HPV and cancer concerns
By Dr. Robert Strominger
After an extended summer break thanks to COVID-19, many parents are looking toward the fall and the start of a new school year. With that comes back-to-school physicals and updates on immunizations.
If your child is a tween, you should make sure he or she receives the human papillomavirus (HPV) vaccine. HPV is a sexually transmitted disease that can lead to a variety of cancers, such as cervical, penal, anal, vaginal and throat.
As an otolaryngologist-head and neck surgeon, I frequently work with patients diagnosed with throat cancer. Since the 1960s the incidence of HPV-positive oropharyngeal squamous cell carcinoma (HPV+ OPSCCA), a type of throat cancer, has increased exponentially and in one study increased more than 225 percent from 1998 to 2004. It is now the leading cause of HPV-associated cancers in humans, having surpassed cervical cancer. Also, men are at increased risk of developing HPV+ OPSSCA compared to women.
Historically, head and neck cancer, including oropharyngeal cancer, was primarily associated with smoking and drinking alcohol. With the decrease in smoking rates, the incidence of smoking-related cancer has decreased and now HPV-associated head and neck cancers account for about 75 percent of all head and neck cancers and about 90 percent of oropharyngeal cancers.
Unfortunately, patients with HPV+ cancers tend to be younger and healthier, with a median age of 54, often without a history of smoking and drinking. Risk factors include a genetic predisposition, early onset of sexual activity and multiple sexual partners, and a previous history of anogenital warts. But in many cases, these risk factors do not apply.
The primary cancer in the oropharynx (a part of the throat) tends to remain asymptomatic until very large, and there is no screening test equivalent to the PAP smear for cervical cancer. Therefore, patients often present with a neck mass after the cancer has metastasized into the neck. With very large primary cancers not amenable to low morbidity surgical therapy, treatment with both chemotherapy and radiation therapy is often required. Luckily, despite the aggressiveness of HPV+OPSCCA, it tends to respond well to therapy and has a much better prognosis than HPV-negative cancer.
HPV is now the most common sexually transmitted infection worldwide. The CDC estimates that up to 75 percent of the U.S. reproductive-age population has been exposed to HPV. Transmission is via sexual contact, including orogenital contact leading to oropharyngeal HPV infection. Most HPV infection is asymptomatic and clears spontaneously within a couple of years. However, if tested for HPV, an oropharyngeal infection can be found in about seven percent of people.
There is no way to predict whether HPV will lead to cancer, and if so, wherein the oropharynx will occur. So preventive treatment after exposure is not possible. Of 100 strains of HPV, about 35 are thought to have the potential to lead to cancer. The most common, and in the case of oropharyngeal cancer, HPV 16 is the primary culprit.
Because there is no prevention after infection and treatment can be so devastating, it is imperative that both boys and girls be vaccinated against HPV infection. The American Academy of Pediatrics (AAP) recommends that children get two doses of the HPV vaccine at ages 11 to 12, or three doses during the teen years if they missed getting it earlier. Following the guidelines, the younger the vaccination is given the more likely it is to prevent infection and future cancer. It is estimated that this will prevent thousands of cases of HPV+ OPSSCA.
For more information on vaccinating your child or children against HPV, talk to your pediatrician or another healthcare provider.
Robert Strominger, MD, is a board-certified otolaryngologist-head and neck surgeon at UT Health East Texas ENT Center on Three Lakes Parkway in Tyler. For more information, visit UTHealthEastTexas.com or call 903-596-DOCS.
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