The Human Papillomavirus (HPV) Connection
Cancers at the back of the throat, including the tonsils and base of the tongue (oropharyngeal cancers), are becoming more common. This increase is happening in people of all ages, even those who don’t smoke or drink. Many of these cancers are linked to human papillomavirus (HPV). More than half of all sexually active people will get HPV at some point in their lives, making it a very common infection. In fact, HPV related head and neck cancers are now more common in the US than HPV related cervical cancers. This is likely due to an increase in oral sex practices.
What is Human Papillomavirus?
HPV is a group of over 150 related viruses spread through skin-to-skin contact, including sexual contact, and shared surfaces. However, it’s important to know that most people with HPV do NOT develop cancer. There are two main types of HPV: high-risk and low-risk.
- High-risk HPV: About 40 types of HPV are considered high-risk. These types can cause cancer in the throat, mouth, cervix, anus, and genitals. HPV 16 is the most common high-risk type, but others like 18, 31, and 33 can also lead to cancer.
- Low-risk HPV: These types don’t typically cause cancer. They can cause genital warts or warts on the hands, or no symptoms at all.
How HPV Can Lead to Cancer
Anyone who is sexually active can be at risk for HPV, even with no or few traditional risk factors. High-risk HPV can change the way cells grow. Over time, these changes can lead to cancer. It’s important to remember that most people with HPV do not develop cancer. Research has shown that:
- Even having just 1 to 5 oral sex partners doubles your risk of HPV related cancer.
- Having 6 or more oral sex partners makes your risk of HPV positive HNC 5 times higher.
Your Best Defense
The HPV vaccine (Gardasil 9®) is a safe and highly effective way to protect yourself and your loved ones from HPV related cancers. It works by teaching your body to fight off the high-risk types of HPV that cause most cancers. The HPV vaccine is most effective when given before a person becomes sexually active. Condoms and dental dams, when used correctly, can significantly reduce, but not eliminate your chances of spreading the virus. They offer some protection, but vaccination is the most effective way to prevent HPV infection. Even if vaccinated, condoms are still important for protection against other STIs and HPV strains not covered by the vaccine.
Why Get Vaccinated?
- Cancer Prevention: The HPV vaccine offers protection against the HPV types responsible for over 90% of oropharyngeal, anal, vaginal, vulvar, cervical, and penile cancers and genital warts.
- Safe and Effective: Over 270 million doses have been given since it was first introduced in 2006, and the vaccine has an excellent safety record.
- Long Term Protection: The vaccine offers lasting protection against HPV, and studies confirm it does not weaken over time.
- Protect Your Loved Ones: Getting vaccinated not only protects you but also helps prevent the spread of HPV to others.
Who Should Get Vaccinated?
- Recommended for: All adolescents (both boys and girls) aged 11 or 12 years old.
- Catch-up vaccination: Recommended for everyone up to age 26 who are not already vaccinated.
- Adults 27-45: Are still eligible for the vaccine. Getting vaccinated may still be beneficial, as it can protect against strains you haven’t yet been exposed to. Talk to your doctor about whether the vaccine is right for you.
What is the Outlook for People with HPV Positive Oropharyngeal Cancer?
Finding cancer early is important for better treatment. Knowing if the cancer is linked to HPV helps doctors understand how it might behave and choose the best treatment. People with HPV positive oropharyngeal cancer usually have a good chance of surviving five years (about 85-90%*). Most people with this type of cancer respond well to treatment.
This is very different from people with throat cancer not linked to HPV. These cancers, often caused by smoking and drinking, have a much lower five-year survival rate (about 25-44%*).
Because treatment works so well for HPV positive cancers, studies are exploring ways to adjust treatment for HPV positive cancers to preserve patient function and quality of life, without reducing the chance of survival. On the other hand, for HPV negative cancers, researchers are looking at stronger treatments and more personalized approaches to improve results.
*Important Note: These survival rates are based on past data and might not reflect new treatment advances.
How do we test for HPV status?
There’s no simple screening test for HPV in throat cancer like there is for cervical cancer. Instead, doctors take a small sample of the tumor and test it for a protein called p16 to see if the cancer is related to HPV. Unlike some other cancers, throat cancer caused by HPV doesn’t have clear precancerous signs, and we lack good tests to find it early, making detection challenging.
Researchers are actively exploring new ways to detect HPV related throat cancer earlier. One promising area is the development of “liquid biopsies.” These tests analyze biological fluids, such as blood or saliva, to look for traces of HPV DNA or other cancer markers. For example, a blood test called NavDx® is a blood test that helps find HPV related throat cancer by detecting specific changes in HPV DNA caused by tumor cells. The goal is to create less invasive and more convenient screening methods that can identify cancer at its earliest stages, potentially improving treatment outcomes. While still in development, these emerging tests hold great potential for the future of HPV related cancer detection.
Addtional faqs
Can I get HPV attributed cancer from kissing?
Open-mouthed kissing and oral sex can both contribute to the transmission of oral HPV virus, but they do so in somewhat different ways and with different levels of risk. Deep or open-mouth kissing is much less likely to spread HPV than oral sex. The risk mostly depends on how much virus is present. HPV can be present in saliva and oral tissues, but the viral load in the mouth is generally less than genital secretions. HPV infection in the genital areas is also much more common, tends to last longer and carries a higher viral load than the mouth, allowing for more of a “chance” of getting infected from oral sex.
How does the HPV vaccine work?
The HPV vaccine can’t treat or clear an existing HPV infection, so if you’ve already been exposed to the virus, it won’t eliminate that strain from your body or contribute to preventing disease caused by it. It’s most effective before exposure (hence the recommendation for adolescents). However, it may still offer some protection against other HPV types you haven’t been exposed to — since the vaccine covers several high-risk strains. So, while the benefit is smaller after exposure, it’s not zero.
The age limit to be vaccinated is 45, yet it's people in their 60s commonly getting this type of cancer. Why is that?
The HPV vaccine is approved up to age 45. Most people are exposed to HPV virus in their teens or 20s, and while the virus can stay dormant and reactivate later (generally in your 60’s or later), the individual and public health benefits drop after age 45 since most people have already been exposed. In adults who may already have HPV, vaccination can still help protect against other strains, but the overall cancer-prevention benefit is reduced. That’s why vaccination beyond that age isn’t routinely recommended, though some may still choose it “off-label” after discussing risks, costs, and possible benefits with their doctor.
