Guest post by Dr. Neil Gildener-Leapman from the New York Eye and Ear Infirmary of Mount Sinai.
When the epidemic started to be recognized by doctors, I can remember diagnosing my first patient with human papilloma virus (HPV)-related throat cancer. The patient was a very easy-going, jovial family man, and an active athlete in a community sports league. He came to the visit with his wife and adult daughter, wanting to have his family’s support as we gave him the details of his diagnosis he laughed and said: “Ahh, that makes sense! You know…back in my day… I used to be a very popular guy!” His wife and daughter giggled and shook their heads in unison.
In my experience, a few moments of giggles during the explanation are fairly typical, but this quickly fades as patients and families focus on the task of choosing the right treatment. Other patients may experience confusion and even anxiety related to questions over how the acquired a sexually transmitted infection. As a head and neck surgeon with a particular focus in HPV-related cancers of the throat, I often get many questions from patients after their diagnosis. We also commonly get questions about HPV from patients who do not have cancer.
Rise in HPV-related Oral and Throat Cancer Cases
There is a rising epidemic of HPV-related throat cancer, especially among young and middle aged men. Many people became aware of this cancer when Michael Douglas shared his story of his struggle and ultimate triumph over the disease. In the United States, more than 9,000 cases of HPV-related throat cancers are diagnosed in men and more than 2,000 cases in women per year (CDC). Historically, almost all cancers of the throat were related to smoking and drinking. Today HPV causes approximately 75 percent of throat cancer (at the area of the tonsils).
HPV is a sexually transmitted infection that can infect the throat, genitals, and anus. Doctors were surprised to discover the linkage between HPV and throat cancer approximately a decade ago. The link between HPV and cervical cancer in women had been suspected since the 1980s. This is why scientists dedicated to women’s health developed preventative vaccines against HPV (Cervarix and Gardasil). Recent data suggests that these vaccines can prevent nearly 100 percent of cervical pre-cancers in women (CDC). We might assume that these vaccines should have similar effectiveness in preventing throat cancer, although no studies are available to confirm this.
Hey, but enough background! Let’s move onto some practical concerns. If you are sitting at home and reading this you might have some of the same questions that my patients have asked me:
Frequently Asked Questions about Oral and Throat Cancer
My partner’s gynecologist told her that she has evidence of HPV on her gynecologic exam. What do you think are my chances of catching HPV related tonsil cancer?
Estimates are that 80% of young adults will have had a genital HPV infection. Around 10% of men have an oral HPV infection. The vast majority of these infections are cleared within a year or so by the immune system. For unclear reasons doctors suspect that some people may have persistent HPV infections.
But to answer your question: spouses of women with cervical cancer are estimated to have approximately 2-3 times the chance of developing HPV related throat cancer over the general population. So if you want me to ballpark you a number, we are looking at maximum something like 2 out of 10,000 chance.
Is there a good screening test for HPV related throat cancer; like a Pap-smear?
No, unfortunately at this point there are no approved tests for screening for throat cancer. Doctors have not been successful in detecting a “pre-cancer” lesion for HPV related throat cancer.
Doctor how did I get cancer in my throat?
Currently, the majority of throat cancers (of the tonsils) are caused by HPV-16. HPV throat infections can be transmitted through most commonly through oral sex. Oral-Anal contact has also been noted to be a high-risk behavior. It’s not clear whether French kissing is a significant cause of HPV spread. Persistent HPV virus in throat can very rarely cause a normal cell to transform into a cancerous one. When this happens, the genetic material of the virus becomes permanently incorporated into the cell, allowing it to grow out of control. Scientists estimate that this infection may happen up to a decade before the cancer shows up.
I have never smoked or used alcohol, and now I have this HPV related throat cancer, what are my chances of beating it?
Your chances of long-term cure are excellent, especially if you are a non-smoker and non-drinker. Estimates are that with appropriate treatment survival is as good as 80-90%.
Doctor, now that I have HPV related throat cancer; can I spread it to my partner?
Look back up to the first question. The answer is sort of Yes and No. Interestingly, once the HPV virus is incorporated into the cancer cell, it is not infectious. That may have happened years ago. Now…not so fast, there is always a possibility that you may have contracted another new HPV oral infection recently. Remember; up to 10% of healthy men have HPV in their mouth. These infections are very common, so there is no need to change your sexual practices with your partner. Additionally, they have likely already been exposed.
For new partners, barrier protection is effective against a variety of sexually transmitted infections.
Doctor, can’t I just get the Gardasil shot to fix this?
For vaccines like Gardasil to prevent HPV infection, they are most beneficial before a young person becomes sexually active. This is due to some details of how the immune system recognizes the surface of the virus. For multiple reasons Gardasil cannot get rid of an already established cancer. For patients who already have throat cancer, the DNA of the virus has become part of the tumor.
I have been doing some reading, and I hear my survival chances are great. Now I am worried about being over-treated. What are my options?
Across the country for the last few years doctors have been talking about ways to “de-escalate” therapy. In other words, make treatment easier for patients. We are especially hoping to decrease long-term side effects and improve long term swallowing function. In the Mount Sinai Health System we are leading the way, and have multiple clinical trials to offer patients with HPV-related throat cancer including immune therapies, robotic surgery, and reduced radiation dosing.
Mount Sinai will be hosting its annual Oral, Head and Neck Cancer free screening event on April 16th from 10 a.m. to 2 p.m. at:
The Mount Sinai Hospital
Guggenheim Pavilion Atrium
1468 Madison Avenue (at 100th St.)
212-241-9410 (for questions – no registration required)
Dr. Neil Gildener-Leapman is a Head and Neck Surgeon at New York Eye and Ear Infirmary of Mount Sinai. For appointments and information, call 646-943-7935.