1. Information for the patient on Human Papilloma
Virus (HPV) and Head and Neck Cancers
The Education Committee- 2012
David Goldenberg- Chair
Kavita M Pattani,
Miriam Lango
Ellie Maghami
Erich M. Sturgis
Theodoros Teknos

2. Human Papilloma Virus (HPV):
Definition
 Human Papillomavirus (HPV) has the
ability to be transmitted from person to
person
 Over 120 subtypes have been identified and
characterized into “low-risk” and “high-
risk” and are referred to by number
 ****One of the most significant infectious carcinogens in
humans

3. HPV and Cancer
 “Low risk” HPV subtypes can cause genital
warts but rarely cause cancer.
 “High-risk” HPV can cause several types of
cancer in men and women
 Cancer of the cervix, vulva and vagina
 Cancer of the penis and anus
 Head and Neck cancers – specifically the
oropharynx

4. HPV- Transmission
 HPV is the most common sexually
transmitted infection in the United States
 >50% of people who are sexually active will
have acquired genital HPV over their
lifetime
 >80% of women over the age of 50 will have
contracted at least one strain of HPV
 The lag time between exposure and
diagnosis of cancer can be 20-30 years

5. HPV-Transmission
 HPV can be passed through genital contact
and oral sex
 7% of the general population (age 14-69) has
a throat infection caused by HPV at any
given time
 However, only 1% is infected with the type that
causes cancer
 3% of 16 - 20 year-olds

6. HPV – Signs/Symptoms
 In >90% of cases the body’s immune system
will clear the HPV (usually within 9 months
to 2 years)
 Majority of patients develop no signs or
symptoms of infection and thus infected
individuals can remain oblivious
**** Cancer occurs when infection persists & body’s defenses fail

7. Who is at risk for HPV infection
of the Oropharynx
 Increasing age
 HPV infection is found in 2% of 14-17 year olds
but 11% of 55-64 year olds
 Men
 HPV infection is more common in men than
women (10% of men and 4% of women are
infected)

8. Who is at risk for HPV infection
of the Oropharynx
 Sexual activity
 HPV infection is extremely uncommon (<1%) in
those who report no sexual activity, and those
who received the HPV vaccine
 Risk of HPV increases with number of sexual
partners. People reporting greater than 20
previous sex partners have the highest rates of
HPV throat infection
 Sexual activity years ago can still result in HPV
infection and resultant cancer

9. Who is at risk for HPV infection
 Smoking
 People who smoke may be at greater risk for
getting an HPV infection in the throat. Those
who smoke more are more likely to get infected:
 20% of those who smoke at least a pack of cigarettes
a day were found to have an active HPV infection

10. Treating HPV infection
 There is no known treatment for HPV infection
 In >90% of cases the body’s immune system will
clear the HPV on its own (usually within 9 months
to 2 years)
 In some people, the immune system is unable to
clear the HPV infection. Some of those people will
develop cancer but it will take 20 or more years.
 The reason that some individuals are not able to
clear the HPV infection, and go on to develop
cancer is unknown

11. How do you prevent HPV infection?
 Prevention of HPV infection:
 Abstinence
 Condoms provide only partial protection
 Vaccination may provide protection against the
most common “high-risk” HPV infections, but not
against all HPV subtypes that cause cancer
 For this reason, routine screening with PAP smears is
still recommended to detect cervical and anal cancers
 There is currently no approved test to screen for throat
cancer
 Data is not yet available regarding the effectiveness of
the vaccination

12. Vaccination
 Centers for Disease Control and Prevention
(CDC) now recommends
 HPV vaccination for both boys and girls as of
2011
 However, since vaccination is not
mandatory
 <50% of teenage girls have received the
vaccination last year

13. FDA-approved HPV vaccines
 Gardasil (Merck)
 Approved for boys and girls, age 9-26
 Covers HPV types 6, 11, 16 and 18
 Cervarix (GlaxoSmithKline)
 Approved for girls, age 10-25
 Covers HPV types 16 and 18

