsils, are the most common among men. Note that a second CDC page, the vaccination page dated August 20, 2024, uses an older rounded figure, about 36,000 cases of cancer caused by HPV each year, so quote the page you read and its date.

The vaccination recommendation is short. CDC recommends 2 doses of HPV vaccine at ages 11 to 12 years, given 6 to 12 months apart, and says vaccination can be started at age 9. Only 2 doses are needed if the first dose was given before the 15th birthday; children 9 to 14 who received 2 doses less than 5 months apart need a third; people 15 to 26 who start later need 3 doses over 6 months, as do people with weakened immune systems aged 9 to 26. Vaccination is not recommended for everyone older than 26, and some adults aged 27 through 45 who are not already vaccinated may decide to get it after speaking with their doctor about their risk for new infections and the possible benefits, with the CDC noting that vaccination in this range provides less benefit because more people have already been exposed. Gardasil-9 is the vaccine distributed in the United States and protects against nine HPV types.

ADA policy supplies the dentist's part, and it is worth reading as written rather than as remembered. The 2018 resolution adopts the position that HPV vaccination, as recommended by the CDC Advisory Committee on Immunization Practices, is a safe and effective intervention to decrease the burden of oral and oropharyngeal HPV infection; urges dentists and local and state dental societies to support its use and administration; and encourages appropriate external agencies to support research to improve understanding of the natural history of oral HPV infection, transmission risks, screening and testing. A 2023 policy adds that the ADA encourages education of the dental profession at state and local levels on the importance of preventing HPV cancers, and collaboration with other health care organizations to support patient education on HPV prevention. The separate oral cancer policy, adopted in 2014 and amended in 2019 to name oropharyngeal cancer, recognizes that early diagnosis has the potential to have a significant impact on treatment decisions and outcomes, and supports routine visual and tactile examinations for all patients.

The ADA's own head and neck cancer topic page supplies the clinical framing. It states that the oral cavity and the oropharynx are separate, non-overlapping anatomic regions, the oropharynx being the soft palate, palatine tonsils, base of the tongue, valleculae and posterior pharyngeal wall, and that oncogenic oral HPV infection is a major risk factor for oropharyngeal cancer rather than oral cancer per se. It reports that an estimated 71% of oropharyngeal squamous cell carcinoma cases each year, over 11,000, are associated with HPV infection, and that over 90% of HPV-positive cases are associated with HPV-16. It puts oncogenic oral HPV infection prevalence at approximately 3.5% of US adults, most prevalent among adult men who currently smoked and men reporting more lifetime oral sexual partners. And it is careful about the vaccine: the vaccine protects against the types of HPV that can cause oropharyngeal cancers, so it may also prevent oropharyngeal cancers, however studies have not been done to show this, and clinical trials designed to answer the question are underway.

Who it applies to#

The exam applies to every patient. ADA policy supports routine visual and tactile examinations for all patients, and this directory's entry on the 2026 ADA oral cancer living guideline covers what that examination should and should not include, including the conditional recommendations against cytology, vital staining and light-based adjuncts; the entry on the 2017 potentially malignant disorders guideline covers the lesion pathway. What the HPV data add is where to look: the oropharynx is a different region from the mouth, and the presenting complaints the ADA page lists for oropharyngeal cancer are a neck mass from metastatic disease, sore throat and difficulty swallowing rather than a visible lesion.

The vaccine conversation applies to adolescents and their parents first, then to unvaccinated adults through 26, then as a shared decision from 27 to 45. Nothing in ADA policy asks a dentist to administer the vaccine; the 2018 resolution asks dentists to support its use and administration, and a separate 2020 policy states the ADA's position that dentists with the requisite knowledge and skills should be allowed to administer critical vaccines, which is a scope question settled state by state.

What changed#

Against the older framing of oral cancer as a tobacco and alcohol disease, the change is which site is growing and in whom. The ADA's page reports SEER data showing statistically significant annual percentage increases from 2009 to 2018 in squamous cell carcinoma of the tongue at 1.5%, tonsil at 1.7% and oropharynx at 4.2%, against decreases for lip, floor of mouth and hypopharynx. Tobacco and alcohol remain the major risk factors named for both regions.

Against ADA policy as it stood before 2018, the change is that supporting a vaccine is now the Association's stated position, and since 2023 so is educating the profession and collaborating with medicine on patient education. The screening policy widened in 2019 from oral cancer to oral and oropharyngeal cancer.

Where the source is#

The CDC's Cancers Linked with HPV Each Year page, linked under the title, carries the full table site by site and by sex, the definitions of associated and attributable, the data note that the figures come from NPCR and SEER registries for 2018 to 2022 covering the whole US population, and its own date of December 3, 2025. Note that cdc.gov refuses some automated browser requests, so a plain client or a browser is needed to open it. The CDC's HPV Vaccination page carries the dose schedule and age ranges and is dated August 20, 2024. The ADA's Oral Health Topics page on Cancer (Head and Neck) is free to the public and is the source of the anatomy, risk factor and HPV-16 statements quoted here. The ADA's resolutions are printed in full in the ADA Current Policies PDF linked above, under Prevention and Health Education; the HPV vaccination policy is at Trans.2018:351, HPV Education and Collaboration at Trans.2023, and Early Detection and Prevention of Oral and Oropharyngeal Cancer at Trans.2014:506 as amended in 2019.