An alarming new study finds that 1 in 9 American men or 11 million adult males are infected with the oral human papillomavirus (HPV) and drives home the need for young people to be vaccinated, doctors say.
HPV is the leading cause of oropharyngeal cancer, or cancer that develops at the base of the tongue, tonsils, soft palate and throat. The National Cancer Institute reports that about 70 percent of oropharyngeal cancer is caused by HPV, specifically the HPV 16 strain.
Nearly 50,000 people will get oral oropharyngeal cancer in 2017, and 9,700 people will die from this type of cancer this year, according to the American Cancer Society. And these cancers are more than twice as common in men as in women.
“These HPV cancers are preventable with vaccination,” said Dr. Moira Sutton, a radiation oncologist at Novant Health UVA Health System Cancer Center at Lake Manassas in Gainesville, Virginia. “A lot of people think of the HPV vaccine as a girls’ vaccine. Many people know that it used to prevent cervical cancer but people don’t realize that it can also prevent people from getting oropharyngeal cancers.”
To prevent an HPV infection, the National Cancer Institute recommends an HPV vaccine before a person becomes sexually active. Two vaccines, Gardasil and Cervarix, are approved for use by the U.S. Food and Drug Administration in the prevention of the virus. While these vaccines do protect against new infections, they do not treat existing HPV infections or the disease brought on by the infection.
Researchers at the National Cancer Institute found in a recent study that the HPV vaccine protects women from oral infections as well as cervical infections.
“It’s important for these young boys and girls to be vaccinated at around 11 to 12 as per the CDC recommendation and for parents not to think of it just as a girls’ vaccine,” Sutton said.
While more teens are getting vaccinated for the HPV virus, many remain at risk, particularly boys. In 2016, 49.5 percent of girls were up-to-date on their HPV vaccine compared to 37.5 percent among boys, according to the CDC.
The CDC recommends the vaccines for boys and girls ages 11 and 12, and for boys and young men ages 13 through 21 as well as girls and young women ages 13 to 26 who have not already had two shots. Vaccinations may also be given to children as young as age 9 and to men between the ages of 22 and 26.
Although oropharyngeal cancer is less common than cancer of the prostate, skin or breast, it’s on the rise among cases Sutton sees at her office. In fact, by 2020 the number of new cases of oropharyngeal cancer caused by HPV is expected to outpace new cases of cervical cancer, according to a study reported by the National Institutes of Health.
Sutton said that in the past most of the cases of oropharyngeal cancer were caused by smoking or drinking, but now the diagnosis is increasingly among nonsmokers infected with HPV. The HPV infection is most likely for people who have had multiple oral sexual partners, are gay or bisexual or who have also had a genital HPV infection.
“The connection between oral cancer and HPV is something that we’re only starting to appreciate in recent years,” she said. “In the late 90s and early 2000s, the typical patient with oropharyngeal cancer was a heavy smoker or drinker and it’s only in the past 10 years that we’ve seen this sudden rise in nonsmoking men with oropharyngeal cancer and those found to be HPV-positive,” Sutton added.
Men seem to be most susceptible to this type of cancer. “The rate of infection with HPV in the oral cavity is much more common in males,” Sutton said. “The ratio is about 5 to 1 males versus females. The typical patient with oropharyngeal cancer that we see now is a male in their 40s or 50s.
In the United States, HPV infections are the most common sexually transmitted infections. The Centers for Disease Control and Prevention estimates that more than 90 percent and 80 percent of sexually active men and women, respectively, will become infected at some point during their lives. The agency points out about half of these infections involve the high-risk type of virus.
In most cases involving high-risk HPV, the infections will clear within a year or two and won’t cause cancer. However, persistent infections can lead to cell mutations and may progress to cancer, according to the National Cancer Institute.
HPV – in reality, not a single disease, but a group of more than 150 viruses – is transmitted through intimate skin-to-skin contact, the CDC says. It can take 10 years or more for cancer to develop. Symptoms of oropharyngeal cancer can include persistent sore throat, earaches, hoarseness, enlarged lymph nodes, pain when swallowing and unexplained weight loss, though the CDC cautions some people may exhibit no symptoms.
Sutton said oropharyngeal cancer can be very hard to detect. “Dentists generally will do a cancer screening, but these are cancers that tend to be in the back of the tongue, the tonsillar area that are not easily seen in a routine dental exam,” she said. “So generally, patients aren’t found to have it until they have symptoms such as pain or difficulty swallowing.”
In many cases, by the time the cancer is diagnosed, patients may already have stage 4 cancer with lymph node involvement, according to Sutton. And while radiation and chemotherapy can be effective in treating cancer, Sutton warned that it is one of the toughest cancer treatment regimens with consequences affecting quality of life.
The good news is, prevention of many HPV-associated cancers is possible with early vaccination, Sutton said.