Head and neck cancers with roots in HPV are appearing in patients that do not demonstrate the high-risk behaviors usually associated with such cancers.
The emergence of a new type of head and neck cancer has exploded in the last 15 years, more often affecting younger men without the traditional oral cancer risk factors of smoking and alcohol. That threat, according to Richard Jordan, D.D.S., Ph.D, professor of Oral pathology, Pathology and Radiation Oncology, University of California San Francisco, is human papillomavirus, or HPV.
“[The cancer] usually is found on the tongue and oropharynx, and this is clearly linked to human papillomavirus HPV type 16, which is the same high-risk HPV that causes cervical cancer,” says Dr. Jordan, who presented “HPV: An old foe in a new form” at the March 2017 American Academy of Dermatology (AAD) annual meeting in Orlando, Fla.
The HPV virus is ubiquitous, and many are exposed, he says. A Centers for Disease Control and Prevention (CDC) data brief released in April 2017, referring to data from 2011 to 2014, shows the prevalence of HPV of all types was 7.3% among U.S. adults ages 18 to 69. Four percent of that population carries the high-risk HPV.1
And while most people who are exposed to the virus clear it, the virus can remain persistent. It’s those who are unable to clear it that end up having a risk of developing the oral form of this cancer, Dr. Jordan says.
“Most of the people that have this virus persisting in their bodies probably picked it up 20 years ago, when they first become sexually active. The virus makes a home in their throats or tongues, sits there for 20 years and eventually develops into cancer in their 40s or 50s,” he says. “This is actually the same story as with the cervix in women. Lots of women get exposed to the human papillomavirus when they first become sexually active. Most women get rid of the virus, but some are unable to clear the virus. They’re the ones that end up getting in trouble with cervical precancers.”
The number of people impacted by the oral cancer due to HPV is growing, while the impact on cervical cancer among women who get pap smears remains mostly flat, according to Dr. Jordan.
“By 2030 there will be more patients per 100,000 with mouth cancer, due to HPV, compared to cervical cancer,” he says.
Check the mouth
Dermatologists are the ideal medical specialty, along with dental specialists, to detect the beginnings of this cancer, Dr. Jordan says.
“They’re just looking for abnormalities. This HPV disease mostly occurs in the tongue and in the tonsil region, so all dermatologists have to do is look at the tongue, the sides of the tongue and the base of the tongue and the tonsillar region,” he says. “They’re looking for an ulcer or an abnormal growth. If they see that, they can either biopsy it themselves or can certainly send the patient to a head and neck surgeon or an oral surgeon to get a biopsy,” he says.
“In a 30-second exam, you can really do wonders for the patient,” Dr. Jordan says.
Dermatologists also can encourage patients to get their children vaccinated.
“It’s something that could turn this all around. I have three daughters. Two of the three daughters are teenagers have been vaccinated and the third one will be vaccinated. We will not know for many decades if this will prevent cancer from happening, because of that latency between the time when you pick up the virus to when you get the disease,” Dr. Jordan says. “But I’m willing to bet that it’s going to work very well, and everybody should get vaccinated. Not just girls; boys too.”
Research shows encouraging results
In April 2017, the Microbiology Society announced that researchers presenting at the Society’s annual conference in Edinburgh, Scotland, found levels of cancer-causing HPV in Scotland have dropped 90% in young women, following a vaccination campaign started in 2008.
Researchers accessed anonymous results from women born in 1995 attending cervical screening with their vaccination records and assessed levels of HPV and the genotypes present. They compared those results to those of unvaccinated women born between 1989 and 1990. Armed with samples from more than 20,000 women, a clinically validated assay showed that about 0.5% of women from the 1995 group tested positive for HPV 16/18, compared with 21.4% of women born before 1990. The study also suggests the vaccine protects against three other high-risk HPV genotypes involved in the development of cervical cancer: 31, 33 and 45, according to a press release by the Microbiology Society, a membership organization for microbiology scientists worldwide
Early detection means a better outlook
HPV oral cancers in adults who don’t smoke are exquisitely sensitive to radiation, Dr. Jordan says. In fact, most are curable.
Usually, those with oral cancers, such as smokers, tend to have fairly aggressive disease and a poor five-year survival rate, according to Dr. Jordan.
“After five years, about 60% will be dead; about 40% will be alive,” he says. “HPV responds very well to currently available cancer therapies. If the patient doesn’t smoke, the five-year survival rate is extraordinarily high-at 80 or 90%.”
But there’s more work to be done, according to Dr. Jordan. One of the objectives is to conduct studies on giving oral and oropharyngeal cancer patients less toxic radiation doses, without sacrificing cure rates. Â
Disclosure: Dr. Jordan reports no relevant financial disclosures.
McQuillan G, Kruszon-Moran D, Markowitz LE, Unger E, Paulose-Ram R. Prevalence of HPV in Adults Aged 18-69: United States, 2011-2014. NCHS Data Brief. April 2017; 280. Available from: https://www.cdc.gov/nchs/data/databriefs/db280.pdf.