A rise in the incidence of certain head and neck cancers among middle-aged Americans and their link to the human papilloma virus (HPV) is leading some medical experts to begin recommending the HPV vaccine for both men and women.
“The last decade has seen a 5 to 6 percent increase per year in the incidence of cancers of the tonsils and base of the tongue,” says William Lydiatt, MD, a head and neck cancer specialist at The Nebraska Medical Center, “and it is primarily due to the human papilloma virus (HPV). Sixty to 70 percent of all tonsil cancers in the U.S. are HPV-related.”
Recent studies also indicate there may be a link between these cancers and having multiple sex partners and oral sex, says Dr. Lydiatt. A 2007 study in the New England Journal of Medicine found that younger people with head and neck cancers who tested positive for oral HPV infection were more likely to have had multiple vaginal and oral sex partners in their lifetime. However, half of these individuals had fewer than five sex partners, he says.
Approximately 80 percent of sexually active women and 75 percent of men harbor the HPV virus. In men, it is usually asymptomatic.
These HPV-related cancers are two times more common in men than women. While still fairly rare among the population as a whole compared to other cancers, the rising incidence is beginning to reach epidemic proportions, says Dr. Lydiatt. Currently, approximately 12,000 Americans will be diagnosed with cancers of the tonsil or base of the tongue each year with 8,000 being men and 4,000 women, he says. “It’s now comparable to the same rate as cervical cancer,” says Dr. Lydiatt.
With numbers on the rise, Dr. Lydiatt recommends that both young men and women receive the HPV vaccine called Gardasil, which has been approved by the Food and Drug Administration (FDA) to prevent cervical and anal cancers.
The good news is that even at stage IV, these individuals have a very high cure rate, says Dr. Lydiatt. The typical patient is a white, non-smoking male in his 50s who presents with a sore in the throat, which will not heal or a painless neck mass just below the jaw line. The patient may complain of difficulty eating, swallowing and talking. Other symptoms include ear pain, change in voice, sore throat, bleeding gums, bad breath and an altered sense of taste. An early symptom that may be detected during a clinical exam is an asymmetry of the tonsil, notes Dr. Lydiatt.
Tonsil cancer can spread very quickly and metastasize to other parts near the throat. A neck mass should be evaluated if it does not go away in one week. Based on clinical suspicion, a CAT scan should be considered followed by a biopsy of the tonsil, tongue or neck mass, says Dr. Lydiatt.
If a positive diagnosis is found, patients with these types of cancers have the best outcomes with a comprehensive, multi-disciplinary approach to treatment because of the nature of the disease and the substantial affects treatment can have on a person’s basic aspects of living including their ability to eat, drink, swallow, taste and talk, says Dr. Lydiatt. The Nebraska Medical Center uses a multi-disciplinary approach that includes a combination of oncologists, radiation oncologists, dental oncologists, head and neck surgeons, speech and swallowing specialists, nutritionists, nurses and social workers. Some patients may also need psychosocial counseling to prevent depression because of the physical changes they may experience to the facial and neck areas.