Cancer experts warn about wave of HPV-related cancers in adults

Experts are concerned about rapidly rising rates of HPV-related throat and mouth cancers, noting that if this trend continues, they could quickly be among the most common forms of cancer in adults between ages 45 and 65.

Recent estimates suggest that middle throat cancer (known medically as oropharyngeal cancer) may become one of the top three cancers among middle-aged men in the United States by 2045, and the most common form of cancer among elderly men in the next 10 years.

According to Matthew Old, MD, a head and neck surgeon at The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James), this rise of middle throat cancers in this age group is due to the direct impact of human papillomavirus (HPV) infection before modern vaccines were introduced in 2006.

HPV is a large group of viruses spread through skin-to-skin and oral contact that occurs during sexual activity. The virus spreads easily, and an estimated 98% of the population has been exposed to it. HPV can remain dormant for decades. High-risk strains of the virus have long been linked to increased risk of cervical cancer; however, data from the past decade shows high-risk HPV is also strongly linked to cancers of the head and neck (mouth, base of tongue and throat).

In 2006, Gardasil introduced an HPV vaccine, which is administered in youth between the ages of 9 and 12, the vaccine protects against the high-risk strains of the virus (HPV 16 and HPV 18) that are linked to cancer, including cervical, vulvar, throat, mouth, penis and anal cancer. There are many other HPV strains that cause non-cancer conditions such as genital warts.

Although it has been available for nearly two decades, lack of awareness about it as a means of cancer prevention in later life has slowed progress in preventing these cancers. The Centers for Disease Control and Prevention (CDC) estimates that timely HPV vaccination cold prevent 90% of cervical cancers alone. The National Cancer Institute estimates that as of 2020 just 54.5% of youth between the ages of 13 and 15 were vaccinated.

"We have a long way to go in educating the public about the importance of HPV vaccination in youth, and of the risk factors and warning signs of HPV-related cancers for adults who did not have an opportunity to get vaccinated in childhood," says Old. "I strongly encourage all parents with children of vaccination age to consider the HPV vaccine. Data increasingly show this is a powerful tool to prevent cancers later in life, and HPV is a risk factor that all genders should be aware of."

Electra Paskett, Ph.D., MSPH, a cancer epidemiologist and co-leader of the OSUCCC—James Cancer Control Program, said the conversation about the benefits of HPV vaccines among parents and health care providers needs to change.

"We need to shift the focus on HPV vaccination from preventing a sexually transmitted disease to preventing future cancers in order to stem the sharp increase in HPV-related cancers. The vaccine has historically been billed as way to prevent infection risk related to sexual activity. It's given in childhood not to encourage sexual activity at an early age, but because it is most effective at preventing HPV infection before the time of exposure and prevents cancer," Paskett said.

HPV vaccination is typically given in two doses between the ages of 9 and 14 and three doses in those ages 15 through 26. While HPV vaccination in adulthood is thought to provide less benefit because most people have already been exposed to HPV, it is now also available for individuals from ages 27 to 45 with a shared decision-making discussion with a health care provider.

According to data from the CDC, there is significant progress in one area. HPV infections and cervical precancers (abnormal cells in the cervix) have dropped since 2006, when the HPV vaccines were first used in the United States. Among teen girls, HPV types that cause most HPV cancers and genital warts have dropped 88%. Infections among young adult women have dropped 81%. Among vaccinated women overall, the percentage of HPV-related precancers have also dropped by 40%.

"We monitor women for HPV, but this should be a concern for people of all genders because partners expose partners," Old said. "For adults considering HPV vaccination, I encourage you have a frank conversation with your doctor about whether it could be right for you. If you know you have been exposed to high-risk HPV, there are ways you can help protect your partner and monitor any concerning symptoms for yourself."