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April 24th, 2014

Younger men may be at high risk for throat cancer

Recently there has been a dramatic shift: Younger men who do not drink nor smoke and are in the prime of their physical health are being diagnosed with throat cancer. The increase is due to a common virus called the human papillomavirus (HPV), and many men don’t even know they have it.

According to the Centers for Disease Control and Prevention, genital HPV is the most common sexually-transmitted infection in the U.S. and worldwide, with half of sexually-active men and women contracting it at some point in their lives.

HPV is most commonly associated with women because certain strains can cause cervical cancer, but now more men are being affected by this silent virus. The incidence of HPV-positive throat cancers more than doubled between the late 1980s and early 2000s. Experts believe the incidence of HPV-positive throat cancer to eclipse that of cervical cancer by the end of this decade.

“The high-risk HPV strains that cause cervical cancer are the same strains that cause throat cancer,” says Dr. Eric Genden, Chairman of the Department of Otolaryngology at the Icahn School of Medicine at Mount Sinai in New York City. “Men are much more likely to get HPV-positive throat cancer than women. At Mount Sinai, we are seeing roughly seven men to every one woman with this diagnosis.”

Often the body’s immune system fights the virus and many people never know they have it. Other times, certain strains of the virus thrive and cause cancer.

“For an individual who has had more than five oral-sex partners, the chance of developing head and neck cancer without smoking and drinking is six times that of an individual who doesn’t have that risk factor. That is a startling number,” says Dr. Jonathan Aviv, Director of the Voice and Swallowing Center at ENT and Allergy Associates, who collaborates with experts at Mount Sinai to screen and treat patients with HPV-positive throat cancer.

According to Dr. Marshall Posner, Medical Director of the Head and Neck Medical Oncology Program at The Mount Sinai Medical Center, survival rates are good. “In comparison to throat cancer from smoking and drinking, a patient has a much higher chance of surviving HPV-positive throat cancer,” explains Posner.

Currently there is no test for HPV in the throat, but that could change in the future. Posner and his colleagues at Mount Sinai are part of a national team of scientists researching a blood test for the disease, which would help make screening easier for people around the world.

The symptoms of HPV-positive throat cancer include:

* Hoarseness for extended periods of time
* Pain or difficulty chewing or swallowing
* A feeling of a persistent lump in the throat or neck
* Change in voice (higher, lower, more gritty)
* Ongoing pain in the ears or neck

If you or someone you know has these symptoms, it’s important to get a quick and painless screening. After a physical examination of the mouth, a doctor will examine the back of the throat, base of tongue, the larynx and the vocal cords with a thin, flexible telescope with a miniature camera on its tip.

“Testing should be accompanied by evidence-driven and patient-centered counseling to best minimize negative psychosocial outcomes as well,” says Dr. Andrew Sikora, Assistant Professor of Otolaryngology at Mount Sinai, who recently published a clinician’s guide to HPV-positive throat cancer counseling in the journal The Oncologist. 

In addition to treatment, some patients typically experience high levels of emotional distress, according to Dr. Sikora. Patients may experience guilt, depression, and low self-esteem, and their loved ones may have fears of transmission or infidelity. Learning to cope with cancer that is caused by a sexually-transmitted infection can be complex. Counseling can help patients heal emotionally while their bodies heal physically.

At The Mount Sinai Medical Center, people with early HPV-positive throat cancer are treated with a robotic procedure to safely remove tumors. Robotic surgery is ideal for small, challenging areas such as the throat, and is far less invasive than many alternatives, which greatly minimizes complications and recovery time. Patients with more advanced cancers have available an array of clinical trials designed to study reducing the amount of radiation patients may receive.

Prevention is important. Posner recommends that you and your children receive an HPV vaccination. To help prevent infection, there are two types of vaccines available for people ages 9 to 26. If you or your children fall into this age group, ask your doctor for more information.

For more information about HPV and throat cancer, visit www.mountsinai.org/oralcancer.

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