HPV in Head and Neck Cancer

What is human papillomavirus?

Human papillomavirus, abbreviated as ‘HPV’, is a very common virus that will infect the majority of people at some point in their life. It can affect the skin and the moist membranes that line certain parts of the body in several areas, including the:

  • Mouth and throat
  • Anus
  • Cervix
  • Penile
  • Vagina
  • Vulva

Over 100 different types of HPV have been identified, with each type known by a number. Some types of HPV have been linked to non-cancerous lesions, but other types are known to cause cancer. For many people, HPV infections come and go without any symptoms. In fact, the virus may remain inactive for months without any symptoms; if you do not get rid of the infection you may develop cancer. However, most people clear the virus without even knowing it, and as such, the probability of developing cancer is low.

What is the link between HPV and cancer?

Some types of HPV, known as ‘high-risk’ HPVs, are known to increase the risk of developing particular types of cancer, including anal, cervical, penile, vulva, vaginal and head and neck cancers. Recent estimates suggest that over 5% of all cancers are attributed to HPV. HPV can cause cancers in the back of the throat, the base of the tongue, and the tonsils, which is an area known as the oropharynx. These cancers are called oropharyngeal cancers and are part of the group known as head and neck cancers. It is estimated that about every year 45,000 new head and neck cancer cases can be attributed to HPV infection worldwide.

The type of HPV most widely linked to cancer is HPV-16; it is accountable for 50-60% of cervical cancers and 80-90% of non-cervical cancers, such as head and neck cancers. Other types of high-risk HPVs linked to head and neck cancers are HPV-18, 31 and 33, but these are much rarer than HPV-16.

How common are HPV-related head and neck cancers?

The incidence of HPV-related head and neck cancer is increasing quickly worldwide. Patients with HPV-related head and neck cancer are generally younger, in good health, and may not have a typical history of tobacco and/or alcohol abuse. Worldwide it is estimated that of all patients with oropharyngeal cancer, HPV is responsible in 18.5%-90%. The range worldwide varies due to cultural differences, range in medical practice standards and diagnosis rates per country.

New research has identified a link between HPV-related head and neck cancer and sexual behaviour. While HPV can be transmitted after just one sexual encounter, the risk increases with the number of sexual partners a person has.

Can I be vaccinated against HPV?

There are currently three vaccines available that provide protection against a number of types of HPV—Cervarix®, Gardasil®, and Gardasil 9®. These vaccines are currently recommended for both males and females, aged between 11 and 12 years old, to provide protection against a number of diseases caused by HPV, including cervical and head and neck cancers. Please note: vaccination recommendations vary according to country. Please contact your local physician for more information. All three approved vaccines target HPV-16, which is responsible for approximately 90% of head and neck cancers. All HPV vaccines are currently preventative and are not effective in treating the infection once cancer has been established.

In recent years, HPV vaccination has become an established medical practice; however, further studies will be required to confirm whether vaccines have been effective in preventing HPV-related head and neck cancers.  

What does the future hold?

While vaccination is a step forward in providing protection against HPV, there are still a number of people who do not receive the vaccine and remain unprotected.

Moving forward, research will focus on developing new vaccines that not only prevent infection, but also treat people with HPV-related cancers. Researchers have also found that patients diagnosed with HPV-related head and neck cancers tend to respond better to certain treatments than those who are not infected with HPV. Trials are currently underway to investigate whether HPV-infected head and neck cancer patients can receive a less intensive treatment which is equally effective but carries fewer side effects.

Additionally, counselling and counselling techniques are being investigated as they are important for the treatment and ongoing support of patients.