Video Q&A about HPV-related Tongue and Tonsil Cancer
5 Things to Know About HPV-Related Throat Cancer
The Changing Face of Throat Cancer
In the past, the primary risk factors for developing oropharyngeal cancer were tobacco and alcohol abuse. The cancer typically occurred between ages 60 and 80, and it was difficult to treat, with mortality rates being between 50 and 60 percent.
Today, in contrast, HPV-associated oropharyngeal cancer occurs at a younger age — usually between 40 and 70 — and the people who develop it often have no or minimal history of tobacco or alcohol abuse. Instead, HPV is now the primary cause of oropharyngeal cancer in the United States and worldwide. The good news is that people with HPV-related oropharyngeal cancer who undergo treatment have a disease-free survival rate of 85 to 90 percent over five years.
The following are five key facts about HPV-related head and neck cancers:
1. HPV Infection Is Common
HPV has been estimated to infect more than 90 percent of the U.S. population. About 12,000 Americans ages 15 to 24 are infected with HPV daily, and on any given day, approximately 26 million Americans have an oral HPV infection.
There are more than 100 strains of HPV. Many of the strains cause noncancerous genital warts or nongenital skin warts, but certain high-risk strains, most notably HPV-16 and HPV-18, are associated with throat cancer.
Research suggests that HPV infection is transmitted through oral sex and open mouth kissing (“French kissing”). The greater your number of sexual partners, the more likely you are to contract an HPV infection. In addition, having sex with a partner who's had multiple sex partners increases your risk of infection.
2. Chronic HPV Infection Is Linked to Throat Cancer
While HPV infection is common, in 90 percent of cases, it clears up on its own. But in the other 10 percent of cases, the infection becomes chronic — and it's chronic infection that raises the risk of developing throat cancer.
Symptoms of oral and throat cancers (from any cause) include a swelling or lump in the mouth, a painless lump on the outside of the neck, an enlarged tonsil, and a sensation of having a foreign object in the throat when swallowing.
3. Sexual Practices Have Led to More HPV Infections
Since 1920, Americans as a group have become sexually active at younger ages and have engaged in oral sexual practices more frequently. Together, these trends have resulted in higher HPV infection rates and an associated rise in cervical and, more recently, oropharyngeal cancer rates.
In the United States, new cases of cervical cancer have declined over the past 30 years because of increased use of the Pap test. Routine Pap tests can prevent many cases of cervical cancer by finding treatable, precancerous changes in the cervix. The Pap test can also find early-stage cervical cancer, which is more curable than invasive cervical cancer.
Worldwide, however, cervical cancer remains a common cause of cancer deaths among women.
4. HPV-Related Throat Cancer Is More Common in Men
HPV-associated throat cancer occurs much more frequently in men than in women: The male-to-female ratio is 9 to 1. No one knows why men develop these cancers more frequently, but one possibility is that men are exposed to larger amounts of the virus during oral sex with women.
Another possibility is that men and women experience similar infection rates, but men mount a less robust immune response and are therefore unable to protect themselves from infection.
5. The HPV Vaccine Could Help Lower the Cancer Rate
Since 2006, the Federal Drug Administration (FDA) has approved three vaccines for HPV, all of which protect against HPV-16 and HPV-18. The newest vaccine, Gardasil 9, also protects against seven other strains of the virus.
The CDC recommends vaccination of all girls and boys at age 11 or 12. The vaccine is given in three doses, and all three should be given by age 13, although those who miss doses can get them later. Women can get the vaccine up to age 26, and men up to age 21.
While the vaccine is effective at preventing HPV infection — and therefore HPV-related cancers — a decade after the first vaccine was introduced, only 2 in 5 girls, and 1 in 5 boys, are vaccinated. This rate falls short of the health policy target of 80 percent.
For women over 26 and men over 21, using condoms or dental dams, in addition to limiting the number of sex partners, can help to lower the risk of HPV transmission.
Eric M. Genden, MD,is the Isidore Friesner professor and chairman of the department of ear, nose, and throat (otolaryngology)-head and neck surgery, and professor of neurosurgery and immunobiology, at the Mount Sinai Health System in New York City. He is internationally recognized as a leader in the management of oral cancer and microvascular reconstruction of the head and neck.
Video: Your Health: HPV Related Throat Cancer
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