Author: Ed Stannard
Source: www.ctinsider.com

NEW HAVEN — While it’s become widely known that the human papilloma virus causes cervical cancer, doctors have more recently discovered HPV is associated with another form of cancer.

While cancer of the throat, back of the tongue, tonsils and soft palate (the location of the uvula), known as oropharyngeal cancer, can be caused by smoking or heavy drinking, HPV also has been linked to it, according to Dr. Saral Mehra, section chief for head and neck and otolaryngology surgery at the Yale School of Medicine.

“This didn’t exist as far as we knew 20 or 30 years ago,” Mehra said, but it became clear that younger people who didn’t smoke or drink could get this type of cancer.

That is why, Mehra said, it is important for all young people to receive the HPV vaccination. “If there’s one message I think we need to get out is we need to vaccinate all of our boys and girls,” he said.

“I feel like head and neck cancer is such an important cancer and it’s not one of the big ones” that people think about, Mehra said. But surgery or radiation for these cancers “impacts so much of a person’s life: speaking, eating, drinking, cosmetic appearance,” Mehra said.

“Head and neck cancer is typically thought of as a disease of people who smoke a lot and drink a lot,” Mehra said. “Not that everybody who has it has bad habits, but that is generally how it was thought of.”
HPV-associated head and neck cancer usually is squamous cell cancer, affecting the flat cells that form the lining of the mouth and throat, according to the American Cancer Society, and has a better prognosis than oral cancer that is not related to HPV. It is not usually associated with cancer of the oral cavity: the mouth, inside of the cheeks, gums, teeth, roof of the mouth, front two-thirds of the tongue or lips.

“In this country and in Connecticut and at Yale, somewhere like 70 to 75 percent of [oropharyngeal cancers] are HPV-related, Mehra said. “In the last year or two, back-of-the-throat cancer surpassed cervical cancer as the most common HPV-related cancer in the body.”

Meanwhile, while women routinely get Pap smears to check for cervical cancer, “we don’t have screening for oropharyngeal cancer,” Mehra said. That makes vaccination even more important, he said, but the numbers are not high.

“In 2018 … 52 percent of boys were vaccine up to date, which means they had both doses of the vaccine in them, and 55 percent of girls” age 13 to 17, he said.

“We’re doing a really bad job, and we know why,” Mehra said. “First, the HPV vaccine is not given with other vaccines” that are routinely given to children. Also, “a lot of parents think of HPV as a sexually transmitted disease, so there’s a stigma associated with the HPV vaccine,” he said.

Dr. Ben Judson, a professor of surgery at the Yale School of Medicine specializing in head and neck cancers, said, “There is an absolute epidemic of throat cancers as a result of the HPV virus and these cancers are completely preventable through use of the vaccine.”

He added that HPV-related head and neck cancer is “one of the few cancers that we could completely eliminate if we vaccinate our kids today.”

Judson said with people like actor Michael Douglas and JPMorgan CEO Jamie Dimon having gone public with their bouts of throat cancer — both have recovered — “there is beginning to be increased awareness, but it’s still overall quite low.”

Judson said he did not think hesitancy over the COVID vaccine “has spilled over to HPV vaccines” but “there has been a slight decrease in vaccination rates just because people haven’t been going to see their pediatrician in the last couple years.”

While it is not sexually transmitted, “there’s a direct relationship with the number of oral sexual partners and risk of getting oropharyngeal cancer,” Mehra said.

“Most sexually active adults have been exposed to the HPV virus … but the vast majority clear it,” Mehra said. “But there are some people for which it sticks around for years and years and years, decades even.”

While the vaccine can be given up to age 26, a first dose is usually given at 11 or 12 and a second dose six to 12 months later. Some people from 27 to 45 can get the HPV vaccine, which protects against the nine most common forms of the human papilloma virus (there are more than 120 varieties), “if there’s a risk of getting a new HPV infection,” Mehra said. HPV-16 “causes about 90 percent of HPV-associated oropharyngeal cancers specifically,” he said.

Treatment includes surgery, radiation and chemotherapy, and immunotherapy is being studied. “Right now, we’re doing a lot of studies to figure out how to give less treatment without compromising cures,” Mehra said. Cure rates “can be up to 80 percent.”

Mehra said “the patients that do the best are the ones who get surgery alone.” Those who have a combination of treatments have the most “problems in eating and drinking and taste and side effects.”

Surgery is much simpler now, using a da Vinci surgical robot. “We used to have to split the mandible, the lower jawbone, and swing it out of the way,” he said.

Dr. Gloria Huang, a gynecological oncologist at Smilow Care Center in Greenwich, said, the adults she sees with cervical cancer or pre-cancerous signs “were not offered an HPV vaccine as a child,” so they are more likely to say, “I wish I had the opportunity to have the vaccine when I was younger.”

Huang, also an associate professor at the Yale School of Medicine, said, “We know the HPV vaccine is safe and effective and I would encourage patients and pediatricians to make sure that we don’t lose the momentum and the progress that we’re already seeing in the reduced incidence” of cervical cancer.

A study published March 31 in Preventing Chronic Disease about promoting HPV vaccines during the COVID-19 pandemic concluded that “clinics struggled to provide routine care, and as a result, many adolescents missed HPV vaccinations.”

One clinician was quoted as saying, “Right now with COVID, I would be amiss if I didn’t say HPV is probably not at the top of our list. We’re trying to make sure that people are staying healthy.”