If HPV Causes Throat Cancer, Why Aren’t More People Getting Vaccinated?

A Keck Medicine of USC head and neck cancer surgeon discusses the need for more awareness among the public and even physicians.

It’s an established fact that human papillomavirus (HPV) can cause throat cancer. But only some physicians — and far fewer members of the public — know that today in the U.S., HPV actually causes more cases of throat cancer than it does cervical cancer.

“It’s a much bigger problem than a lot of doctors and people realize,” says Daniel Kwon, MD, a head and neck cancer surgeon with the USC Head and Neck Center at Keck Medicine of USC. The specialists at this center stem from the USC Caruso Department of Otolaryngology – Head and Neck Surgery and the USC Norris Comprehensive Cancer Center, both part of Keck Medicine.

Recently, researchers from the Keck School of Medicine of USC — including Kwon, who is an associate professor of clinical otolaryngology — examined survey data to see whether public awareness is growing about the link between HPV and throat cancer, known medically as oropharyngeal squamous cell carcinoma (OPSCC).

This link was first detected by researchers in 1985. Today, it’s established that most sexually active women and men will contract HPV at some point in their lives. In a small percentage of those people, the virus can develop into a chronic infection that ultimately disables cell regulation, leading to carcinogenesis.

To conduct their cross-sectional cohort study, the researchers took data from the National Cancer Institute’s Health Information National Trends Survey (HINTS). HINTS is regularly administered to measure Americans’ knowledge about cancer and health information related to cancer.

Kwon and his colleagues compared data from the 2018 and 2020 iterations of the survey. (In 2018, HINTS surveyed 3504 U.S. adults. In 2020, HINTS surveyed 3865 U.S. adults.) Respondents were asked about their knowledge of HPV; the types of cancer HPV can cause, including oral cancer; and HPV vaccinations.

What the researchers found was disappointing.

More awareness is needed about the link between HPV and throat cancer

“Basically, we found very little growth in people’s awareness that HPV causes throat cancer,” Kwon says. The lack of awareness is particularly notable considering that health advocates have issued more guidelines and recommendations about HPV and throat cancer in recent years.

“In 2020, for instance, the national vaccine guidelines included head and neck cancers as one of the primary diseases targeted by the HPV vaccine,” he says. In 2018, the American Cancer Society updated its staging system to recognize HPV-related throat cancers as a separate diagnosis. And in October 2018, FDA approved expanded use of the Gardasil 9 vaccine to an older age group — adults 27-45 years old — noting that “HPV viruses are associated with several other forms of cancer affecting men and women.”

“At this point,” says Kwon, “the link between HPV and throat cancer is absolutely established and there are not many more unanswered questions in this regard.”

What is needed is increased public awareness of the prevalence of HPV-related throat cancer — and the fact that HPV vaccines can help prevent HPV-related throat cancer. “We need to see this trickling down to actual patients,” he says.

HPV-related throat cancer on the rise

Because HPV awareness campaigns to date have largely targeted cervical cancer and women, more women today know that HPV can cause cervical cancer — and more are getting HPV vaccines to prevent the disease.

“There is a huge infrastructure built around Pap smears and cervical cancer, backed by a lot of recognition and health care funding,” Kwon says. “This is likely a big factor in why rates of cervical cancer have declined in women.”

But today, many people don’t know that HPV-related throat cancer is now more common than HPV-related cervical cancer.

One population at high risk of HPV-related throat cancer is men, who generally aren’t targeted by HPV messaging and who tend to get more throat cancer overall. Another disadvantaged population is people of poor socioeconomic status who are less health literate, less likely to have access to health care and less likely to get vaccinated.

“Traditionally, head and neck cancers have been stigmatized as diseases of the elderly, poor and minorities, including those who smoke and abuse alcohol and other substances,” Kwon says. This bias is one reason that funding for head and neck cancer awareness campaigns has paled in comparison to campaigns for other cancers such as breast, cervical and even thyroid cancer — diseases which are considered more common in affluent, white populations, he adds.

With HPV-related throat cancer impacting a broader population, stronger education is needed, Kwon and his co-authors state. “We should be informing people about this link,” he says.

At Keck Medicine of USC, Kwon says he and his colleagues are also studying better ways to detect throat cancer caused by HPV, including blood tests and liquid biopsies.

The slow progress in awareness is frustrating to see, especially because HPV-related throat cancer can be prevented by vaccines. “That’s the bottom line,” Kwon says. “This is a preventable cancer. We are seeing gaps in patient knowledge and even doctor knowledge. I would guess that there are a lot of primary care doctors and pediatricians who know there is some type of link, but they may not have all the up-to-date information. I think most doctors would be pretty shocked to learn there are more HPV throat cancers happening today than there are cervical cancers. Since doctors and other health care providers are at the forefront of patient education, we should all be talking to patients about this.”

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