Perhaps one of the most difficult cancers to endure in terms of treatment is cancer of the head and neck (H&N), specifically oropharyngeal cancer (areas of the tonsils, base of tongue, pharynx). The combined chemo-radiation indicated is enough to take down even the strongest, most positive person.
Lately, most of the H&N patients Iíve seen have all had the same distinctive characteristics -- white men, 40 to 50 age range, and their disease is positive for the human papillomavirus (HPV).
HPV-related H&N cancer is on the rise, specifically in developed countries and in younger males. Why is this? Well, Iím sure you are all familiar by now with the well-publicized link to HPV types 16 and 18, which cause 70 to 80 percent of all cervical, anal, and vaginal cancers. Not surprisingly, HPV 16 is responsible for the majority of HPV-positive oropharyngeal cancer.Ļ In other words, the majority of the H&N cancers are most likely directly related to oral sex.
Do your patients, or more importantly, everyday people you know, understand this? Dr. Chaturvedi, with the National Cancer Institute, hypothesizes that the rise in HPV-positive disease may be linked to changing sexual behavior in recent decades. With more premarital sex, increase in the number of sexual partners, and oral sex being performed in these settings, HPV is spreading more readily.≤
As oncology professionals, and perhaps as spouses or parents, how does this information affect us? If HPV transmission is indeed via the oral-genital route, more education may be necessary.
First, the obvious light bulb moment for most should be that vaccinating young men and women against the most common types of HPV is not just about preventing genital warts -- you are potentially protecting a female from a gynecological cancer and a male from oropharyngeal cancer.
While women too can have HPV-positive H&N cancer for the exact same reason, itís just statistically much more common in males. Thus, as a healthcare professional, you must understand the weight of this vaccination and just how much more important it is in cancer prevention than what is being broadcast to the masses.
Secondly, news just out from a study presented at ASCO 2013 shows no increase in oral HPV infections in spouses or long-term partners of patients with HPV-positive oropharyngeal cancers.
"The Human Oral Papillomavirus Transmission in Partners over Time" (HOTSPOT) study examined 166 individuals with HPV-positive disease and 94 partners, specifically analyzing oral HPV DNA. In the end, the prevalence of oral HPV in partners was similar to the general population. This is important to understand because when youíre facing a patient who has just learned they have HPV-positive H&N cancer, they will invariably ask, ďIs my partner at risk?Ē At least these results point to the likelihood that ďno,Ē the partner is not.
Not so surprising was the fact that five patients in this study had partners or past partners with cervical cancer or precancerous changes, thus pointing to a direct link. Dr. DíSouza stressed that the results were preliminary and more research of couples is necessary to better understand HPV transmission:
We donít know how HPV is transmitted. Oral sex most likely transmits it to the mouth, but there is no evidence that saliva transmits it to the genitals.
One thing is for sure -- HPV, like smoking, is linked to cancer in ways that are becoming increasingly clear. It is imperative that you remain educated on the subject as information continues to emerge and our approach to prevention, diagnosis, and treatment evolves.
What has been your experience in treating cancer patients affected by HPV? Are you helping to educate their partners as well?
DíSouza, G., Gross, N.D., Pai, S.I., Haddad, R. I., Gillison, M. L., Posner, M. R. (2013). Oral HPV infection in HPV-positive oropharyngeal cancer cases and their spouses. Journal of Clinical Oncology.
Chaturvedi, A. (2011). HPV and incidence trends for head and neck cancer.