Head and Neck Cancer: Link with Human Papillomavirus (HPV)

 

Transcript:

 

Guest:  Dr. Boyd Gillespie - Otolaryngology

Host:  Dr. Linda Austin – Psychiatry

 

Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Boyd Gillespie who is Associate Professor of Otolaryngology, or Ear, Nose & Throat, here at the Medical University of South Carolina.  Dr. Gillespie, there’s been a lot of interest recently in the news about the relationship between HPV, or human papillomavirus, and cancers of the head and neck.  What is that relationship?

 

Dr. Boyd Gillespie:  Just stepping back a minute, cancers of the head and neck are cancers that involve several different sites, including cancer of the lips, jawbone, tongue, the palate area, the back of the throat, or the larynx, and the pharynx.  The back of the throat includes the tonsils and basic tongue region.  There are approximately 40,000-50,000 cases of head and neck cancer per year in the United States.  Traditionally, these cancers have been related to tobacco use and alcohol use. 

 

However, over the past 10 years, we’ve noted a rise in patients with head and neck cancers who have very minimal tobacco exposure, particularly cancers of the tonsil and tongue base region.  This led investigators, about 10-15 years ago, to study other possible causes of head and neck cancer.  We knew from earlier research that cancers that appear similar to these head and neck cancers occurred in the uterine cervix in women, cervical cancer in women.  That’s why women get a yearly pap smear.  Under the microscope, these tumors appeared very similar to some of these cancers that we were seeing in the tonsil and tongue region. 

 

We knew from earlier research that these cervical cancers in women were caused by human papillomavirus.  Human papillomaviruses are a broad class of viruses.  They’re DNA viruses.  There are over 100 different subtypes of these.  Commonly, they’re the type of viruses that cause warts on the skin.  The can also cause genital warts and other growths in the body.  Out of those 100 different subtypes, there are only five to seven that have the potential to be malignant.  So, most of them cause benign growths, but there are certain subtypes of human papillomavirus that can cause malignant growths.

 

From this earlier research in the obstetrics and gynecology field, we knew that these tumors were related to human papillomavirus.  Because of the similar appearance of these tumors in the head and neck region, we also began using molecular methods to test these tumors and we found that, indeed, these tumors were also positive for human papillomavirus.  So, the current feeling is that up to 25 percent of head and neck cancers are likely related to human papillomavirus.  

 

If you look at specific sites within the head and neck, such as the tonsil or tongue base, up to 60 percent of these cancers are HPV positive.  And, unfortunately, what we’ve seen is, as the number of smokers in our population has gone down, we have, indeed, seen a decrease, overall, in certain head and neck cancers, however cancers of the tonsil and tongue are starting to go up, and these are the ones related to the HPV virus.  So, it’s becoming a major concern among head and neck surgeons who are interested in getting the word out about risk factors for this type of head and neck cancer.

 

Dr. Linda Austin:  Now, most people, I think, know by this time that there’s been a very strong push to get young girls and women vaccinated against the HPV virus because, obviously, the cervix is something girls have and boys don’t.  These HPV positive cancers, though, of the tongue and tonsils, are they equally common in boys?

 

Dr. Boyd Gillespie:  Right now, we see slightly more of these HPV head and neck cancers in men than women, but we do them in both.  Some of the potential epidemiological things that have been looked at are the number of lifetime sexual partners, early onset of sexual contact and oral sexual involvement.  The people who fit that profile are a little bit more at risk.  However, that’s not true for everyone.  We don’t know if it’s directly due to a sexual mode of spread or if it can be spread through other ways, such as saliva or skin contact.

 

Dr. Linda Austin:  I know that among adolescents, oral sex is becoming almost a method of birth control.  It certainly is effective for birth control, but one wonders if it may not lead to this increased rate that you’re seeing now.

 

Dr. Boyd Gillespie:  That’s one reason why head and neck surgeons are interested in informing the public that a lot of people are under the impression that oral sex is a safer method of sex.  Certainly, from the standpoint of pregnancy, that’s true.  But from the standpoint of sexually transmitted diseases, it’s not true.  There are sexually transmitted diseases, a variety of which, chlamydia, gonorrhea, HPV, can be spread through oral sex.  Unfortunately, this type of sexually transmitted disease can also lead beyond the infection itself to precancerous and cancerous changes.  Therefore, I think it’s just good for people to be to be informed of their risk factors and to take that into account with their behavior.

 

Dr. Linda Austin:  Is there a recommendation that boys should be vaccinated then?

 

Dr. Boyd Gillespie:  A lot of people are coming to that conclusion.  Right now, there is no policy for that and, unfortunately, third party payers are not covering that.  But, it makes sense.  I mean, the way young women get this virus is through contact with young men, so young men are carriers of the virus.  We know that only women can get cervical cancer.  They get it from their contact with men who are carriers of the virus.  So, a lot of people are of the opinion that boys should be vaccinated.  It’s my feeling that within a few years, that will be public policy. 

 

Dr. Linda Austin:  I’ve heard it said, even aside from the issue of the tongue and tonsillar cancers, that if we don’t vaccinate the boys, we won’t be able to get a handle on this virus because they are the reservoir for it; they carry it. 

 

Dr. Boyd Gillespie:  That’s true.  It’s been estimated that at any given time, up to 10 percent of the population is carrying HPV of some type.  And up to 30 or 40 percent of the population has exposure during their lifetime.  That’s a tremendous number of people.  Luckily, very few of those people will go on to develop cancers of the cervix or the head and neck region.  So, there are other factors beyond just the viral infections themselves that likely lead to cancers.  There may be relationships with a person’s immune system or their underlying genetics that make them more susceptible to a cancer from the HPV virus.

 

Dr. Linda Austin:  How deadly of a cancer is this?

 

Dr. Boyd Gillespie:  Head and neck cancers are very deadly.  Early signs of head and neck cancer include sore throat, swallowing difficulty, a white or red patch on the inside of the throat, bleeding around the gums or throat, hoarseness.  Late signs include developing a mass or lump in the neck region.  That’s an indication that the cancer has spread from the throat to some of the lymph nodes.  Unfortunately, up to half of our patients present, already, at that level.  So, half of our patients coming already have a mass in their neck, and that reduces their likelihood of survival by 50 percent.

 

My recommendation is, anyone who has a sore or an irritation in the throat that doesn’t clear up within two weeks should have that evaluated to rule out the possibility of a cancer.  One reason why we want to make the public aware of the relationship between HPV virus and head and neck cancer is that a lot of people who develop these symptoms who don’t smoke are of the opinion that, how could I have a head and neck cancer, I don’t even smoke.  Well, again, up to 25 percent of our head and neck cancer patient population, really, had minimal to no smoking history.  So, people can get head and neck cancer who have never even touched a cigarette.  It’s important for people to be aware of the signs and symptoms and if they’re experiencing those to come in for an evaluation.

 

Dr. Linda Austin:  Dr. Gillespie, thank you so much for talking with us.

 

Dr. Boyd Gillespie:  Thank you.

 

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