Wittekindt C, et al. - In a cohort of consecutively enrolled patients with oropharyngeal squamous cell carcinomas (OPSCC), researchers focused on human papilloma virus (HPV) association and incidence rates from 2000 to 2017 in Giessen, Germany. They also compared the findings with regional (Giessen and the federal state of Hesse), national (Germany) and international (US) databases. The overall incidence rates of oropharyngeal cancers, as well as the incidence of HPV-related cancers of the tonsils and oropharynx (sub-sites) were significantly higher, while no significant change was shown by other oropharyngeal sub-sites, as revealed in regional data. In Germany and in the US, a significant incidence increase was evident. In Germany, OPSCC incidence rates increased significantly, which corresponded to the known incidence increase of HPV-associated oropharyngeal cancers based on experimental data from consecutively included patients of authors' cohort. Findings revealed different patterns of this increase in Germany and in the US, indicative of spatial heterogeneity.