In the past, cancer of the throat was mainly a disease of heavy tobacco use and drinking. Thanks to a successful public health campaign promoting the dangers of smoking, overall rates of throat cancer have decreased.

But starting in the 1990s, a different type of this cancer began to strike more often, and rates have been increasing ever since. It’s called HPV-positive oropharyngeal cancer (HPV-OPC), which means cancer of the oropharynx (the middle part of the throat, including the base of the tongue and the tonsils) caused by the human papillomavirus (HPV).

If the acronym HPV sounds familiar, that’s because it’s the most common sexually transmitted infection in the United States. In fact, the U.S. Centers for Disease Control and Prevention says that nearly every sexually active person will come into contact with the virus at some point in their lifetime.

There are more than 100 strains, or types, of HPV. Some cause genital warts and others can cause cervical, vaginal, penile, anal, or throat cancer. That said, most people will never even know they’ve been infected, because their immune system clears the virus from their system, usually within two years.

If it doesn’t, HPV can cause trouble years, and even decades, after the initial infection. This is what we’re now seeing with HPV-OPC. The prevailing theory behind the rise in oral HPV is that oral sex has become much more commonplace, which increased the spread.

Actor Michael Douglas made headlines in 2013 when he was diagnosed with HPV-OPC in his late 60s, and he was outspoken about its oral sex link.

Who is most at risk?

Approximately 20,000 cases of oropharyngeal cancer cases are diagnosed in the United States annually. Of those, about 80 percent are caused by HPV. Men are three times more likely to be diagnosed with HPV-OPC than women. White, middle-aged and older men (ages 50 to 59) have the highest risk, especially those with a history of multiple oral sex partners and those who smoke. 

A specific strain of HPV called HPV16 is responsible for more than 90 percent of HPV-OPCs in the United States. HPV16 is one of the strains targeted by the Gardasil and Cervarix HPV vaccines. (HPV vaccination is recommended starting at age 9 and up until 26. Certain individuals between the ages of 26 and 45 may also be eligible for vaccination, based on their risk factors.)

Widespread vaccination has the potential to decrease rates of cervical and penile cancer and is also thought to protect against HPV-OPC when these vaccinated children, teens, and young adults are older. However, a 2021 JAMA Oncology study estimated that it will take more than 25 years until those effects can be seen. But because these vaccines became available only relatively recently, people who are currently in their 50s and older never had the chance to receive them.

What to look for

About 10 percent of men and 4 percent of women have detectable HPV in their mouths at any given time, and rates increase with age. That doesn’t mean all of them will go on to develop throat cancer: Most of them will clear the virus from their system before it can cause major trouble. Clinical trials are looking into whether screening may be warranted or effective.

Most people with HPV-OPC don’t have symptoms. Typically, patients have a painless lump in the neck (swollen lymph node). Some may have a sore throat, difficulty swallowing, or persistent earache.  If you notice any of these, it’s time to call your health-care provider.

Treatment options

Here’s some reassuring news: Patients with HPV-positive throat cancer tend to live longer than those with HPV-negative throat cancer, such as that caused by tobacco and/or alcohol use. If found early, the four-year survival rate for HPV-OPC is
87 percent.

Your doctor will test the tumor to determine whether it is HPV+ or HPV-. Treatment typically involves minimally invasive robotic surgery, neck surgery, and possibly radiation or a combination of radiation and chemotherapy. In the future, immunotherapy, a cancer treatment that recruits the body’s own immune system to fight cancer, might have a role, though it is still being studied.

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