Overall, our review points to smoking tobacco posing an additional risk for development of head and neck cancer in the presence of HPV infection. This is consistent with available laboratory data that show evidence of biological plausibility for interaction between smoking and progression of HPV infection to carcinogenesis. It is therefore important that cessation of smoking is promoted in smokers with HPV infection. In the end this is kind of a no shit statement� when you have two strong risk factors instead of one, the world is going to be worse for you. Please note they use of the word plausibility, In spite of many articles not in their bibliography which clearly show that HPV is a unique pathway, they say that it is plausible that there is some synergy between the two.

Rightfully the article piece you have posted states that they have poorer outcomes. That is not the same as saying that it requires the two things to have happened (smoking and HPV infection) simultaneously to develop a malignancy. This is just observations on a subset of patients that smoke and have HPV, which is not the largest group of HPV+ oral cancer patents. Most oral cancer patients in the US that are HPV etiology are non smokers.

This paper is part of a meta analysis of many other papers. It is just indicating that there is indeed a sub set of individuals that are both smokers and HPV+, but it is very clear at the end where they say that we do not know the life history of the virus, and that would give definite answers to things which they are only speculating on. This is not a study, it is a review of many studies.

Meta analysis is highly useful. But there is always the potential for bias in them as they select the articles that they wish to look at, and that introduces bias of its own. The most recent example was one done by the ADA that was listed over 100 articles in its bibliography, but when I questioned a friend that had been part of the process he acknowledged that they omitted 60 of them as not worthy of being included in their analysis. Those 60 were peer reviewed published articles!! The ADA's conclusion was that screening in oral cancer does not work�. The Cochran Group is notorious for doing this kind of thing as well.

The penis is covered with normal epithelium, not squamous cells. There is more but I don't agree with most of your conclusions.

Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.