October is breast cancer awareness month. It is nearly impossible to go through the month without noting a sea of pink adorning everything from charity walks to NFL football players. It was all the more surprising therefore to see the amount of media coverage provided last week to an article from the Annals of Internal Medicine highlighting the relationship of the HPV virus to mouth and throat cancer in men. Nearly every major news outlet ran stories on the article, but many of them left patients with more questions than answers: What is the HPV virus? How do we catch it? Who is at risk? How do we test for it? Can it be cured? Can it be prevented? We'll try to briefly provide some clarity here today.
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HPV, or Human Papilloma Virus, has long been recognized for its causative role in cervical cancer in women. It is just really in the past fifteen years or so that we have come to understand the increasing role the virus plays in cancers of the mouth and throat. Head and Neck Cancer had historically been seen almost exclusively in older men with a long-standing history of heavy smoking and drinking. Over the past few decades however we started noting more and more of it in younger and younger patients with no significant history of tobacco or alcohol use. HPV turned out to be the cause. There are dozens of strains of the virus, some of which cause benign warts on the skin or mucosal surfaces of the body and others that carry high risk for development of cancer. We know that risk is significantly increased in carriers who also use tobacco products. This latest article in the Annals of Internal Medicine estimates that 11 million men in the US (roughly 1 in 9) carry the virus in their mouth or throat, and up to 7 million of those are likely the high risk strains. While the virus affects both men and women, this new article is poignant in that most prior attention to the HPV virus focused on women due to the cervical cancer relationship.
The strains of the virus that can cause cancer of the mouth and throat are spread primarily sexually. The virus is extremely common and nearly anyone who's been sexually active with more than two partners in their lifetime has been exposed. Most people clear the virus after an initial exposure, like we would the common cold. For reasons we don't fully understand though, some people become chronic carriers of the virus in the mucosa of the mouth or throat and may harbor it for decades before it causes any problems. There is currently no FDA approved screening test for oral HPV, and there are no antiviral medications that can clear a localized infection. Persons who are at high-risk or have known cervical/genital exposure are recommended to have regular screening examinations of the mouth, throat, and neck. Most important is to not ignore symptoms or growths in these areas.
Perhaps the biggest point of emphasis from the article is the need for significant improvement in preventing this rising public health threat. We have very effective vaccinations with excellent safety profiles for HPV that have been on the market for roughly a decade now. Unfortunately, they have been largely marketed towards young girls due to the cervical cancer risk. Rate of vaccination among young girls is still far too low and there is no way to eradicate a disease with only one gender being vaccinated. This article, more than anything, drives home the point that men are also at high risk for HPV related disease and we should therefore be addressing this preventable disease process in young people of both sexes. Until we can eradicate the virus through vaccination, our focus must remain on early detection of disease in order to minimize unnecessary morbidity and mortality.
Dr. J.P. Gniady is the laryngology specialist at the Silverstein Institute. To further evaluate your risk or any symptoms of potential cancers of the mouth and throat, call for an appointment with Dr. Gniady at 941-366-9222.