A growing epidemic: HPV-related oropharyngeal carcinoma

The incidence of Human Papillomavirus(HPV)related oropharyngeal cancer has increased by epidemic proportions (225%) over the past 30 years. If it continues to increase at the current rate, the incidence of HPVrelated oropharyngeal cancer will be even greater than the incidence of cervical cancer by the year 2020. Therefore, it is vitally important to be aware of this disease and to take advantage of the currentlyavailable vaccines against HPV.

The oropharynx includes the base of the tongue, the tonsils, the soft palate, and the back wall of the throat. In the past, cancer in this area (as in other areas of the head and neck) typically affected older adults who had a history of tobacco or alcohol use. HPVrelated oropharyngeal carcinoma, however, tends to affect people who are younger and who have been exposed to different risk factors, such as a history of multiple vaginal and/or oral sexual partners, and marijuana use. The odds of HPVrelated oropharyngeal cancer increase significantly in people with these risk factors. However, tobacco and alcohol use remain strong risk factors for oropharyngeal cancer as well as other cancers of the head and neck.

Symptoms of oropharyngeal cancer can include mass or lump in the neck, trouble swallowing, pain with swallowing, sore throat, globus sensation (feeling like there is something stuck in the throat), and ear pain. Because these symptoms can occur with more benign diseases, people often wait until the symptoms become severe or the mass becomes very large before being evaluated by a physician. When this occurs, the cancer is often at a more advanced stage that is more difficult to treat and carries a worse prognosis. For this reason, it is critical to be aware of these symptoms and be evaluated by a physician if the above symptoms are persistent.

The alarming increase in the incidence of this cancer highlights the importance of vaccination against HPV. Nearly 1 in 25 people are infected with highrisk HPV, and about 1 in 100 are infected with HPV16 (the type associated with the vast majority of oropharyngeal cancer). The currentlyavailable vaccine has been demonstrated to be over 90% effective against oral HPV infection, and has the potential to significantly decrease or even eradicate HPVrelated cancers, including oropharyngeal cancer. Although the Centers for Disease Control (CDC) recommends the use of the HPV vaccine in both males and females age 9 to 26, vaccination rates in the United States remain abysmal. Males account for roughly 80% of cases of HPVrelated oropharyngeal cancer, yet in 2014 the vaccination rate for males was only 13.9%. Increased rates of vaccination against HPV could have enormous potential benefit to both human life and health care costs.

HPVrelated oropharyngeal cancer can result in devastating consequences. Treatment for this disease can sometimes be as drastic as removal of the entire tongue, and even the larynx (voice box) if the disease becomes advanced enough. Although HPVrelated oropharyngeal cancer incidence continues to grow, awareness of the signs and symptoms and, most importantly, vaccination of all those who are eligible for the vaccine, can significantly decrease the impact of this disease.

Kevin Moore II, MD and Vikas Mehta, MD

 

Publication

The Growing Epidemic of HPV-Positive Oropharyngeal Carcinoma: A Clinical Review for Primary Care Providers.
Moore KA 2nd, Mehta V
J Am Board Fam Med. 2015 Jul-Aug

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