HPV-Associated Head and Neck Cancer Rates on the Rise: What Physicians Need to Know

Human papilloma virus (HPV)-associated head and neck cancer is rising at a fast rate. This subset of head and neck cancer has some key differences from other head and neck cancer diagnoses. It’s associated with a younger, healthier patient population, and it tends to cause squamous cell carcinomas in the oropharyngeal or tonsillar areas. Patients typically have no symptoms and present with an isolated, persistent neck mass.

HPV-associated head and neck cancer generally has a very good prognosis that can exceed 90% for many patients.  There are various effective treatment options, which include:

1. A combination of chemotherapy and radiation up front – a treatment that has been effective for decades. 

2. Trans Oral Robotic Surgery followed by a course of reduced-dose radiation or no radiation at all.   

“At the University of Maryland Medical System, we’re pushing the envelope on reducing treatment side effects even more for these patients,” said surgical oncologist Kyle Hatten, MD, Associate Professor of Medicine and Chief of the Division of Head and Neck Surgery. “We recently completed a clinical trial where we reduced the radiation dose significantly, and it still had excellent effectiveness.  We are carefully reducing the radiation doses through clinical trials in an effort to optimize the opportunity for cure and minimize treatment related side effects.” 

Side effects from treatment for head and neck cancers can affect speech and swallowing, reducing the ability to eat and talk comfortably. Reducing the impact of these side effects translates to a real improvement in survivors’ quality of life. 

University of Maryland Medical System is actively engaging in clinical trial development to use new technologies and further reduce treatment-related side effects, including novel therapies to reduce radiation dose, shrink radiation treatment fields, and in some cases, remove radiation in general.  In April 2024, the health system opened a new study – A Single Arm Phase II Trial Evaluating Selective Adjuvant Therapy for HPV-mediated Oropharynx SCCs based on Residual Circulating Tumor DNA Levels (SAVAL) – that introduced a diagnostic tool that identifies tumor DNA in the blood after TORS. Patients with no tumor DNA after surgery can potentially avoid radiation altogether. 

Recommendations for identification and prevention with the HPV vaccine

If a patient presents with a neck mass and no other symptoms – order imaging to characterize the mass and identify whether it has suspicious features that may signal a malignancy. In terms of prevention, vaccines are the best course of action, if a patient is eligible. 

“The most important take-home message for physicians is that we now have a vaccine that can prevent certain types of cancer. It’s a groundbreaking vaccine all eligible patients should get, and if you don’t recommend it, you are missing an opportunity to prevent a deadly disease,” said V. Dixon King, MD,  Co-Medical Director of the University of Maryland Upper Chesapeake Health Kaufman Cancer Center. 

The vaccine’s protective effects must be in place before an individual gets exposed to the HPV virus through sexual contact. Nine out of 10 people are exposed to the HPV virus by age 25 or 30. The Centers for Disease Control and Prevention’s recommendations apply equally to all genders:

• Patients can receive the vaccine as early as age 9
• Typical start is at age 11 or 12
• If patients get their first dose before age 15, they only need two doses of the vaccine
• From age 15 to 26, patients need three vaccine doses

The vaccine is approved up to age 45. Because the incidence of new infection drops dramatically in the 30s and 40s, vaccine administration in patients older than 26 should follow a conversation between clinician and patient. 

Dispelling misconceptions about the HPV vaccine:

• There is no evidence that the vaccine correlates to increased sexual activity
• The HPV vaccine’s side effects are the same as any other vaccine; it’s very safe
• Because there is no virus DNA in the vaccine – it’s impossible to get HPV from the vaccine

Effectiveness studies have shown dramatic results. Sweden started distributing the HPV vaccine in 2009. In 2020, they saw an 88-percent reduction in cervical cancer in women who had been vaccinated before age 17. “Raising awareness, dispelling myths, and making the HPV vaccine part of the routine pediatric vaccination schedule are the key ways to reduce HPV-related cancers in the future here in the U.S.,” Dr. King said. 

Refer a patient and learn more about head and neck cancer care today.