HPV & Oropharyngeal Cancer

January 20, 2021

Close up of otolaryngologist making endoscopic examination of oral cavity for senior patient

The Centers for Disease Control and Prevention (CDC) cites the human papilloma virus—HPV—as the most common sexually transmitted infection in the United States. The virus spreads through intimate sexual contact, causing infections that are so common, that “nearly all men and women will get at least one type of HPV at some time in their lives.”

Most infections are asymptomatic, undetected and resolved by the body’s immune system. Less commonly, the infection can be persistent, progressing to cancer in both women and men later in life.

HPV's connection to oropharyngeal cancers

Oropharyngeal cancer—cancer of the oropharynx, which includes the tongue, tongue-base, tonsils, and soft palette—now is the most common cancer caused by HPV, having surpassed cervical cancer in incidence in 2015. It is thought to cause 70% or more of oropharyngeal cancers in the United States.

The game-changer in HPV prevention came in 2006, when the Food and Drug Association (FDA) approved a vaccine called Gardasil®. The FDA’s indications and recommendations for eligible ages for the vaccine (an updated version called Gardasil 9®) have expanded over time, and now includes both males and females up to age 45, and now with indication for preventing HPV-associated head and neck cancer, in addition to the prior anogenital indications.

Causes of oropharyngeal cancers

“The landscape of cancers of the oropharynx has shifted dramatically in the last 20 or 30 years,” says Andrew Tassler, MD, assistant professor of otolaryngology, Weill Cornell Medical College, and assistant attending otolaryngologist, NewYork-Presbyterian Hospital.

The majority of oropharyngeal cancers seen at that time were associated more with tobacco and alcohol consumption, not related to HPV, Dr. Tassler said.

“There has basically been a flip in the epidemiology —in my practice now, probably 80 to 90 percent of oropharyngeal cancers are HPV related,” he says, adding that the typical patient with this type of cancer is male, Caucasian, and between the ages of 55 to 65, with minimal exposure to alcohol and tobacco. Dr. Tassler estimates that 10 to 20 percent of the oropharyngeal cancer patients he sees are women.

Minimizing transmission and risks

In addition to receiving the Gardasil 9® vaccine, the CDC also recommends using condoms and dental dams consistently and properly during oral sex, which may help lower the chances of transmitting or contracting HPV.

Although there is no specific screening for oropharyngeal cancer, like something akin to a pap smear to detect cervical cancer, Dr. Tassler says some patients may experience symptoms, including a lump in the neck or throat, difficulty swallowing or painful swallowing, and possibly change in their voice. Other symptoms can include trouble breathing or speaking; a feeling that something is caught in the throat; or throat pain that won’t go away.

“Generally speaking, patients who present with HPV-associated oropharyngeal cancers do quite well, and their condition is usually highly treatable and curable,” Dr. Tassler says. “The five-year survival rate is 90-plus percent for the majority of patients, he adds—and the HPV vaccine adds long-term optimism to the picture.”