With the world’s attention focused on the development of a COVID-19 vaccine, we believe the time is also right to bring the public’s attention to the U.S. Food and Drug Administration (FDA) approval of expanding the human papillomavirus (HPV) vaccine’s use to include women and men aged 27 through 45 years. The first HPV vaccine was approved in 2006, to be given to children 9 to 12 years old. On this World Head and Neck Cancer Day (July 27), we applaud the FDA ‘s recent expanded approval, which will have far-reaching lifesaving impact for anyone who may be at high risk for developing oropharyngeal cancer— a type of cancer that affects the back of the tongue and the tonsils.
Despite widespread recognition of the effectiveness of the HPV vaccine within the medical community, we still need to overcome the embarrassment and stigma associated with head and neck cancers caused by HPV – the most common sexually transmitted disease. We must do this not just for the sake of those who suffer today, but for the next generation.
“HPV” includes a family of over 200 viruses. It is transmitted through direct contact. Most of us are exposed to these viruses once we become sexually active. Usually, we clear the virus through our immune system without even realizing its presence. In a minority of us, the virus evades our detection system and stays inside our cells for years. It may then cause warts, benign tumors or on rare occasions, cancer.
HPV-associated cancers of the head and neck have tripled in the past several decades, while other types of head and neck cancers have declined. Cancer of the oropharynx used to affect older men – longtime heavy smokers or drinkers. Many of today’s patients with HPV-associated throat cancer are men in their 40s and 50s. According to the National Cancer Institute, HPV is now responsible for 70% or more of oropharyngeal cancers. The incidence of head and neck cancers associated with HPV will outnumber that of cervical cancer this year.
There are no early warning signs that are specific to HPV-associated throat cancer. Symptoms can mimic a typical upper respiratory infection that is not getting better. Sometimes patients can have earache, hoarse voice and/or burning pain with swallowing. Other times there may be a painless lump in the neck or ulcer on a tonsil. When any of these symptoms persist for more than three weeks, it’s time to seek help.
If a physician discovers a lump or ulceration in your throat, he or she should refer you to a specialist: an otolaryngologist (ENT) or head and neck surgeon. If you do not have these symptoms, but you or someone you have been intimate with has a history of sexually transmitted diseases, ask your physician to examine your throat and neck area carefully. Dentists can also detect suspicious-looking lumps or ulcers in the mouth. Treatments for these cancers have significantly improved in recent years, and may include minimally invasive robotic or laser surgery done through the mouth, targeted radiation therapy that spares healthy tissue, and chemotherapy.
The best treatment for HPV associated head and neck cancer is prevention. We have effective HPV vaccines that prevent infection with cancer-causing HPV types. In general, the vaccine must be given before a person has become sexually intimate. We are many years into this growing silent epidemic, and the stigma shows no signs of abating. If you get HPV-associated cancer, or suspect you may have it, you are not alone. Do not be afraid to speak with your physician and your significant other. More importantly, get your children vaccinated.
Tom Thomas, MD, MPH is medical director, Head and Neck Reconstructive Surgery and Transoral Robotic Surgery, Leonard B. Kahn Head and Neck Cancer Institute at Atlantic Health System’s Morristown Medical Center and Carol G. Simon Cancer Center. He is one of the leaders of the Atlantic HPV Center.