Below is an instruction from Human. Write a response.
    ### Instruction:
    What are the genetic changes related to head and neck squamous cell carcinoma ?
    ### Response:
    HNSCC is caused by a variety of factors that can alter the DNA in cells. The strongest risk factors for developing this form of cancer are tobacco use (including smoking or using chewing tobacco) and heavy alcohol consumption. In addition, studies have shown that infection with certain strains of human papillomavirus (HPV) is linked to the development of HNSCC.
    