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The Sidney Kimmel Comprehensive Cancer Center

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Risk and Screening

Head and neck cancers are diagnosed in more than 70,000 Americans each year. Men are nearly three times more likely than women to develop the disease. Head and neck cancers include cancers of the mouth, such as lip and tongue, the pharynx (throat) and the larynx (voice box).


Common symptoms found in several head and neck cancer sites include a lump or sore that does not heal a sore throat that does not go away, difficulty swallowing and a change or hoarseness in the voice. Other symptoms, depending on the location of the cancer, may include white or red patches on the gums, tongue, or lining of the mouth; jaw swelling that causes dentures to fit poorly or become uncomfortable; unusual bleeding or pain in the mouth; chronic sinus infections that do not respond to antibiotic treatment; nose bleeds; frequent headaches; numbness or paralysis of the facial muscles; ear pain; trouble hearing; or a ringing in the ears. Because these symptoms may result from cancer or other conditions, it is important to be evaluated by a physician to get the right diagnosis and treatment.

Risk Factors

An estimated 85 percent of head and neck cancers, especially of the oral cavity, oropharynx, hypopharynx and larynx, are linked to tobacco use. Risk factors for head and neck cancers include cigarette smoking, excessive alcohol consumption and chewing smokeless tobacco. Johns Hopkins experts have found that people who smoke one pack of cigarettes per day are six times more likely than nonsmokers to get cancer of the head and neck. Those who also have two alcoholic drinks each day increase their risk 20 times.

Additional risk factors include sun exposure; radiation; inhalation of asbestos or wood or nickel dust; or poor oral hygiene.

HPV-related Head and Neck Cancer

The human papillomavirus (HPV), a common sexually transmitted disease, is associated with the development of some head and neck cancers, particularly in the upper throat and back of the tongue. It has been observed in up to 72 percent of patients. This information was first reported by Johns Hopkins researchers directed by Dr. Maura Gillison in 2000. Dr. Gillison’s research has shown than HPV-linked cancer has nearly doubled in incidence in the United States during the past 30 years. Oral HPV infection is the strongest risk factor for the disease.

Risk factors for HPV-related head and neck cancers include certain sexual behaviors and smoking marijuana, Dr. Gillison’s research has found. The sex behaviors associated with HPV-positive cancers include increasing numbers of lifetime vaginal or oral sex partners, participating in casual sex at least once, infrequent use of barriers during vaginal or oral sex, and having had at least one sexually transmitted disease. Regarding marijuana use, research has noted that people who smoked marijuana for at least five years were 11 times more likely to develop HPV-positive cancers.

Screening Test Research

Researchers at Johns Hopkins are working to develop a screening test that could detect the presence of certain head and neck cancers based on compounds found in saliva. Scientists led by Dr. Joseph Califano have found that by looking at saliva samples from patients with cancer, it was possible to accurately detect cancer about 42 percent of the time.

The screening test focuses on finding cells with genetic signatures suggesting the presence of these cancers. In a trial of this “swish-and-spit” test, patients were asked to brush the inside of their mouths, then rinse and gargle with a salt solution. The scientists filtered out cells in the rinsed saliva that containing one or more of 21 bits of chemically altered genes associated with head and neck cancers. More information