Head And Neck Cancer: Why Both Sexes Need The HPV Vaccine

Dr. Paula Johnson

This is a guest post by Paula A. Johnson, MD, MPH, Executive Director of the Connors Center for Women’s Health and Gender Biology, and Chief of the Division of Women’s Health at Brigham and Women’s Hospital and Robert Haddad, Chief of Head and Neck Oncology at Dana Farber/Brigham and Women’s Cancer Center, and Associate Professor of Medicine, Harvard Medical School

Dr. Robert Haddad

The rhetoric around the HPV vaccine and the recommendation that we vaccinate girls against cervical cancer has reached a fevered pitch. But while the HPV vaccine is being debated, a silent epidemic has gone unrecognized and is brewing. HPV has crossed gender lines and become the number one cause of oropharyngeal cancer in the nation for both men and women.

According to the National Cancer Institute, oropharyngeal cancer has reached epidemic proportions with over 20,000 new cases annually. This cancer attacks the middle part of the pharynx (throat) behind the mouth, and includes the back one-third of the tongue, the soft palate, the side and back walls of the throat, and the tonsils.

Whereas smoking and drinking were once the main causes of oropharyngeal cancer, a disturbing shift in the epidemiology to non-smokers and non-drinkers who are young (late thirties/early forties), and parenting young children is directly linked to HPV. At the Dana Farber/Brigham and Women’s Cancer Center (DF/BWCC), we see two new cases of HPV related oropharyngeal cancer per week with a rise in cases playing out across the U.S.

HPV is a silent risk factor because there are no symptoms. There is no test for HPV in men although women can find out they are infected by getting a Pap smear. When patients are diagnosed, they often ask about the risk of infection and HPV-related cancer in their spouse and children. Unfortunately, although we assume the risk is probably small, we have no way of really knowing given the lack of longitudinal data. Investigators at DF/BWCC are currently conducting research on the risk of HPV-associated oropharyngeal cancer in patients’ spouses and partners but those results may take several years to develop.

The resultant marital problems are not surprising; anger, guilt and shame around a sexually-transmitted disease linked to a cancer diagnosis compound an already stressful situation. Complicating matters is that there is no definitive way for a doctor to identify which partner was first infected with HPV. The shame and guilt are analogous to a smoker with lung cancer.

Fortunately, even at stage 4, the disease is highly curable. Treatment includes chemotherapy, radiation and surgery. Survival rates average 80-90 percent but a dearth of longitudinal data prevents a long-term prognosis. What we do know is that there are long-term side effects including persistent dry mouth, increased depression and anxiety and a loss of income due to missed employment. Dental problems resulting from the radiation can present a huge financial burden for patients.

Despite these sobering statistics, we can potentially stop the epidemic by vaccinating our children, both boys and girls, with girls benefiting from the additional protection against cervical cancer risk. Experts, including the FDA and CDC, now recommend that boys and girls between the ages of 9 and 26 receive the vaccine. However, we need to act now to benefit future generations as vaccine strategies can take decades to make an impact.

The HPV vaccine cuts across gender lines. It is as much a male issue as a female issue. In addition to educating the public, the medical establishment needs to acknowledge the link HPV has to, not one, but many types of cancer. We need to educate parents of the risks so they can make informed decisions when it comes to protecting their children during routine vaccination visits. By moving away from viewing the HPV vaccine as a political, moral or religious flashpoint, we can finally embrace this vaccine for what it truly is, a vaccine that reduces our children’s risk for certain types of cancer, and what we hope will be the first in a long line of vaccines against cancer during our lifetimes.

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