By Henry N. Ho, M.D., F.A.C.S., Medical Director of the Head and Neck Program at the Florida Hospital Cancer Institute
Oral head and neck cancers are on the rise in younger adults who do not smoke, due to an increase in the number of cases caused by human papilloma virus (HPV), a sexually transmitted disease.
Research now indicates that HPV-16 has a strong association to a subtype of head and neck squamous cell carcinoma (HNSCC).
HPV positive HNSCC is not necessarily linked to the traditional causes of HNSCC (tobacco and alcohol use); and cases are continuing to rise among the young adult population because it is most commonly transmitted through oral sex.
Up to this point, education about HPV and preventative vaccination, have largely focused on women because it has been known as an important cause of cervical cancer. Now, HPV education should be directed more universally.
What is HPV?
HPV positive HNSCC Prevalence
In a recent presentation by Maura Gillison, et. al. from Ohio State University titled “Prevalence of Oral HPV Infection in the United States, 2009-2010” given at the American Society for Radiation Oncology Multidisciplinary Head and Neck Cancer Symposium in January 2012, the Gillison Group presented results from a study completed to evaluate the epidemiology of oral HPV infection in the U.S.
Saliva samples and questionnaires were analyzed from 5,579 study participants aged 14 through 69. It identified the incidence of HPV postive HNSCC increased by 225 percent from 1988 to 2004, or from 0.8 to 2.6 cases per 100,000 population. The Gillison group found that 10.1 percent of males and 3.6 percent of females had oral HPV infection. The rate of infection for HPV 16, the subtype associated with head and neck cancer, was 1 percent, which translates to 2.13 million people in the U.S.
The study showed that HPV infection is sexually transmitted, as sexually active people have an eightfold higher risk of infection as compared to the sexually inexperienced. Men were more at risk as they had 3 times the risk of HPV infection than women and 5 times the risk of having HPV 16 infection.
It is important to note that, although the majority of cases of oral and oropharyngeal cancer are traditionally attributed to tobacco and alcohol use, a study of oral cancer cases, ages 45 years and younger, report that 25 percent did not have a history of tobacco or alcohol use (e.g. Llewellyn et al., 2003).
According to the National Cancer Institute, “more than half of HPV related cancers diagnosed by 2020 will be located in the oropharynx, rather than cervix, in the U.S.” The most common head and neck sites associated with HPV infection is the oropharynx which includes the palatine tonsils, lingual tonsils, base of tongue, and the lateral wall of the oropharynx. Critical functions of speech, voice, and swallowing may be affected by the cancer or its treatment.
Understanding HPV and Preventative Measures
Oropharyngeal cancer deaths is approaching nearly 12,000 lives per year. If diagnosed early, many of these cancers can be more easily treated without significant consequences, and the chances of survival are enhanced as well.
The Center for Disease Control now recommends vaccination against HPV infection for both boys aged 9-21 and girls aged age 9 to 26. It is anticipated that the risk of developing HPV-16 infection and subsequently, oropharyngeal squamous cell carcinoma will be diminished in this way.
If you have any questions about HPV, HNSCC or any other head and neck concerns,
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About the Author
Dr. Henry N. Ho serves as President of The Ear, Nose, Throat and Plastic Surgery Associates as well as the Medical Director of the Head and Neck Program at the Florida Hospital Cancer Institute. His practice focuses on all phases of otolaryngology as well as head and neck tumors, sleep apnea, robotic and endoscopic sinus surgeries.