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Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S.—it’s so prevalent that nearly all sexually active men and women will get the virus at some point in their lives.
There are many different strains of HPV and while certain strains can cause cervical cancer in women, most who are infected with the virus will never have symptoms or know they have it. Other strains, such as HPV-16, have been associated with up to 70 percent of cancer in the oropharynx, which includes the back of the throat, the base of the tongue and the tonsils. And perhaps surprisingly, these cancers are spiking among younger and healthier adults.
LISTEN: Dr. Pierce discusses the link between head and neck cancers and HPV in the Medical Intel podcast.
Who’s at risk for head and neck cancer from HPV?
HPV-related cancers of the head and neck occur in the oropharynx and less commonly in the larynx, or voice box.
Among those who are infected with the HPV16 strain, only a small number actually develop cancer. There is ongoing research to learn why some people develop it and others don’t. But healthy, non-smoking individuals between 35 and 55 are the fastest-growing segment of the oropharyngeal cancer population. In these patients, cancer occurs in males more than females, at a rate of about three to one.
Head and neck cancers can be difficult for patients to cope with because they can affect aspects of day-to-day life, body features and the organs that help us communicate. These challenges can have negative effects on a patient’s mental well-being and quality of life:
- Altered appearance, due to changes to skin, tissues or facial structures
- Difficulty swallowing, which can affect eating and drinking, and involuntary swallowing, such as during sleep
- Speech or voice impairment
The good news is that head and neck cancers caused by HPV respond better to treatments and have a much better prognosis than other cancers of the head and neck. In fact, HPV-positive patients have half the risk of death compared with patients whose head and neck cancers weren’t caused by HPV. Researchers also are investigating de-escalation, or a reduction in the amount of treatment we give to these patients, while still maintaining the same good outcomes.
What are the symptoms?
Some of the symptoms of HPV-related head and neck cancer may initially be attributed to other benign conditions, or they may be somewhat subtle, such as:
- Coughing up blood or nosebleeds
- Difficulty or pain in swallowing
- Difficulty speaking or changes in your voice
- Ear pain
For most patients with HPV-related cancer, the symptoms are less subtle and include a mass in the neck or a lesion in the mouth that does not heal. At this time, there is no screening approved by the Food and Drug Administration (FDA) that has been shown to reduce the risk of developing or dying from oropharyngeal cancer. I urge you to make an appointment with your doctor or see a specialist if any of these symptoms last for more than two or three weeks without improvement.
Can HPV be prevented?
The best line of defense against HPV is to avoid the virus in the first place, and the best way to do that is with the HPV vaccine. We expect vaccinations to decrease the amount of cancers we see in the future. The Centers for Disease Control and Prevention (CDC) has the following recommendations for the HPV vaccine:
- Females and males 11 to 12 (can start at nine)
- Females 13 through 26 and males 13 through 21 who were not adequately vaccinated previously
- Males 22 through 26 who have certain immunocompromising conditions or who have sex with men
- Transgender people who were not adequately vaccinated previously
After age 26 for women and 21 for men, patients can avoid HPV infection but not completely prevent it with a vaccine. I give patients the same advice to avoid HPV as any sexually transmitted disease: use condoms and dental dams. Even someone in a monogamous relationship has the risk of being exposed from their partner’s past partners, and even open-mouth kissing potentially can spread HPV.
When a patient develops an HPV-related cancer, we use a team approach to treat them. Many specialties work together to provide whole-patient care and achieve the most effective outcome. We bring ear, nose and throat doctors, head and neck cancer surgeons and chemotherapy and radiation doctors together in a meeting called a tumor board to discuss each patient’s condition and management options. This benefits the patient with a well-rounded approach and ensures that every angle is considered before we recommend a treatment decision.
If surgery is needed, we often can use minimally invasive robotic techniques to reduce scarring and recovery time. After treatment, we connect patients with specialists to maximize their recovery, such as speech pathologists and palliative care specialists for pain management.
The medical community is making great progress in the fight against head and neck cancers caused by HPV. We have effective treatments for patients who have these cancers, and I’m confident that these diseases will become less common as more young people get vaccinated against HPV.