14. Timing of Vaccination
 Vaccination is recommended prior to the
start of sexual activity
 “Catch up” vaccinations may be
administered to girls and boys aged 13-25,
 However, vaccination is ineffective in those
already infected with HPV

15. HPV - Vaccination
 Length of protection against HPV infection
following vaccination
 Is unknown
 Protection lasts at least 5 years, but length of
protection continues to be studied
 Safety
 Not yet fully determined
 Reported rare side effects have included fainting
and blood clots

16. Screening for HPV-related cancers
 There is no blood test to screen for HPV
infection
 Screening for cervical/anal cancers:
 PAP smear
 Used to screen for cervical and anal cancers and pre-
cancers
 HPV DNA test
 is more sensitive than PAP smear, as a screening test
for cervical cancer and pre-cancer
 has not been studied as a screening test for throat
cancer

17. Screening for HPV-related cancers
 Screening for oropharyngeal cancer
 There are currently no screening tests approved
for the early detection of throat cancer caused
by HPV
 A comprehensive physical examination (and
biopsy if needed) by an otolaryngologist/
head and neck surgeon is essential to
establish the diagnosis

18. What is the Oropharynx?
 The oropharynx consists of: tonsils and tonsillar
fossa, base of tongue, soft palate including the
uvula, pharyngeal wall, anterior and posterior
tonsillar pillars
 The oral tongue (anterior portion) is not a part of
the oropharynx

19. Oropharynx cancer caused by
HPV
 The incidence of oropharynx cancer caused by
HPV in the United States is increasing, and is
believed to be caused by changes in sexual
practices

20. Oropharynx Cancer:
Signs/Symptoms
 Common
 Persistent mass in the neck
 Less common
 Difficulty swallowing
 Persistent sore throat
 Ear pain
 Weight loss
 Bleeding from throat

21. Oropharynx cancer caused by
HPV
 Can occur in young people
 Who are otherwise healthy
 With an otherwise healthy life-style
 Who never smoked cigarettes
 Many people develop a prominent neck
mass, and the oropharynx cancer itself may
be small, and barely visible

22. Diagnosis
 Referral to an Ear, Nose and Throat
specialist, or Head and Neck Surgeon is
needed
 A physical examination, biopsy and
imaging studies may be recommended

23. HPV Testing
 Testing for HPV status for biopsies obtained
from the oropharynx area or from neck mass
if present can result in diagnosis.
 p16 will also routinely be tested which
indicates HPV etiology as well

24. Oropharynx cancer caused by
HPV - Treatment
 Oropharynx cancer caused by HPV
frequently responds well to treatment.
 The type of treatment is determined by the
extent of the cancer, and whether it has
spread. Often, a combination of treatments
is recommended,
 For example, surgery and radiation, or radiation
and chemotherapy

25. Oropharynx cancer caused by
HPV - Treatment
 Prognosis for Oropharynx cancers that are
HPV positive is very good given the
available treatment options
 Consultation at an institution with expertise
in the treatment of such cancers is
recommended.

26. Frequently asked Questions
 Can I get cancer from my spouse who has HPV
positive tonsil cancer?
 Most adults in the United states have already been
exposed to HPV by the time they are in their 50’s
 Greater than 90% of individuals mount an effective
immune system and clear the infection within two
years of exposure
 Those with HPV associated cancers probably
became infected 20-30 years prior to current cancer
diagnosis as a young adult

27.  If you have been in a long-term monogamous
relationship there is very little concern as you
have probably already been exposed to the virus
and acquired natural immunity; the medical
evidence so far does not call for lifestyle
modifications in this setting
 If you are a young adult under age 26 consider
getting vaccinated and being more selective and
conservative in your sexual practices

28.  There is some evidence that the HPV virus can
even be passed along with mouth to mouth
kissing but this needs to be examined
scientifically with further studies