Local doctors see increase in cancer tied to HPV virus
CHAMPAIGN — Two local doctors say they're seeing more cases of a type of head and neck cancer that has become increasingly associated with the sexually transmitted HPV virus.
Oropharyngeal cancer — which involves part of the throat, including tonsils, soft palate (back of the roof of the mouth) and the base of the tongue — has been in the spotlight recently since a story in The Guardian linked actor Michael Douglas's 2010 case of throat cancer with human papillomavirus and oral sex.
Douglas was quoted as saying HPV contracted through oral sex causes the kind of throat cancer he had. Douglas's spokesmen have said the actor was merely saying oral sex can be a suspected cause and not necessarily that it was a cause of his own cancer.
Risk factors for oropharyngeal cancer include smoking and heavy alcohol use and being infected with HPV.
Genital HPV is the most common sexually transmitted virus in the United States. More than half of sexually active men and women are infected with it in their lifetimes, according to the Centers for Disease Control and Prevention.
Recent studies have shown about 63 percent of oropharyngeal cancers are caused by HPV infection, according to the CDC.
But that doesn't mean this kind of HPV-related cancer necessarily resulted from oral sex, says Dr. Amit Date, a Christie Clinic otolaryngologist and head and neck surgeon.
There can be other forms of transmission and other comorbid (simultaneously occurring) factors involved, he said.
Date says he sees at least one new case of oropharyngeal cancer a month.
Traditionally, these patients have been heavy smokers and drinkers, but now doctors are seeing people who don't have much alcohol and/or smoking exposure, and are still getting this cancer, he said.
"One good thing is, these cancers that seem to be driven by HPV respond much better to treatment, and these people tend to have better survival rates," he said.
Oropharyngeal cancer is often found late, at stage three or four, because people often don't have symptoms until they develop a neck mass, Date said.
"Or sometimes the tonsil will be very large, and that is what brings them in," he added.
Dr. John Brockenbrough, head of the otolaryngology department at Carle Physician Group, said there are two ways to check cancer for an HPV connection: through DNA testing of the cancer cells or through testing for HPV marker p16.
"We actually check all patients with head and neck squamous cell (the most common type) carcinoma," he said.
Brockenbrough said oropharyngeal cancer isn't the same disease it was 20 or 30 years ago, and those patients with cancer linked to HPV respond better to treatment.
"It's more treatable, and we're seeing more long-term survivors than we were in the past," he said.
Still, he says, the treatments are hard on the patients.
Treatment is typically either simultaneous chemotherapy and computer-guided radiation therapy, or surgery followed by chemotherapy and lower-dose radiation, Brockenbrough said.
"If we do surgery first, we can lower the radiation dosage and cut back on the chemotherapy," he said.
Some patients prefer surgery and a lower radiation dosage, because radiation of the throat is painful and makes it hard to swallow, he said.
To protect against this kind of cancer, don't smoke, avoid drinking a lot and maintain good oral health, doctors say. And see your physician about a persistent sore throat or if you find a lump. Also, consider the wisdom of multiple sex partners and what you do with them.
"I don't know how I feel about telling people not to take part in oral sex, but it's definitely a risk factor," Brockenbrough said.
Whether the HPV vaccines intended to protect against cervical cancer (Gardasil and Cervarix) offer protection against oropharyngeal cancer won't be known for some time, he said. Gardasil, which protects against cervical cancer and warts, is available for both girls and young women and boys and young men. Cervarix is available for girls and young women.
It can take decades after HPV exposure for cancers to develop. Brockenbrough said many patients he sees for oropharyngeal cancer are in their 40s and 50s.
Meanwhile, HPV-associated oropharyngeal cancer has increased over the past two decades, especially among men, and it has been projected HPV will cause more oropharyngeal cancer than cervical cancer by 2020, according to the National Cancer Institute.
"We're hopeful Gardasil will begin to slow the progression of this type of cancer in our population, because the incidence is increasing," Brockenbrough said.