HPV Is Not Just a Women’s Problem: Mouth and Throat Cancer Is Increasing in Men

JAMA Otolaryngology-Head & Neck Surgery published a study online on 16 December reporting that the incidence of oropharyngeal (mouth and throat) cancer continues to increase nationwide among men in the United States.

One of the leading causes of head and neck cancers is chronic infection with HPV (Human Papillomavirus). Among the 179 known HPV subtypes, those designated 16, 18, 31 and 33 carry a high cancer risk in humans. Different subtypes can produce different clinical effects, ranging from harmless warts to various cancers. HPV is associated with genital warts, head and neck cancer, vaginal-vulvar cancer, penile cancer, anal cancer and cervical cancer.

HPV and Head and Neck Cancers

The proportion of HPV-associated head and neck cancers is increasing. Previously, most head and neck cancers were caused by smoking and alcohol consumption, as is still the case in Turkey; today, HPV positivity accounts for more than half of head and neck cancers in Western societies. Recent studies have shown that 25% of head and neck cancers and 60% of oropharyngeal (oral cavity and throat) cancers are caused by HPV. 

The Study by Haluk Damgacıoğlu and Colleagues

Haluk Damgacıoğlu, Ph.D., and colleagues from the UTHealth Science Center in Houston used the United States Cancer Statistics dataset to examine trends in oropharyngeal cancer incidence (the rate of newly occurring cases within 1 year) from 2001 to 2017.

The researchers found 260 “bim” oropharyngeal cancer cases nationwide (the source’s wording), with 80 percent in men, 65 percent at early stages (stages 1-3), and 55 percent in the Southeast and Midwest.

Among men, oropharyngeal cancer incidence increased nationwide by 2.7 percent annually, particularly among non-Hispanic white men and men aged 65 or older (more than 3 percent per year). The most pronounced increases also clustered in the Southeast and Midwest (> 3.5 percent per year).

Among women, the annual percentage change was 0.5 percent. Among men, the incidence of regionally staged oropharyngeal cancer increased almost twice as much, compared with 1 percent per year in women. Mortality based on oropharyngeal cancer incidence (the death rate) increased by 2.1 percent per year among men from 2006 to 2017, while there was a 1.2 percent decline among women.

Conclusion

The substantial increase in early and regionally advanced oropharyngeal cancers (stages 1-3), and the recent simultaneous rise in mortality from these cancers among men, are concerning. Urgent awareness campaigns are needed to prevent these cancers. In this context, it is noteworthy that most mouth and throat cancers are HPV-associated and that a substantial proportion can be prevented through HPV vaccination; this information should be spread throughout society. Accordingly, vaccination is recommended for girls and women aged 9-26 and for boys and men aged 9-21. Age matters for immunity from HPV vaccination. The ideal vaccination age recommended for both sexes is 11-12.

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• Related topic: How safe is the HPV vaccine?