By Nadir Ahmad, MD, FACS
Head of the Division of Otolaryngology-Head and Neck Surgery
Director of the Head and Neck Cancer Program, MD Anderson Cancer Center at Cooper
The incidence rate of throat cancer has spiked nearly 225 percent over the past 20 to 30 years, particularly in younger, otherwise healthy men without the traditional risk factors of cigarette and alcohol use. The cause, experts agree, is the human papillomavirus (HPV).
At this rate, by 2020 the number of new cases of throat cancer, also called oropharyngeal cancer, are projected to surpass those of cervical cancer, which are expected to decline as a result of better screening and prevention. HPV is the most common sexually transmitted disease in the United States today, infecting nearly one in four people at some point in their lives. There are over 100 different sub-types of the HPV virus. Most are not harmful and will typically resolve on their own within two years without causing any health concerns. In fact, most people who are infected with the virus aren’t even aware they have it or that they can spread it unknowingly to others.
The small percentage of people with immune systems unable to clear the virus are at a higher risk for developing health problems, such as cancer, later in life. HPV sub-types 16 and 18, the two strains most commonly associated with cervical cancer, are now recognized to cause up to 70 percent of oropharyngeal-related cancers. These cancers affect the throat, tonsils, and back portion of the tongue and can take 10 or more years to develop after becoming infected. HPV 16 is responsible for the majority of these cases.
Although cases of oropharyngeal cancer are still less common than prostate, skin, or breast cancers, physicians are alarmed by the increasing number of cases among men in their 40s and 50s, some even younger, who have no history of smoking or drinking but are HPV-positive. At this time, for reasons not yet known, men seem to be most susceptible to this type of cancer. In fact, the ratio is about five to one, males versus females.
Typically, these patients first notice a large, painless mass in the front or side of their neck. Other common signs and symptoms include a long-lasting sore throat, a feeling of something stuck in the throat (called a globus sensation), difficulty swallowing, hoarseness, ear pain (usually one-sided), and weight loss.
Once other causes of these signs and symptoms are eliminated by a physician, a biopsy of the lymph node(s) and primary tumor site is performed to confirm the presence of cancer. If cancer is identified, the treatment could involve surgery or radiation therapy, with or without chemotherapy.
The good news is that most patients, even those with advanced disease, usually respond very well to treatment, with higher cure rates than their HPV-negative counterparts. In earlier stage HPV-positive oropharyngeal cancers, there can be an 80 to 90 percent cure rate.
According to the American Cancer Society, men with HPV-related throat cancer are likely to have a better outcome, live longer, and have less recurrence than those caused by other risk factors, such as smoking.
The increased prevalence of this disease drives home the need for prevention. The risk of contracting HPV, for example, can be significantly lowered by engaging in safer sex practices. Condoms and dental dams, when used consistently and correctly, may decrease the chances of giving or getting an HPV infection and an HPV-related cancer because they can stop the transmission from person to person.
The medical community believes the greatest promise lies in the HPV vaccine. Although initially intended as a preventative vaccine against cervical, anal, and genital cancers, the vaccine can also protect men and women from oropharyngeal cancers. Currently, there are two HPV vaccines on the market approved by the Food and Drug Administration and recommended by the American Academy of Pediatrics: Gardasil® and Cervarix®.
By increasing vaccination rates, HPV could eventually be eliminated as a health threat to future generations. The vaccine typically offers the greatest health benefits to individuals who receive all the doses before having any type of sexual activity. That is why it is recommended for preteen girls and boys at age 11 or 12, although they may get vaccinated as early as nine and as late as 26. Traditionally, the vaccine is given as a series of three shots; however, the Centers for Disease Control recently reported that young people who start it before the age of 15 only require two doses.