The human papillomavirus, or HPV, is the most common sexually transmitted infection in the United States. While most strains of types of HPV are not harmful to people, there are strong reasons to take precautions.
According to the Centers of Disease Control and Prevention, the same types of HPV that infect the genital areas can also infect the mouth and throat; this is called “oral HPV” and some types can cause cancers of the head and neck area.
What is head and neck cancer?
Oropharyngeal (head and neck) cancer makes up a small number of cancers. The National Cancer Institute at the National Institutes of Health says that cancers of the head and neck account for 3 percent of cancer in the United States. Head and neck cancer include cancers that start in the tissues and organs of the head and neck, including the larynx (voice box), throat, lips, mouth, nose, and/or salivary glands, the National Cancer Institute says.
“On the average, about 63,000 people per year are diagnosed with head and neck cancer, and about 13,000 die from it every year,” said Robert Thomas, MD, an Ear, Nose and Throat specialist with Trinity Health.
In 2016, it was estimated that 61,760 people – 45,330 men and 16,430 women – would develop head and neck cancer. It was also estimated there would be 13,190 people – 9,800 men and 3,390 women – who would die from head and neck cancer.
Who can get head and neck cancer?
There are two very different subsets of patients that get head and neck cancer, Thomas said.
The “classic kind” of head and neck cancer is HPV-negative, which means that risk factors such as smoking tobacco, drinking alcohol and having poor dental hygiene caused it, Thomas said, noting that this form tends to occur with older patients. Cigarettes and alcohol cause damage to the lining of the throat, lining of the mouth and voice box. “There are mechanisms that tell the cells when they need to stop – to die – and if those parts of the cells get damaged from these toxins in tobacco and alcohol, they don’t receive that signal, and it turns into a cell that doesn’t die. It continues to grow and divide; that’s what cancer is,” Thomas said.
The “new kind” of head and neck cancer is something “we are seeing more frequently,” he said. HPV-associated head and neck cancer is caused by risk factors such as the number of sexual partners a person has and use of marijuana.
The number of head and neck cancers related to HPV has increased over the years, Thomas noted.“In 1985, only 16 percent of head and neck cancers were associated with HPV. The remainder were tobacco related,” he said. “In 2005, the number of HPV related head and neck cancers had risen to 72 percent.”
Furthermore, studies show that by 2025, it is estimated that 90 percent of head and neck cancers will be HPV-positive.
HPV tends to cause tonsil and base of tongue cancer, Thomas said. (According to The Centers for Disease Control and Prevention, HPV is also associated with: cervical, vaginal, and vulvar cancer in females; penile cancer in males; and anal and throat cancer in male and females.)
HPV infections tend to happen when a person is in their teenage years and into college-age, Thomas said. “We see HPV-associated head and neck cancer in young patients,” Thomas said. “The peak is 35 to 55 years old, whereas with non-HPV, it’s older than that – in the sixties, or so.”
The risk of getting HPV-related cancer goes up with the number of sexual partners a person has, Thomas said, noting the risk is lower when there are less than five. “If you’ve had more than 20 sexual partners, your risk is around 30 percent of having a type of HPV that causes cancer.”
More men than women – a ratio of 3 to 1 – tend to get HPV-related head and neck cancer, Thomas said. “We think it’s because women are getting vaccinations more than men, and women get HPV infections in their cervix and get immunity, whereas men don’t.”
There are two main kinds of HPV – types 16 and 18 – that cause cancer; type 16 is the main cause of head and neck cancer.
Prevention and Treatment
Signs to look for include a mass in the tonsil or neck, pain in the tonsil, bleeding from the tonsil, trouble swallowing, or pain swallowing, Thomas said.If you present any of these signs, Thomas recommends that you see your primary care doctor.
“The symptoms are non-specific, and there are other things that can cause these symptoms. The doctor may send the patient to see an Ear, Nose, and Throat specialist if there is concern,” he said. “We’re always happy to see people who have any concerns. In our clinic, we can use our scope to determine if there is anything concerning that would warn a biopsy or further treatment.”
Prevention for the HPV viruses that cause head and neck cancer are available in the form of vaccines:
• Gardasil – protects against four kinds of HPV, types 6, 11, 16, and 18;
• Gardasil 9 – protects against the four kinds of HPV in Gardasil plus an additional five kinds that have been linked to cancer.
Thomas strongly suggests parents get HPV vaccinations for their children, regardless of gender. “It is a true cancer vaccine and will protect them in the future from getting this kind of cancer,” he said. “Early detection and quick treatment for this type of cancer is the best way to insure that it is cured.”
Vaccines, which can be given by your primary care doctor, are typically recommended for children and teenagers, as they haven’t been exposed to the virus yet, Thomas said. There is still ongoing research to determine if HPV vaccines have a role in older patients who may have already been exposed to the virus.
If you have questions or concerns regarding head or neck cancer, please contact Mark Noel, DO; Robert Thomas, MD; or Robert Fischer, MD, Ear, Nose, and Throat Specialists with Trinity Health, at 857-5986. Their office is located at Health Center – West, Suite 203, 101-3rd Avenue SW, Minot.