HPV is the most prevalent sexually transmitted virus. In fact, there are 14 million new infections in the United States each year. The HPV vaccine, which prevents cervical cancer and other malignancies, is now FDA-approved for men and women from 27 to 45-years-old.
Oral cancers have typically been found to be associated with smoking and excess alcohol intake and were diagnosed in patients around the age of 60. These HPV-linked oral, or oropharyngeal, cancers tend to affect the back of the throat, tonsils, and back of the tongue, and are occurring in much younger people.
“In the past, cancer of the tonsils and tongue were almost entirely attributable to smoking," says Dr. Elizabeth Franzmann, an otolaryngology expert who has a special focus in HPV-related oropharyngeal cancers at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System. "Now, 70 percent of them are caused by HPV.” The tissue in the tonsils and tongue are more susceptible to the HPV virus which causes the cells to divide uncontrollably, she adds.
What has changed?
In 1999, the most common site of HPV-associated cancer in the United States was in the cervix. By 2015, the mouth and throat became the most common location of HPV-related cancers and far more oropharyngeal cancer cases were being diagnosed in men than in women, according to the Centers for Disease Control.
The drop in cervical cancer began in the 1950s, and is credited to cancer screening. The increase in oropharyngeal cancers is due to changing sexual behaviors, since unprotected oral sex is a risk factor for HPV infection.
To stem the increase, the HPV vaccine guidelines have been expanded to people up to age 45. The vaccine, Gardasil 9, had been previously approved for minors and people up to age 26.
The FDA is running a clinical trial for a rapid test for oral and oropharyngeal cancer that involves rinsing the mouth, gargling and spitting the solution into a cup. A clinician reads a sample after it is applied to a strip. In the future, if the test proves to be a good diagnostic tool, specialists will likely use it to decide if a biopsy of a suspicious throat lesion is appropriate.
It's not always just 'a sore throat.'
“The reason these cancers are often diagnosed late is because they can masquerade as a more benign condition, like a sore throat. Patients don’t realize it’s serious or they’ll go to the doctor and be told it’s a throat infection and maybe they’ll get antibiotics,” said Dr. Franzmann.
Antibiotics may make you feel better but symptoms never go away completely. Ultimately, a doctor will send you to have a biopsy, she said.
What can you do?
Pay attention to your body, and any symptoms, and have them checked out by your physician, says Dr. Franzmann. Some warning signs are:
- A sore throat that seems to be only on one side and doesn’t go away within three weeks
- Localized pain in the back of the mouth or throat that may radiate up to the ear
- Bad breath
- Lump in the neck
- Any other mouth sores
Prevention is always the best approach.
- If you are 45 years old or younger and haven't already, get the vaccine. Studies predicted that HPV vaccination could prevent 90 percent of US cancer cases caused by the virus.
- Practice safe sex.
- If you smoke, stop.
- If you drink alcohol heavily, cut back.
- Take good care of your teeth
- Follow a healthy diet high in fruits and vegetables. Take care of other health problems, like stress and depression, which affect your immune system.
Mary Jo Blackwood, RN, MPH, is a contributing writer for UMiami Health News. Based in St. Louis, MO, and Colorado, she has written medical articles and webpages for consumer publications and major university health centers.