The Changing Face of Head and Neck Cancer

Oral, head and neck cancer refers to cancer that develops in the mouth, throat, voice box, sinuses, nasal cavity or salivary glands. In 2020, it is estimated that 650,000 people will be affected by head and neck cancer (HNC) worldwide. Globally, there are roughly 330,000 deaths due to HNC each year.

Smoking and drinking have traditionally been considered the strongest risk factors for HNC, with the disease primarily affecting older individuals. However, there has been a striking change in the demographics of HNC in the past few decades. Since the late 1980s, cases of HNC in older adults with excessive smoking/drinking habits have been declining. But during the same period, diagnoses among young adults in their 30s and 40s without traditional risk factors have been increasing at a staggering rate.

We now know that the rising incidence of HNC in young adults is due to the human papillomavirus (HPV), a potentially cancer-causing sexually transmitted infection (STI). Most people know HPV as the cause of cervical cancer in women. While it’s true that about 90% of cervical cancers are due to HPV, that is not the only cancer caused by the virus. HPV is also the cause of most cases of vaginal and vulvar cancer in women, penile cancer in men, and anal and throat cancers in men and women. Due to HPV vaccination and routine preventive screening, cases of cervical cancer have been declining. And, in 2018, HPV-attributed throat cancer surpassed cervical cancer as the most common HPV-related cancer in the U.S. Currently, close to 70% of throat cancers in the U.S. are caused by HPV infections. In Europe and Asia, HNC cases attributable to HPV are estimated to be 31% and 17.5%, respectively.

Research around HPV-attributed throat cancer is ongoing, but there are some things we do know about this newer patient population:

  • HPV-attributed throat cancer affects men 3 times more often than women.
  • The odds of developing HPV-attributed HNC are double in individuals who reported 1-5 lifetime oral sex partners.
  • The risk increased five-fold in those patients with six or more oral sex partners, compared with those who have not had oral sex.
  • Data suggest that HPV-attributed throat cancer is easily treated. It responds well to almost all forms of therapy, including surgery, radiation, and chemotherapy.
  • Patients with HPV-attributed throat cancer have a disease-free survival rate of 85-90% over five years. In contrast, the traditional patient population of excessive smokers and drinkers with advanced disease has a five-year survival rate of approximately 25-40%.

HPV is an incredibly common STI, but there are some things you can do to reduce your risk:

  • Consistent and correct use of condoms can reduce, but not prevent, the transmission of HPV between sexual partners. Because there are areas not covered by a condom, infection may still occur.
  • Vaccination is expected to reduce the number of HPV-attributed throat cancer cases over time. To this end, it is recommended that girls and women between 9 and 26, and boys and men between 9 and 21 years of age should be vaccinated for HPV.
  • Studies have indicated there may be some benefit of vaccinating adults over the age of 26 against HPV. As such, the FDA recently approved Gardasil for use in men and women up to age 45.

Ask your healthcare provider about the benefits of vaccination and what you can do to decrease your risk of contracting HPV.