For years, human papillomavirus (HPV) has been clearly linked to cervical cancer. The HPV vaccine could help decrease cervical cancer cases dramatically if administered to adolescents and young adults prior to infection. And because HPV also causes some cases of head and neck cancer, there’s even more reason to be proactive about prevention, experts say.
HPV is linked to some cases of cancer in the oropharynx, the part of the throat at the back of the mouth that includes tonsils and the back portion of the tongue. It has not been connected to other types of head and neck cancer. Yet because oropharyngeal cancer is often asymptomatic in its early stages, most cases are diagnosed only after the cancer has metastasized to lymph nodes in the neck, causing a palpable lump.
Dr. Bruce Haughey, director of the Head and Neck Cancer Center with Washington University Physicians, says that it’s routine to screen for HPV in conjunction with oropharyngeal cancer diagnosis. “The main reason is that the clinical behavior is very different for the HPV-related tumors versus the non-HPV-related tumors,” he says. “That then gives us some information to take to the patient in terms of the outlook of their disease and how we’re going to treat it.”
Patients whose tumors are HPV-positive have a better prognosis than those whose cancer is primarily related to smoking or alcohol use. “As of yet, there’s no prospective, randomized trial investigating outcomes comparing HPV-positive versus HPV-negative patients,” notes Dr. Mark Varvares, director of Saint Louis University Cancer Center and a SLUCare otolaryngologist. “But what we know from retrospective data analysis is that the patients who are HPV-positive in the oropharynx have a much better prognosis than those patients who are HPV-negative. What we also know is that the HPV-negative patients many times don’t respond as well to therapy, regardless of what we use.”
Survivorship for head and neck cancer in general is about 70 percent, adds Dr. Amit Bhatt, a St. Luke’s Hospital radiation oncologist. He cites a 2010 study published in the New England Journal of Medicine that looked at three-year oropharyngeal cancer survival without the cancer progressing during that time. “They found that patients who were HPV-positive did better than those patients who were HPV-negative: HPV-positive patients were 74 percent versus 43 percent,” he says.
Treatment may include surgery, chemotherapy, radiation therapy or a combination. “We know that the HPV-positive patients need to have the same aggressive treatment we’ve been giving them for decades,” Vavares says. “If you have an advanced HPV-negative tonsil cancer, you’re going to get high-dose radiation therapy and chemotherapy. What we’re now attempting to answer in clinical trials is whether we can treat the patients with HPV-positive disease with a lower dose.”
Again, prevention is key, notes Bhatt. “The reality is that HPV is preventable. There’s a vaccine available, and we should avail ourselves of that. The Centers for Disease Control and Prevention just reported that there’s only 35 percent of eligible people actually being vaccinated; and with that kind of track record, we’re not really going to make a dent.”
Human papillomavirus (HPV) is responsible for a variety of serious health concerns, ranging from genital warts to cervical and oropharyngeal cancer. However, it is possible to prevent the spread of this sexually transmitted disease, and experts say therein lies the key to better health.
“We need more people to get the vaccine,” says Dr. Amit Bhatt, a St. Luke’s Hospital radiation oncologist, who treats HPV-positive cancers with high-dose radiation therapy. “Because of the way it’s transmitted, if not everyone is vaccinated, we’re not going to get anywhere. In addition, the vaccine really works before exposure so young women and men need to be vaccinated before they start sexual intercourse.”
The U.S. Centers for Disease Control and Prevention (CDC) recommend the vaccine in three doses over six months for all boys and girls (11 to 12 years of age). Catch-up vaccines are recommended for males through age 21 and for females through age 26 if they were not vaccinated when they were younger.
The CDC also advises that people who are sexually active should use condoms, which offer some degree of protection against HPV transmission, and be in a mutually monogamous relationship.
Although the vaccine is known to protect against the strains of HPV associated with oropharyngeal cancer, it’s going to take years to figure out the true impact, notes Dr. Mark Varvares, director of Saint Louis University Cancer Center and a SLUCare otolaryngologist. “You have to vaccinate people before they become sexually active and then wait decades to see if they develop the cancer. But there’s no doubt, it’s the same strains, and the vaccine provides excellent protection against cervical cancer.”
Vavares is hopeful that as the HPV vaccine become more widely used, there will be far fewer cases of HPV-positive oropharyngeal cancer. “We have the opportunity to prevent this cancer in 80 percent of patients who have oropharyngeal cancer,” he says. “That’s staggering.”