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More awareness needed to detect HPV-related throat cancers
Staff reports | News Center | March 25, 2014
|Actor Michael Douglas served as a spokesperson for The Oral Cancer Foundation last year as an oral cancer survivor to raise awareness of the risks associated with HPV, a virus spread through sexual contact. MUSC study finds more awareness still is needed that HPV is a growing cause of certain types of oral cancer.|
A new MUSC study spotlights the need for better screenings and more awareness for oropharyngeal or throat cancer and the symptoms that appear to be associated with the human papillomavirus (HPV) status of the tumors.
A prolonged sore throat and a neck mass appear to be the initial symptoms according to the findings. The retrospective study of 88 patients with known HPV status was published online March 20 in JAMA Otolaryngology – Head & Neck Surgery. See the abstract here.
Senior author Terry A. Day, M.D., from the Medical University of South Carolina, said patients were the inspiration to do the study. “Patients were coming into our office and didn’t have any idea they could get a cancer in that area and didn’t realize that a virus could have been the cause, and we found that often times their physicians and dentists may not know either.”
Day and colleagues reviewed national cancer websites and many had information related to signs and symptoms that he and his colleagues were not seeing in these patients, he said.
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been on the rise, unlike some head and neck cancers that have been on the decline. The trend has been associated with an increased incidence of HPV-positive cancers (which comprised 40.5 percent of OPSCC cases before 2000 and up to 70 percent of cases since 2009 according to figures referenced in the study). HPV-positive cases tend to affect younger, nonsmoking men, and some studies reported it more common in patients with more extensive sexual history. HPV-negative OPSCC typically affects older patients with more tobacco and alcohol use, Day said.
According to the Centers for Disease Control and Prevention, about 79 million Americans currently are infected with HPV. About 14 million people become newly infected each year. HPV is so common that most sexually-active men and women will get at least one type of HPV at some point in their lives. There are many different types of HPV. Only some types can cause health problems, including genital warts and cancers.
Day said the good news is that HPV-associated cancers tend to have a better prognosis than other cancers and that new options are now available for treatment including transoral robotic surgery done through the mouth without incisions in the skin. This means there may be options to improve outcomes by avoiding extensive treatments that have been used in the past. “There’s often not as much disfigurement and can be less speech and swallowing problems.”
Day and colleagues found that in the HPV-positive cases, the neck mass did imply that the cancer had spread to lymph nodes, but HPV-positive patients have a better cure rate than the HPV-negative, even though the cancer has spread to the lymph nodes. “It’s still treatable, and it’s still usually curable.”
Day said if people develop any symptoms in their throat or neck that lasts for more than two weeks, such as a sore throat that doesn’t go away, pain on swallowing or a lump in the neck, they should ask their physician if there’s a chance they could have an oropharyngeal cancer. This should prompt referral to a specialist.
“There needs to be more awareness of this disease and how to find it earlier."
Part of that is better screenings, which is why Day and his colleagues want the public to take advantage of Oral, Head and Neck Cancer Awareness Week (ohancaw.com), April 20 – 26, when there will be free screenings by physicians and dentists at various centers internationally. To find out locations, patients can visit the Head and Neck Cancer Alliance website to find a local site. People need to be proactive about screening, especially since most of the patients can be diagnosed by a simple office visit, he said.
He encourages physicians and dentists who would like to participate and offer free exams to their community to go onto the website to register and their practice will be listed internationally.
The findings also raise awareness about the HPV vaccine. Sandra Fowler, director of MUSC’s Division of Pediatric Infectious Diseases, said the HPV vaccine is recommended for all youth, for females aged 11-26 years and males, 11-21 years.
The vaccine currently is approved by the U.S. Food and Drug Administration for use in children and young adults. Day said researchers are studying whether the vaccine can be used to prevent oropharyngeal squamous cell carcinoma. In the meantime, patients should note suspicious symptoms and take advantage of screenings.
“The earlier a diagnosis, the better,” he said.