Head and neck cancer causes almost 200,000 deaths each year and is now recognized as one of the major health concerns both in the United States and worldwide. In particular, there has been a noted increase in the incidence of oropharynx cancer (OPC), mainly tonsil and base of tongue cancers, that are linked to infection with the human papilloma virus (HPV).
According to the National Cancer Institute, HPV infections are the most common sexually transmitted infections in the US and more than half of sexually active people are infected with one or more HPV types at some point in their lives. Most HPV infections occur without any symptoms and go away without any treatment over the course of a few years. However, HPV infections sometimes persist for many years and can increase a person’s risk of developing cancer.
The human papilloma virus 16 (HPV16) infection linked to oropharynx cancers is a sexually transmitted virus that seems to affect mostly young Caucasian males. Traditionally the non-HPV related head and neck cancers are strongly linked to smoking, but patients with HPV related cancers are usually not tobacco users. HPV-related head and neck cancers are a distinct disease entity which has particular molecular, epidemiological, and clinical characteristics. Multiple studies have shown that HPV-related oropharynx cancers are easier to cure compared to the head and neck cancers caused by tobacco and alcohol use, but smoking still seems to affect the chances of curing patients with HPV related OPC. There is also recent evidence suggesting that smoking is linked to a higher risk of having HPV-related OPC.
Still, sexual transmission of HPV is believed to be the main risk factor for HPV-related head and neck cancers and oral sexual behavior has been linked to an increased risk of HPV-related oropharyngeal squamous cell carcinoma. For example, studies have shown the odds of developing oral HPV infection among a group of college-aged men increased with increases in the number of recent oral sex partners or open-mouthed kissing partners, but not vaginal sex partners.
The Food and Drug Administration (FDA) has approved two vaccines that are highly effective in preventing infection with HPV types 16 and 18. Because research clearly shows that vaccination makes a difference in preventing cervical cancer, which is very closely linked to HPV-16, the HPV vaccine has been recommended for girls aged 11 to 12. There is also a more recent recommendation from the Advisory Committee on Immunization Practices (ACIP) for boys of the same age to receive the HPV vaccine. Even though vaccination for HPV-related oropharynx cancers has been an active area of research, the implementation of such an approach is still limited.
For the majority of cancers of the head and neck that do not originate from the area of the oropharynx (non-OPC), HPV does not seem to be a significant risk. However, of interest, HPV is still apparently linked to some patients who have non-OPC. The significance of this link is not clearly known and more studies are needed to understand the role of HPV in patients with non-OPC.
About Dr. Saba
Nabil Saba, MD, FACP, is a nationally recognized expert in the treatment of head and neck and esophageal cancer. As principal investigator on several head and neck cancer trials, he has initiated studies focusing on novel approaches for treating these diseases. Dr. Saba is a member of the ECOG Head and Neck Cancer steering committee, and an elected member of the American Head and Neck Society (AHNS). He also serves on the American College of Radiology appropriateness criteria panel for Head and Neck Cancer.