Cases of late-stage cervical cancer are on the rise among American women in their 30s and 40s. Human papillomavirus is now the leading cause of oropharyngeal cancers, beating out smoking and alcohol consumption. Men are more likely to develop head or neck cancer from HPV compared to women, according to data from Johns Hopkins Medicine.
Reckon spoke with Dr. Jeyarajan Harishanker, an ear nose and throat (ENT) doctor at the University of Alabama at Birmingham Hospital and Dr. Ronald Alvarez, a gynecological endocrinologist at Vanderbilt University Hospital. We discussed how HPV affects cisgender men and women differently and how people can protect themselves from preventable disease and cancer.
Reckon: Why are cases of late-stage cervical cancer on the rise?
Dr. Alvarez: We have a very effective HPV vaccine. And yet, there’s a lot of vaccine hesitancy. People aren’t taking advantage of getting the vaccine to prevent tragic disease. Australia, which has more of a universal vaccine policy expects to eradicate cervical cancer in the next decade because their vaccine uptake is more universal.
Reckon: You told us most of your cancer patients had smoking-related cancers, but things are changing. What happened?
Dr. Jeyarajan: In the last few decades we’ve had a pretty rapid emergence of head neck cancer that is attributable to the HPV virus. Thirty years ago, the vast majority of cancer of the mouth, throat, voice box, and esophagus were due to smoking, but in the last few decades, we’ve found oropharyngeal cancer is increasingly attributed to the HPV virus, particularly HPV subtype 16 and 18 – the same types are seen in women’s cervical cancer.
We’re seeing much younger—men in their 30s and 40s. There used to be an association between low economic status and disease. Now we’re seeing HPV-related cancer in people that are in higher socioeconomic class, classically younger, with no smoking history.
Reckon: What do you want your patients to know about getting a positive HPV diagnosis?
Dr. Alvarez: It’s very common for people to have HPV exposure particularly as they become sexually active. It’s like a cold virus. We all get exposure to cold viruses and some people don’t have any symptoms. Some people have cold symptoms. Some people get pneumonia. The same thing happens with HPV. Most people don’t even know they had it and some people will get genital warts or an abnormal pap smear. Some people get cervical cancer.
I think people should understand the importance of HPV vaccination and screening for cervical cancer. People aren’t getting vaccinated and they aren’t getting their regular cervical cancer screenings-- that’s why we’re seeing more cases of late-stage cervical cancer. Healthcare access disparities are also why we’re seeing more people with late-stage disease. Anyone who is experiencing cervical cancer or HPV symptoms should see a health provider.
Reckon: What do you want your patients to know about being diagnosed with an HPV-related head or neck cancer?
Dr. Jeyarajan: I do robotic surgeries for head and neck cancer, but I always recommend that they get another opinion from radiation oncologist.
Before we had surgical robotics, the surgery was horrible. But now with surgical robotics, the discomfort associated with treatment is comparable to radiation. Like I said, no treatment for cancer is free. But I think that the old paradigm that surgery is worse than radiation has definitely changed.
Reckon: Should people who are older than the previous cutoff age of 27 (it’s now 45 for women and men) get the HPV vaccine?
Dr. Alvarez: For women who are in their 30s who have never been vaccinated, I would recommend them to get vaccinated. They should talk to their doctor about those options. The vaccine may not be as effective as it would have been if they were 11 to 14 years old, but there is some protection.
Dr. Jeyarajan: Definitely. People that present with HPV related cancers I treat are generally nonsmokers. They are generally fit and healthy have no other health issues. if you’re 30 years old, sexually active and had been for 10-15 years, getting the vaccine now does correlate with a decrease in risk of HPV-related cancers around the body. So get vaccinated, even if you’ve already been exposed to HPV.
Reckon: What is treatment and prognosis for these cancers?
Dr. Jeyarajan: Any kind of smoking-related cancer does very, very poorly. Stage by stage, it is significantly better to have an HPV related tumor than it is to have a non-HPV related tumor. We only have 30 years of data to work with. We do not know what this means long term. I do know that whether they have primary surgical treatment or primary radiation-based treatment, we know that they will do incredibly well with treatment, at least, at least in the first 10 or 15 years.
Dr. Alvarez: Survival is dependent upon stage and so patients with a more advanced stage cervical cancer have poorer outcomes. The five-year survival rates for stage three cervical cancer around 40%.
Reckon: Is there any disparities you’re noticing about your patients?
Dr. Jeyarajan: There’s definitely a much greater This is a cancer that’s more common more in males, particularly young males, than females. I would say that it’s two to three times more common in men.
Reckon: We know the answer about why men don’t get cervical cancer. So why are men more likely than women to have head or neck cancer related to HPV?
Dr. Jeyarajan: We know that the rise in oropharyngeal cancer due to HPV virus is directly related to changing sexual practices, particularly the increase in oral sexual activity since the 60s. There has also been an increase in the number of sexual partners people have, and we know men tend to have more sexual partners than women.
Women also tend to clear HPV infections relatively quickly, men tend to clear it slower. We don’t know why.
We also know having cervical exposure to the HPV virus translates to translates to antibody mediated protection against tonsil cancer. So if you have been exposed to the HPV virus vaginally, you have some degree of protection against oral HPV as well. Men don’t have that.
Reckon: What are the warning signs for HPV-related cancers of the head and neck?
Dr. Jeyarajan: if you’re over the age of 30, and you get a neck lump that is either associated with a sore throat or doesn’t go down after a couple of weeks, you should get referred to an ear, nose and throat surgeon.
Reckon: While we were talking earlier, Dr. Alvarez, you said the recent data about late-stage cervical cancer among younger women was a tragedy. Could you elaborate on that?
Dr. Alvarez: Well, any cervical cancer is tragic to me because it is such a largely preventable disease. The median age of people that get cervical cancer tends to be people around 40 to 45 years old.
There’s a lot of people that tragically expire from this disease and leave behind young families. They don’t get to have all the life experiences we all hope to have as we and our children age.