Human Papilloma Virus, or HPV, is the most common sexually transmitted virus in the United States. While it causes few symptoms on its own, it is linked to several forms of cancer—in fact, the National Cancer Institute reports that nearly all cervical cancers are the result of HPV infection.
HPV can also infect the mouth and throat, causing cancers of the mouth and throat. HPV is thought to cause more than 70 percent of oropharyngeal cancers in the United States. Fueled by a passion to reverse this trend is Indiana University School of Medicine’s Michael G. Moore, MD. Moore, the Arilla Spence DeVault Professor in the Department of Otolaryngology, is one of three head and neck surgeons on the American Cancer Society HPV Vaccination Roundtable.
An advocate for vaccination efforts, Moore answered some questions about the cancer-causing virus.
Why should people know that HPV causes throat cancer?
It’s important because many people who develop it otherwise would have considered themselves to be very low risk. Oftentimes these HPV-related cancers occur in non-smokers who don’t drink a lot. Since tobacco and alcohol have traditionally been considered the main risk factors for head and neck cancer, many individuals are shocked to learn that they’ve got a significant cancer without these bad habits.
Here in Indiana and several places around the country, we’re trying to raise awareness about this. We do this by highlighting the importance of vaccination. The association between HPV and cervical cancer, a cancer that affects women, is widely recognized. However, the people who usually are affected by HPV-related oropharyngeal cancer are men—it’s about four times more common in men than women—and that’s a demographic that lagging far behind on getting the HPV vaccine.
What are some of the symptoms people should be looking for when they are determining if they should be screened?
The most common presenting symptom for an HPV-related throat cancer is a lump in the neck. Some people refer to it as the “shaving cancer”, because people find it when they’re shaving and they feel it. Any persistent neck mass in an adult is not normal and should be evaluated. You can start with your primary doctor. Occasionally they’ll do an initial course of antibiotics, but if it doesn’t get better within a couple of weeks, it needs to be seen quickly. Usually having them assessed by an ear, nose and throat doctor, or potentially even a head and neck surgeon is needed. Other symptoms may include, pain in the throat, pain in the ear, which is just referred pain from the throat, difficulty swallowing, and change in the voice. These are all some signs and symptoms that may represent cancer.
If someone feels they have one or more of these symptoms what should they do?
If they are worried about it, usually the initial step is just an office evaluation by an ear, nose, and throat doctor. The doctor will take a history and perform an ear, nose and throat examination. Often as part of the exam, they’ll use a small flexible telescope to look in the nose and back of the throat to evaluate the areas at risk for HPV-related cancers, such as the tonsils and the back of the tongue or tongue base. Based on that they’ll determine what would be the appropriate next step. If there is an abnormality that they see as worrisome, that may warrant a biopsy.
What makes IU School of Medicine unique in its approach to bringing awareness and treatment?
I think our main strength here is the multidisciplinary approach that we have. We have insight from people even outside of the field of head and neck surgery that provide their perspective on everything from evaluation and treatment of HPV-related diseases to mechanisms for improving vaccination rates. We work with our colleagues in the IU Simon Cancer Center as well as our pediatric and public health colleagues and other basic science researchers in the field of OB-GYN. I think that allows us to be positioned well to really have active involvement on the national front.
What should people know about the HPV vaccine?
The FDA approved it in 2006 for girls and in 2009 for boys. Right now it’s recommended to be taken between the ages of nine to 45. The best age to get vaccinated is ages 11 to 12 for both boys and girls. If you didn’t get it at that age, then it can be done before you turn 15 years old, and it would be a two-shot vaccine. If you don’t get it before the age of 15, then it will be a three-shot vaccine.
The vaccine had been shown to be very effective, over 90 percent effective as far as preventing infection. It’s been shown to actually reduce certain kinds of cervical, anal and genital cancer as well as throat HPV infections.
What is your advice for someone who is hesitant to receive the vaccine?
It’s very safe. It’s been shown to have very low adverse effects, less than 0.1 percent of any severe side effects in over a 100 million doses. I think of it as a cancer prevention vaccine. It’s one of the rare opportunities we have to eliminate a type of cancer. The people who are affected by HPV-related cancer can die from their disease, but even people who survive have permanent side effects from their treatment. As a result, it’s critical to try to prevent it. It’s a rare opportunity to give cancer prevention to your children. So we strongly recommend it.
What would you say to those who feel they can’t speak to their doctor or family about HPV because of a stigma associated with sexually transmitted diseases?
The fact that there’s a stigma is unfortunate because more than 80 percent of adults will get exposed to HPV at some point. It comes from not only sexual activity but also nonsexual, intimate contact can cause it. The chance of being exposed to HPV comes from the fact it’s the most common STD in America. The big thing is recognizing that people now have the opportunity to prevent it.
Would you say the vaccine is a cure for HPV and HPV-related cancer?
It provides hope of an eradication rather than a cure itself. While the cure rates are relatively high when you treat it, we could have the potential to eradicate HPV completely if we got the rates of vaccination high enough that it would just eliminate the infection and therefore eliminate the type of cancer. That’s the goal.
What is the goal for your future HPV and HPV-related cancer research?
We are researching all areas, everything from increased adherence to vaccination, screening, discovering both blood tests, ultrasound and other screening options to detect cancers caused by HPV. We are also advancing in technical ways to remove these types of cancers in ways that are less invasive. We have a transoral oral robotic surgical team at IU Health that uses endoscopes and robotic instruments to remove throat tumors in a way that causes fewer side effects than older traditional approaches.
