The current study identified 4% HPV infection in the Gujarati oral squamous cell carcinoma subset. We screened total of 50 patients using type specific PCR. Out of fifty patients one patient with advanced stage carcinoma, without any carcinogenic history found infected with HPV-16 and another patient with stage IV, without any personal, genetic or tobacco history observed infected with HPV-18.
The same study has been done in same population recently; they found 2% HPV frequency in oral cancer subset . They have enrolled 200 cancer samples and found 2 HPV infected patients. They did this study in year 2010, so it may be the difference in frequency which support the notion of HPV infection, as this is the highly tobacco consumed region, the development of OSCC was observed due to tobacco, a rare history of HPV found in both the studies. Another previous study reported in Gujarati population stated absence of HPV infection  (Fig 2). It seems, as this is the tobacco growing belt and tobacco consuming region, the frequency of HPV infection is very low compared to another population of India. The main reason of onset of oral cancer is tobacco. The previous study reported 80% of the OSCC patients had history of tobacco in form of chewing and smoking . Hence, it might be the reason of lower frequency of the HPV infection.
Same study in Eastern India [26,27] reported highest (51.3%) prevalence of HPV infection as compared to south India (48.63%) [14,28-32], Followed by North India (35.2%) [33-36]. West India [12,25,37-39] accounted 15.54% frequency of HPV infection and present study in Western India stated only 6.6% prevalence of HPV infection (Fig 3). The western Indian population is showing lower HPV frequency compare to rest of the Indian region, tobacco history might be the main factor for the OSCC carcinogenesis over Guajarati population.
The frequency of HPV infection varies from ethnicity to ethnicity. When we have compared the HPV infection frequency of Western part of the India with other parts of the globe, it is showing contrast result (Fig 4). The difference in results may be due to race, ethnicity, etiological factor, dietary patterns, environmental factors, personal history such as genetic history and mostly tobacco history do affect the results. HPV infection found more frequent in Japan (93.89%) [40-46] then Greece (65.67%) [16,47]. The similar study performed in Venezuela [48-50] and Netherland [51,52] demonstrated 62.93% and 31.27% prevalence of HPV infection respectively. The study in USA [24,53-59], China [60-66] and Brazil [67-69] has shown 22.95%, 22.83% and 23.8% HPV prevalence respectively. Total HPV mutation frequency of Indian population is showing 36.04% [12,14,25-39] which seems similar to Netherland population.
The HPV screening must require before any genetic analysis of the cancer patient. This is the personalized medicine era, based on the patient’s genomic profile; the prognosis of the patients can be improved . The patients with HPV infection has better prognosis than any other personal history. Thus, HPV studies must have been carried out in line with all the basic test of the cancer patients. The limitation of the study is lower sample size. The further study with larger cohort should be needed to validate the findings and to establish HPV as a prognostic biomarker.
The present study identified 4% HPV infection frequency in advanced staged OSCC Indian subset. Both the patients were not observed with any personal history. Our finding differs with rest of the population, as the region have high amount of consumption of tobacco, so that might be the reason for developing oral cancer. Another reason race, ethnicity, environmental factor, etiology, dietary factor may affect the results. The future studies with large cohort must be carried out to establish HPV infection has a better prognosis then patients have history of tobacco. The further study would be needed to establish the findings that will open the new vista in cancer biology.
Within the limitation of study, the Saurashtra region of Gujarat is not HPV prone region for onset of OSCC. Tobacco is the prime factor responsible for the development of OSCC. HPV infected patients have shown better prognosis, compared with non-HPV oral cancer patients. Thus, before medication, HPV screening must be done as it shows promising prognostic biomarker.