Head and Neck Cancer Awareness Month: Why We Should Be Concerned about HPV
The term "head and neck cancer" refers to a variety of tumors that occur in the throat, larynx (voice box), nose, sinuses, and mouth. Head and neck cancers account for approximately 3 percent of all cancers in the United States and are nearly twice as common among men as they are among women. Alcohol and tobacco use (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) are historically the two most important causes of head and neck cancers. However, over the past decade we have been learning about the significance of HPV as a cause of head and neck cancer. Human Papilloma Virus (HPV) infection is a well-known cause of cervical cancer in women, and it is the most common sexually transmitted infection in the world according to the National Cancer Institute. The same types of HPV that infect the genital areas can infect the mouth and throat. HPV infections often resolve before they cause any health problems.
However, HPV infection can cause cervical, vaginal, and vulvar cancers in women; penile cancer in men; anal cancer, cancer of the back of the throat (oropharynx), genital warts, and throat warts in both men and women.
About 27000 new HPV associated cancers are diagnosed each year. More than 12000 of those cases occur in the oropharyngeal region – usually in the tonsil or the base of the tongue. The incidence of HPV associated head and neck cancer has been rapidly rising since the 1990’s, while tobacco related cancers are declining. This incidence of oral HPV cancer will soon surpass the number of HPV related cervical cancer cases diagnosed per year in the United States.
Historically, head and neck cancers occurred in heavy smokers and drinkers and most frequently in the 5th through the 7th decade of life. HPV associated oropharyngeal cancers present in younger individuals, more often in white males, and often in non-smokers. HPV positive cancer often presents at a higher stage with metastatic lymph nodes in the neck, but treatment results in better disease-free survival and longer overall survival.
The most widely used treatment regimen for the management of oropharyngeal cancers has been the combination of chemotherapy and radiation. Newer technology has allowed for the surgical resection of such tumors with decreased complications and good outcomes. There are new trials in progress aiming to identify the optimal treatment modality with least amount of toxicity for HPV associated cancers without compromising the outcomes. Based on the national cancer institute guidelines, recommendations for management of HPV associated and non-HPV cancers are similar.
At this time, the only preventive method available is vaccination prior to becoming sexually active. The new HPV vaccines -- recommended for both boys and girls age 9 to 12 -- have been shown to protect against cervical, vaginal, and vulvar cancers. No such data exists that this vaccination is effective for oropharyngeal cancers, but research is underway. Animal tests suggest that an HPV vaccine would be preventative, and all approved vaccines are active against HPV stains 16 and 18, the subtypes of the virus that cause more than 95% of head and neck cancers.
Community adoption of the HPV vaccine in the United States remains lower than expected. One national survey suggests that only 40% of the girls and 22% of the boys received all three recommended doses of vaccine.
HPV vaccine is important because it protects against cancers caused by human papillomavirus infection. HPV is a very common virus; nearly 80 million people—about one in four—are currently infected in the United States. About 14 million people, including teens, become infected with HPV each year.
This is a true public health epidemic that is preventable and can be stopped through education and vaccination.
Dr. Arash Mohebati is a board certified general surgeon who completed additional fellowship training in head and neck oncologic surgery at Memorial Sloan Kettering Cancer Center. He practices with West Coast Surgical Associates -- offices in Walnut Creek, San Ramon, and Concord. Dr. Mohebati is scheduling free visual oral cavity screenings on April 15 from 1-5pm in recognition of Head and Neck Cancer Awareness Month – April. Call 925- 933-0984 to schedule your free screening appointment.