HPV and Head & Neck Cancer

What is HPV?

Human papillomavirus (HPV) is the broad term for a group of viruses. Certain types of HPV cause warts on the skin and others cause warts in the genital region. Some types of HPV are known to cause cervical cancers, as well as cancers of the anus, penis, vulva, vagina and head and neck.

What is HPV-related Head and Neck Cancer?

HPV-related head and neck cancers occur primarily in the oropharynx ( tonsils and the back of the tongue ). Oropharyngeal cancers are more common in white men. Most head and neck cancers are caused by tobacco and alcohol use, but researchers believe that up to 80% of oropharyngeal cancers in the U.S. are due to infection with the HPV virus. HPV-related head and neck cancer occurs in both people who smoke and those who do not smoke.

How can I get tested for HPV?

For women, annual tests done by gynecologists screen for pre-cancerous changes caused by HPV infection in the cervix. There is similar screening for anal HPV infections as well, however; for oral HPV infection, there is currently no common clinical test used to detect previous or current HPV infection. Research at Johns Hopkins and elsewhere is underway to develop such tests. If you are concerned about your risk for HPV in the head and neck region, you should be evaluated by an otolaryngologist or your primary care physician with a complete head and neck exam, who will look for lesions that may be caused by HPV. It also is important to be aware of changes that occur in your body by routinely looking at the back of your throat (when brushing your teeth) and checking for lumps in your neck ( for example, while shaving). If you find any new lumps in the back of your throat or neck, seek further evaluation by your primary care physician or otolaryngologist. Find an otolaryngologist in your area through the American Academy of Otolaryngology.

What are the signs and symptoms of HPV infection?

Most people infected with HPV don’t know they are infected. Their immune system is able to clear the virus from their body. A small percentage of people can’t clear the virus and may develop problems ranging from benign skin warts to abnormal cell growth that could lead to cancer.

How common is HPV?

It is estimated that 20 million people in the U.S. currently have HPV infection. One in 49 people will get a new HPV infection each year. HPV infection is very common. Most sexually active people have had an HPV infection at some point in their lives, although many never know they were infected.

What should I know about HPV?

HPV is a common infection. In 90 percent of cases, the body’s immune system is able to clear the genital and anal HPV infection within two years. We do not know how long it takes to clear oral HPV infections, but the timeframe may be similar. Most people will not have any health problems related to HPV infection.

Is there a vaccine for HPV?

There are two vaccines – Cervarix and Gardasil -- commercially available that protect against infection with certain types of HPV. These vaccines prevent only new HPV infections but do not cure HPV infections you already have. Immunization is recommended for 11 and 12 year-old girls, and the vaccine is approved for girls and women aged 13 – 26. Gardasil is also approved for boys and men aged 9 - 26 and was found to protect against most genital warts and anal cancer. Learn more about HPV vaccines from the Centers for Disease Control.

How is HPV transmitted?

HPV can be transmitted by sexual contact. HPV is found in saliva, semen and genital secretions. Benign skin warts, caused by certain types of HPV, are transmitted through skin-to-skin contact. The types of HPV that can cause cancer are not casually transmitted. Active research is ongoing to determine risk factors for oral HPV infection. Since HPV is sexually transmitted, safe sex practices such as using a condom can generally decrease your risk for infection. They may not fully protect against HPV, as with genital and benign skin warts. Both men and women get HPV infections and can spread them.

I have lesions in my mouth/throat – what do I do?

You should be evaluated by your primary care physician or an otolaryngologist to obtain a complete head and neck examination. Find an otolaryngologist.

I have head and neck cancer – how do I know if it was caused by HPV?

The only way that head and neck cancers can be evaluated for the presence of HPV is to biopsy the lesion and test it for the presence of HPV DNA. Not all surgeons and hospitals routinely test for HPV, so please be sure to ask your doctor. Patients who have already completed surgery ,for head and neck cancer ,can find out if their cancer is HPV related if the pathology sample is still available. Ask your surgeon or doctor for the nearest facility to test your pathology sample for HPV DNA. If there is not a local facility which performs these tests, please refer to the Johns Hopkins Pathology Department for HPV testing of tumors.

Why should I get my head and neck cancer tested for HPV?

Knowing whether your cancer was caused by HPV may help physicians determine your prognosis for survival. Head and neck cancers caused by HPV infection tend to respond better to current treatments as compared to head and neck cancers caused by tobacco or alcohol use. There are also new treatment options such as vaccine clinical trials and de-intensification chemoradiation protocols available to patients whose cancers are caused by HPV.

How do I join the HOTSPOT study?

The HPV Oral Transmission Study in Partners Over Time (HOTSPOT) is being led by Dr. Gypsyamber D’Souza at the Johns Hopkins Bloomberg School of Public Health and enrollment is ongoing at four institutions (Dana Farber, Mount Sinai, Oregon Health Science University, and Johns Hopkins) across the nation. In order to better understand risk of oral HPV infection in high-risk partners, researchers will evaluate oral HPV infection in HPV-positive oropharyngeal cancer patients and their sexual partners. Patients must be newly-diagnosed with head and neck cancer that is suspected to be HPV-positive. Study participants are enrolled shortly before undergoing initial therapy for their cancer. We cannot enroll patients who have already received treatment. The researchers are evaluating factors including age, oral hygiene, marijuana and tobacco use, sexual behavior and other factors associated with persistent and newly-detected oral HPV infection in partners. Partners of study participants will receive a free head and neck examination. Study participants must travel to the institution conducting the study. They include:

Johns Hopkins School of Public Health
Overall study Principal Investigator: Gypsyamber D’Souza, PhD
410-502-2583

Johns Hopkins Hospital
Site Principle Investigator:  Sara I. Pai, MD, PhD
410-502-9825

Dana Farber
Site Principle Investigator:  Robert Haddad, MD
617-632-3090

Mount Sinai Medical Center
Site Principle Investigator:  Marshall Posner, MD
212-241-6756

Oregon Health Science University
Site Principle Investigator:  Neil Gross, MD
503-494-3649