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HPV: The Surprising Risk Factor of Head and Neck Cancer

Over the last few decades, public awareness has increased surrounding the associations between tobacco use, alcohol consumption, and cancer. Today, most people know that years of using tobacco products and/or consuming alcohol can lead to the development of mouth or throat cancer in old age. 

As a result, we have seen a decline in usage of these products, and a decline in newly diagnosed cases of cancers of the mouth and throat. However, while the rate of cancers of the larynx and oral cavity has been going down, the rate of cancer in the oropharynx (tonsil and base of tongue) has actually been on the rise.

This puzzling trend led to the discovery of a viral cause of head and neck cancer: human papilloma virus (HPV).  HPV is now recognized as the most common cause of oropharyngeal cancer.

Let’s dive into some common questions about HPV-related head and neck cancer.

What is Human Papilloma Virus (HPV)?

HPV is a virus and is the most common sexually transmitted infection. It is associated with oropharyngeal cancers, as well as cervical, penile, anal, and vulvar cancers.  While there are many different strains of HPV, the strain associated with oropharyngeal cancer is HPV-16.  Approximately 1 percent of adults have detectable HPV-16 in their saliva.

What are the risk factors for HPV-associated head and neck cancer?

A history of multiple sexual partners, particularly oral sex partners, has been associated with an increased risk of developing an HPV-related head and neck cancer. In addition, head and neck cancer is more common in men than women.

How is HPV status determined in head and neck cancer?

When a head and neck tumor is biopsied, special stains are used to detect HPV and determine if the virus is present in the tumor. This is done prior to starting treatment. HPV status informs treatment planning because these HPV-positive tumors “behave” differently than HPV-negative tumors.

What is the difference between HPV-positive and HPV-negative head and neck cancer?

People who develop head and neck cancer from HPV tend to be younger and healthier at the time of diagnosis than people with HPV-negative tumors.  HPV-positive tumors tend to have a better prognosis. This means that these tumors respond more favorably to treatment than HPV- negative tumors, which improves the likelihood of long-term survival.

What are the symptoms of HPV-positive head and neck cancer?

Because of where they arise in your throat (oropharynx), HPV-positive tumors often have no symptoms initially. However, over time, signs and symptoms can include a neck mass, sore throat, visible lesion, difficulty swallowing, and a feeling like there is a lump in your throat.  

Can HPV be prevented?

There are 2 FDA-approved vaccines available to prevent HPV infection. The vaccine must be given prior to exposure to HPV, typically in early adolescence, prior to the start of sexual activity.

What should people know about HPV-related head and neck cancer?

A healthy lifestyle that doesn’t include smoking or drinking is important but doesn’t completely absolve you from the risk of developing head and neck cancer. If you develop a neck mass or the above symptoms for more than 4 weeks, you should seek prompt evaluation with an Ear, Nose, and Throat (ENT) physician.

Also, it is important for everyone with risk factors (e.g. sexual activity, tobacco use, alcohol use) to take advantage of opportunities for head and neck cancer screening. This can be done at any time by your dentist, oral surgeon, or general physician.   Screening takes 5 minutes and it is 5 minutes that could save your life!

The second week of April is designated as Oral, Head and Neck Cancer Awareness week. Organizations throughout the world offer free head and neck cancer screenings during this week. At Fox Chase Cancer Center, in collaboration with the Temple Head and Neck Institute, we are also offering free head and neck cancer screenings this week.  

Learn more about how to sign up for a free head and neck cancer screening at Fox Chase during Oral, Head and Neck Cancer Awareness Week.