Head and Neck Cancer Awareness Month: HPV & Cancer Research
April is Head and Neck Cancer Awareness Month. This is a good time to learn about this group of cancers and its risk factors, symptoms, and prevention strategies, as well as what’s new in head and neck cancer research. Head and neck cancers are a large group of many cancers that affect different areas of the head or neck. Some cancers affecting areas of the head or neck are NOT included in the group of head and neck cancers, such as cancers of the brain, eyes, esophagus, thyroid, and skin.
About Head & Neck Cancer
Head and neck cancers account for about 4 percent of cancer cases in the United States. It is estimated that nearly 67,000 people in the United States will be diagnosed with head and neck cancers in 2023. Men are twice as likely to be diagnosed with head and neck cancer compared to women. Symptoms for head and neck cancer can include lumps, sores, a sore throat that does not go away, difficulty swallowing, voice changes or hoarseness, etc. Dentists should check for signs of oral cancer during routine check-ups, but other head and neck cancers don’t have routine screening tests.
There are many different types of head and neck cancers. The most common head and neck cancers affect the squamous cells in surfaces that line the head and neck, such as the mouth, throat, and voice box. These are also called squamous cell carcinoma. Head and neck cancers can also affect salivary glands, as well as sinuses, muscles, and nerves in the head and neck. Each type of head and neck cancer has a different name for the part of the body affected.
Heavy and frequent alcohol consumption and tobacco use (cigarettes, cigars, pipes, chewing tobacco, and snuff) are significant risk factors for head and neck cancers. About 70-80 percent of head and neck cases are linked to tobacco use. Human papillomavirus (HPV) infection, particularly HPV Type 16, is another common risk factor for certain head and neck cancers, especially for those in the throat. Head and neck cancer prevention strategies include quitting smoking and other tobacco products, decreasing alcohol consumption, HPV vaccination, and regular dental care.
HPV infection is linked to health problems including cancer. HPV infection is caused by skin-to-skin contact, and it is most often associated with sexual contact. There are more than 100 strains, or types, of HPV, but not all cause health problems. About 14 strains of HPV are considered high risk, and two types, HPV 16 and 18, cause most HPV-related cancers. HPV infection is most often associated with cervical cancer. However, it was suspected for many years that HPV infection was also linked to some head and neck cancer cases. Researchers were particularly interested in if HPV is linked to oropharyngeal cancer, which is cancer of the middle section of the throat. However, the only way to better understand head and neck cancer and know for sure if HPV is a risk factor is to conduct research.
One way to conduct research on HPV is to test tumors. Researchers can take a biopsy from a tumor. This is usually collected by swabbing or brushing the mouth or throat. They can then test the tumor and detect HPV DNA. This process can also determine which type of HPV is present. Studies have found that HPV 16 is the most likely type of HPV found in head and neck cancer tumors. About 90 percent of HPV-positive cancers are found to be HPV 16. In addition to testing tumors, researchers may collect other information from study participants to see what other behaviors, history, and risk factors are present. This could include demographic information, smoking and tobacco history, alcohol consumption, medical history, sexual behaviors, oral hygiene, dental history, and more.
Head & Neck Cancer Clinical Trials
An example of a head and neck cancer clinical trial is a study from 2007 that looked at 100 people with oropharyngeal cancer (cases) and 200 people without cancer (controls). The study was an observational study. This means that researchers observed patients who were already diagnosed with cancer and observed their history and behaviors without intervening or changing anything. The study team collected specimens from the throat for all participants to detect HPV. All participants completed interviews about their health history, demographic information, sexual history, tobacco and marijuana history, alcohol consumption, and dental hygiene habits. Researchers then analyzed and compared the data for cases and controls.
The study found that oropharyngeal cancer was strongly associated with HPV infection. 72 percent of oropharyngeal cancer tumor specimens contained HPV 16 DNA. Oropharyngeal cancer was also associated with family history of cancer, infrequent toothbrushing, heavy tobacco use, and high alcohol consumption. The study team also analyzed whether HPV infection combined with tobacco use to increase head and neck cancer risk even more. However, they did not find an association. This may suggest that HPV infection and tobacco use are separate pathways to developing head and neck cancer.
Another area of HPV and head and neck cancer research is determining how treatable cases are and prognosis. Studies have shown that HPV-positive head and neck cancers may be more responsive to treatment and are associated with longer survival than other head and neck cancers. A 2010 study enrolled 720 participants with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Tumor samples were taken from participants with oropharyngeal cancer to determine if tumors were HPV-positive or negative. Researchers followed the participants for an average of 4.8 years to determine treatment responses and survival. After three years, 82 percent of people with HPV-positive oropharyngeal cancer survived compared to 57 percent of those with HPV-negative oropharyngeal cancer. Overall, people with HPV-positive cancer cases had a 58 percent reduction in risk of death.
This study’s results point to the need to determine HPV status of tumors for those with oropharyngeal cancer to tailor treatments and create the best outcomes for patients. Researchers are working on new ways to detect HPV DNA in head and neck cancer patients, such as blood tests and saliva tests. These tests would make it easier and less invasive for patients and help clinicians determine results and create treatment plans quickly.
To learn more about head and neck cancer and research milestones, visit the following resources:
Head & Neck Cancer Progress Timeline- ASCO