Preventing throat cancer: The importance of vaccination and screening

The human papillomavirus (HPV) can cause genital warts and several types of cancer, including cervical and oropharyngeal, or throat cancer. There are more than 100 strains of the HPV virus, transmitted through sexual contact or direct skin contact, and experts believe the vast majority of people will be infected at some point in their life, according to Dr. Erich Sturgis, director of the Head, Neck and Thyroid Cancer Multidisciplinary Program at the Dan L Duncan Comprehensive Cancer Center at Baylor St. Luke’s Medical Center.

Fortunately, the HPV vaccine protects against the nine most dangerous strains of HPV.

Is the HPV vaccine right for me?

The CDC recommends vaccinating children at age 11 or 12, but vaccination can begin as early as age 9 and is recommended for all teens and young adults up to age 26.

“We want people to get vaccinated before they’re exposed to the virus, and most people will be exposed as they become sexually active,” said Sturgis, professor and vice chair of clinical affairs in the Bobby R. Alford Department of Otolaryngology – Head and Neck Surgery and Brown Foundation Endowed Chair at Baylor College of Medicine. “After you’re exposed to the virus, the cells in your throat may begin to change, even if it takes decades to become cancer. At that point, the vaccine wouldn’t be effective.”

In 2018, the FDA approved the vaccine for people up to age 45. According to Sturgis, people who were not vaccinated as a child still may benefit from getting vaccinated later in life. He recommends speaking to your doctor to assess your risk level and to determine if the HPV vaccine is right for you.

“For example, if you are recently divorced and have started dating again, you may be at risk for new exposure to the virus,” Sturgis said. “The vaccine is not going to be 100% protective because it won’t reverse exposures in your past, but it could prevent new exposures.”

HPV-related throat cancer on the rise

Preventing new HPV cases with the vaccine is especially important now as Sturgis and other otolaryngologists have seen a rise in HPV-related throat cancer. That’s in part because the disease does not have recognizable symptoms and is hard to catch early. The cancer starts in the tonsils or the base of the tongue, but the tumor usually doesn’t cause any pain or trouble swallowing until it has grown substantially. Often, the cancer goes unnoticed until it has already spread.

“The most common story I hear from men with this cancer is that they noticed a lump in their neck while shaving,” Sturgis said. “The lump is actually cancer that has spread to the lymph node. That’s worrisome because advanced cancer means more intensive treatment.”

The standard therapy for advanced throat cancer includes six weeks of radiation therapy – often coupled with chemotherapy, which can be extremely damaging to throat tissue, and results in scarring, stiffness and swelling. Some survivors will lose the ability to swallow and may require a feeding tube. A small percentage of survivors may suffer death of the jawbone, requiring surgery to remove the bone.

“The cure rates at five years are quite good, but survivors are still at higher risk of early death due to long-term effects of the cancer treatment.”

Screening for throat cancer

To prevent the need for radiation therapy and the dangerous side effects that come with it, Sturgis and his team at Baylor are working to develop an effective screening process for HPV-related throat cancer.

“With the Pap smear test, we can screen effectively for cervical cancer, and we catch a lot of cases before they develop into cancer,” Sturgis said. “But we still don’t have a way to screen for throat cancer.”

Sturgis is conducting a study to screen for HPV biomarkers in men aged 50 to 64. It includes a blood test and an oral rinse. Participants who are identified to have a higher risk for developing cancer will be selected for further in-person screening. Sturgis hopes this test will prove effective at helping to diagnose throat cancer patients earlier.

“If you’re diagnosed earlier, your options change,” he said. “You might be able to have surgery to remove tonsils. You may not need radiation, which would help avoid the long-term effects. Eventually, the hope is that we can identify high risk individuals and catch these things before they become an invasive cancer.”

Additional Resources

Learn more about the throat cancer screening study and how to participate.

See information about head and neck cancer care at the Dan L Duncan Comprehensive Cancer Center.

-By Molly Chiu