Human papillomavirus (HPV) is becoming a leading cause of head & neck cancers in the US. Vaccination remains the best way of protecting yourself on top of safer sex and reduced alcohol/tobacco use.
You may have heard a lot about cervical cancer and human papillomavirus (HPV) in the news, but did you know HPV can cause other cancers? Besides vaginal/vulvar, anal, and penile cancer, one of the most common HPV-related cancers are those of the head & neck. As of 2022, head & neck cancers have now exceeded cervical cancer as the most common HPV-related carcinoma (i.e. cancer of the cells lining your organs and skin).
Thankfully, many HPV-related cancers are preventable through vaccination, safer sex practices, and reduced alcohol and tobacco use.
Head and Neck Cancer Regions (Credit: adopted from the National Cancer Institute)
While alcohol and tobacco use were previously the main drivers of head & neck cancers, in recent years they have gradually been taken over by HPV in higher-income countries like the US. High-risk variants of HPV are associated with over 70% of cancers in the back of the throat, tonsils, and/or base of tongue, an area collectively known as the oropharynx. Less common sites of HPV-positive head & neck cancer include the mouth, nose, sinuses, and voice-box (larynx).
HPV-related head & neck cancers have risen among white men under 45 and are also expected to increase among older white men and women 65+ within the next few decades. This rise may be due to changes in sexual behavior (e.g., increased oral sex) and the aging boom, with fewer older adults being vaccinated for HPV in the past. Alcohol and tobacco use can also contribute to the development of HPV-related head & neck cancers, but scientists are still teasing out the exact relationship between all of these components.
How does HPV spread and cause head & neck cancer?
HPV remains one of the most common sexually transmitted infections (STIs) in the US [archived link] and is primarily spread through skin-to-skin contact during sexual intercourse (vaginal, anal, and oral). People infected with HPV are generally asymptomatic but can develop genital or oral sores/warts up to 6 months after exposure.
Having oral HPV doesn’t always mean you will get head & neck cancer. Most people can clear the virus within two years without treatment. However, HPV can remain “silent” for decades, and although we don’t completely understand how, the virus can turn normal cells into cancerous ones when it makes copies of itself (i.e., replication). The HPV vaccine can keep this cancer transformation process from happening by preventing HPV infection in the first place.
🤓Nerd Alert!
In biopsy reports for HPV-positive head & neck cancer, you may see comments about whether the sample was also p16-positive or negative. P16 is a tumor suppressor protein, or a “brake” that can keep cells from uncontrollably dividing and becoming cancerous. P16-positivity is often linked to HPV-positive oropharyngeal cancer, but being p16-positive doesn’t always mean you have HPV. Some people test p16-positive without having HPV, and some people have HPV without testing p16-positive. Generally, people with p16-positivity tend to respond better to HPV-related cancer treatment and are less likely to have their cancer return.
How can I tell if I have HPV-positive head & neck cancer?
Unfortunately, there are no standard screening protocols for head & neck cancer. Currently, the only FDA-approved screening test for HPV-related cancers is pap smears for cervical cancer. If you see your dentist regularly, they may perform a quick oral cancer screen to look for any unusual sores or lumps in your mouth. However, your dentist will not be able to see far enough into your throat to check for any abnormalities.
Many people often discover they have head & neck cancer once they develop symptoms such as:
➡️ A firm and/or enlarging lump in the mouth, neck, or throat
➡️ Difficult and/or painful swallowing
➡️ Changes or hoarseness of voice
➡️ A nonhealing, sometimes painful, sore in the throat or mouth
➡️ Pain/ringing in the ears, or trouble hearing
Anyone who develops any of the above symptoms will usually be referred to an ear, nose, & throat (ENT) doctor. The ENT specialist may then perform a flexible laryngoscopy (i.e., insert a thin flexible scope through the nose to see the back of the throat) and/or biopsy to determine whether the person has (HPV-positive) head & neck cancer.
Is there any way I can decrease my chance of getting this?
Simple ways to reduce the risk of HPV infection include using a condom or dental dam during (oral) sex. While these barrier devices don’t provide complete protection, they do lower the risk of HPV transmission. Similarly, decreasing and/or eliminating alcohol and tobacco use can significantly reduce the risk of developing (HPV-positive) head & neck cancer.
The good news is that many HPV-positive head & neck cancers are vaccine-preventable and tend to have better outcomes than HPV-negative head & neck cancers. The HPV vaccine is estimated to prevent up to 90% of HPV-related cancers [archived link] , and was FDA-approved in 2020 for the prevention of HPV-positive head & neck cancers in people 9-45 years old. Although the vaccine only protects against HPV strains you haven’t encountered, it’s still a safe and effective way to prevent new HPV infections.
While the CDC recommends starting the 2-dose regimen at 11-12 years, people can still receive the vaccine up until they turn 45 [archived link]. Talk with your clinician if you are unvaccinated and are 27-45 years old, especially if you anticipate having a new sex partner, oral sex, or are immunocompromised.
Stay healthy, stay smart.
Those Nerdy Girls
Additional Resources:
TNG – January is Cervical Cancer Awareness Month
Immunize.org – Ask the Experts: HPV (Human Papillomavirus) [archived link]
Children’s Hospital of Philadelphia – Q&A about HPV and the Vaccine
