Lately, a lot of attention has been given to the human papillomavirus (HPV) and the importance of vaccinations to prevent it. The HPV vaccine, Gardasil, currently is recommended for all boys and girls between ages 11 to 14 before sexual exposure to prevent genital warts and cervical cancer. However, there are many types of HPV, and it’s more common than you think.
More than 20 million Americans are infected with this disease, which is sexually transmitted and affects the anus, genitals and oropharynx (tonsils and back of throat). Now, research is being done to see if we also can protect against HPV-related head and neck cancers.
The incidence of head and neck squamous cell carcinoma (HNSCC) has been gradually increasing over the last three decades. In fact, nearly 65,000 patients are diagnosed with head and neck cancer each year in the United States alone. In some people, oral HPV infection leads to HPV-OSCC (HPV-positive oropharyngeal squamous cell cancer) after many years.
According to CDC and the American Cancer Society, HPV types 16 and 18 are responsible for most HPV-caused cancers. The dominance of HPV 16 in HPV+ HNSCC is even greater than that seen in cervical carcinoma. Strong evidence suggests that HPV+ status is associated with a favorable outcome in head and neck cancers.
Both types of cancers are currently treated in the same way whether or not they are caused by or related to HPV. Treatment decisions are made based upon the following:
• Size of the tumor
• Location of the tumor
• Stage of the disease
• Overall health of the patient
• Patient wishes of the patient
Researchers are studying to determine whether cancer treatments should be changed based on the presence or absence of HPV. Approximately 30–40 percent of HNSCC patients present with early stage I/II disease. These patients are treated with medicinal intent using single modality treatments such as radiation or surgery alone. HPV-driven tumors are more sensitive to radiation and to Cisplatin or chemo-based therapy.
Gardasil and Gardasil 9 are approved for the prevention of diseases caused by the four shared HPV types (6, 11, 16 and 18). With the availability of these vaccines, physicians are hopeful that the incidence of HPV-related throat cancers will decrease over time.
One study showed that Ceravix, the only vaccine tested, reduced oral HPV infections by more than 90 percent in a group of more than 5,000 women. The vaccine is effective only if given before HPV infections occur. As a result, there is no proven benefit from the vaccine for people with HPV-related cancer or for their partners.
An open dialogue between patients and providers about HPV, testing and vaccines can mean a better prognosis. Clinical trials are an option and participation is determined once the HPV test is administered.
As a sexually transmitted disease, the concern for contracting or passing the virus is a concern. HPV is not spread through touching or kissing. HPV is contagious through genital and oral contact, so if you have been diagnosed with HPV, your sexual partners also have been exposed. Since most people get rid of the infection on their own (not all viruses become cancerous), the chance of your partner getting an HPV-related cancer is low. Still, there are precautions you should take, and as always, discuss your concerns with your doctor.
If your partner is female, she should follow normal women’s health guidelines, which include having a routine Pap test. If your partner is male, he does not need any special exams or tests, because there is no routine or standard HPV screening offered for men. Additionally, there is no effective screening test for head and neck cancer.
Special precautions are necessary, even though your partner’s chance of getting cancer as a result of HPV infection is extremely low. Your partner should discuss any specific symptoms or concerns with his or her doctor.
• About 7 percent of Americans have oral HPV, which is three times more common in men than women.
• Only 1 percent of those with oral HPV have HPV type 16, which is found in oropharyngeal cancers.
• About 8,400 Americans are diagnosed with oropharyngeal cancer every year.
• Just as oral HPV is three times more common in men than women, oropharyngeal cancer is three times more common in men than women.