The mounting wave of deadly throat and mouth cancers—particularly in adults older than 45—has raised an alarm in the medical community, as a link between a common virus and vulnerability to these illnesses has become starkly evident. Dr. Matthew Old, a head and neck surgeon at The Ohio State University Comprehensive Cancer Center, points directly to human papillomavirus (HPV) as the main catalyst of this surge.
Nearly 55,000 Americans are diagnosed with throat or mouth cancer each year, and this number is climbing. The findings of a study published in JAMA Otolaryngology-Head and Neck Surgery highlighted a 2.7 percent increase per year in the incidence of oropharyngeal cancer cases in men, with a surge of more than 3 percent per year among white males above the age of 65.
Older adults grappling with oropharyngeal cancer are now being seen as the new face of the HPV epidemic. Current trends paint a sobering picture, with medical experts cautioning that this particular cancer could soon rank among the top three affecting older adults in the United States. Even more concerning is that it may even become the most common cancer in this age group within the coming decade, signaling a significant public health concern on the horizon.
Unraveling HPV and Its Role in the Surge of Cancer Rates
HPV is a sprawling family of more than 100 related viruses. Typically characterized as a sexually transmitted disease, it’s passed along through intimate contact with others, whether skin-to-skin or oral.Story continues below advertisement
While these viruses have garnered a reputation as significant contributors to the prevalence of cervical cancer, they cast a wider shadow than previously recognized. High-risk HPV is emerging as a considerable driving force behind head and neck cancers, notably those affecting the mouth, base of the tongue, and throat—the swath of conditions commonly categorized as oropharyngeal cancers.
An encounter with HPV isn’t rare; by the age of 45, approximately 80 percent of people in the United States will have encountered it. However, not everyone who comes into contact with the virus will face cancer down the line. The spotlight falls on specific strains—particularly HPV 16 and HPV 18. Known as the “high-risk” duo, these strains have a notorious correlation with various cancer types.
According to the American Cancer Society, HPV manufactures two key proteins: E6 and E7. These proteins have the ability to switch off important genes that generally help to keep cell growth in check, namely Rb and p53. When HPV makes itself at home in the throat, these proteins run rampant, potentially setting the stage for abnormal cell growth that has the potential to lead to cancer.
The chance of developing oropharyngeal cancer is linked strongly to one’s sexual history—specifically the number of partners with whom oral sex was practiced. A 2021 study in the medical journal Cancer sheds light on these startling connections. Those who have had oral sex with five or more partners in their lifetime face a risk of HPV-related cancer that’s 2.5 times greater than individuals with fewer partners. The risk jumps to 4.3 times higher for those with 10 or more partners.
Studies indicate that the body’s immune system is able to purge most HPV infections within a couple of years. Yet, in about 1 in 10 cases, the virus plays a longer game, laying low within the body for many years, sometimes even decades.
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In these instances, after the initial contact and infection, the virus lays dormant, causing no noticeable symptoms in the infected person, until it springs back to life, causing health issues and potentially manifesting as cancer many years down the line. This period of dormancy is why HPV-related cancers are often diagnosed in middle-aged adults, despite the initial infection likely occurring much earlier in life.
Scrutinizing the Vaccine’s Role in the HPV Cancer Landscape
Medical experts disagree as to whether the significant rise in HPV-related cancers can be attributed to a lack of immunization.“We have a long way to go in educating the public about the importance of HPV vaccination in youth, and of the risk factors and warning signs of HPV-related cancers for adults who did not have an opportunity to get vaccinated in childhood,” Old said. “Data increasingly show this is a powerful tool to prevent cancers later in life.”
HPV is a risk factor for both men and women, experts say.
A preventive measure against the virus, the HPV vaccine is typically administered in two doses to those aged 9 to 14 and three doses to those aged 15 to 26. In October 2018, the FDA expanded use of the vaccine to include women and men aged 27 through 45.
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Strides have been made in controlling HPV infections and cervical pre-cancers since the HPV vaccine was introduced. Vaccines have demonstrated a high level of effectiveness—between 90 percent and 98 percent—in combating the rapidly growing, abnormal cells that could potentially lead to cancer.
A 2021 systematic review of nine studies involving 48,777 participants found a significant decrease in vaccine-type oral or oropharyngeal HPV infections among those who had been vaccinated, with a relative prevention percentage of around 83 percent. And nearly all of the participants developed HPV-16 IgG antibodies in oral fluids post-vaccination, indicating a potentially strong protective effect.
However, the vaccine may not provide the anticipated comprehensive solution. Research spearheaded by the Harvard T.H. Chan School of Public Health has called into question whether HPV vaccination is financially sensible for individuals older than 26. The study indicates that the health benefits tend to diminish with age while the expense attached considerably surpasses the quality-adjusted life years acquired.
“Our study found that the added health benefit of increasing the vaccination age limit beyond 26 years is minimal, and that the cost-effectiveness is much lower than in preadolescents, the target age group for the HPV vaccine,” Jane Kim, professor of health economics and lead author of the study, said in a statement.
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In addition to economic considerations, there have been safety issues linked with the vaccine. Reports from the FDA and CDC have underlined several concerning incidents related to Gardasil, the HPV vaccine. Side effects have been reported to span a broad range, from less severe issues such as fainting, fever, and dizziness to more alarming conditions such as Guillain-Barré syndrome, blood clots, nervous system disorders, and autoimmune disorders.
Moreover, the potential impact on fertility has prompted further concerns. Case series and VAERS report analyses have found a possible link between Gardasil and premature ovarian failure, leading to further investigations.
Finally, assessing the actual effectiveness of the HPV vaccine against any cancer is complex due to numerous challenges. Indeed, a significant issue is the relatively brief follow-up periods in most HPV clinical trials, which constrain the comprehensiveness of their results. There’s a pressing need for more extensive, longer-term investigations to grasp the full spectrum of the vaccine’s effects.
Preventing HPV-Related Cancer Through Awareness, Lifestyle Changes
Because HPV-related throat and mouth cancers, often asymptomatic, are spread via intimate contact, awareness is vital to prevention. Research shows that minimizing or abstaining from oral sexual activity can diminish the risk, but it’s not the only game-changer. Lifestyle choices are pivotal. Doctors single out alcohol, tobacco, and poor nutrition as extra risk escalators for oropharyngeal cancer. Thus, adopting a healthier lifestyle could serve as a vital shield.According to CDC guidelines, consistent and correct use of condoms and dental dams can lower the risk of HPV transmission. Nevertheless, completely avoiding genital contact remains the most effective prevention method. Engaging in monogamy or limiting the number of sexual partners also can play a pivotal role. While condoms provide some level of protection, it’s important to acknowledge their limitations due to potential skin-to-skin contact beyond the coverage.
Nutrition also enters the battle against head and neck cancers. A diet abundant in fruits and vegetables, especially those laden with antioxidants, offers valuable health advantages when it comes to battling HPV. Moreover, various nutritional elements—from spirulina and selenium to green tea and certain medicinal mushrooms—have shown promising signs in the fight against oropharyngeal cancer.
“We monitor women for HPV, but this should be a concern for people of all genders because partners expose partners,” Old said.
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