Head and neck Cancers are on the rise— and younger men are at risk

For a long time, experts knew that HPV could raise a woman’s risk for cervical cancer. But there didn’t appear to be much risk for HPV-infected men. That’s changed. New research shows HPV is fueling a massive spike in oropharyngeal (head and neck) cancer among men. And surprisingly, some doctors say this form of cancer is showing up more and more among guys in their 20s and 30s.

“Traditionally, we thought of head and neck cancers as mostly due to excessive smoking and drinking,” says Brett Comer, M.D., an assistant professor of otolaryngology, as well as a surgeon, at the University of Kentucky.

Dr. Comer says that in the past, these cancers tended to show up during a man’s 50s, 60s, and beyond. “But for the past 20 years, we’ve seen those smoking- and drinking-related cancers go down, while HPV-related cancers have gone up,” he says.

At the same time, he says his patient population has shifted. “We’re seeing a lot of men in their 30s, and some even in their 20s, coming in with cancer at the base of their tongue, on their tonsils, and in their throat,” he says.

One recent study found the incidence of HPV-related oropharyngeal cancer jumped 225% between 1988 and 2004. In fact, this type of head and neck cancer is now the fastest growing form of cancer in America, according to the Oral Cancer Foundation. Another concerning studyfrom 2014 points to a big jump in oropharyngeal cancers among men in their 30s and early 40s.

So how does HPV cause cancer? In a nutshell, some strains of the HPV virus can shut down genes in the cells of your head and neck that suppress the growth of cancer cells, Dr. Comer explains.

“The human body, all the time, is trying to make cancer, but usually there are genetic safety mechanisms in place to keep cancer cells from proliferating,” he explains. “When you get a virus like HPV, it can turn off some of those mechanisms, and so allow cancer to proliferate.”

How Does the Cancer Show Up?

The cancer is often diagnosed when "someone will come in with a big neck mass or mass on their tonsils or pain in the throat,” Dr. Comer says. Once other causes are eliminated—common stuff like mono or tonsillitis, or enflamed lymph nodes due to a cold—a doctor can take a biopsy from the guy’s throat or tongue to check for cancer cells. If cancer is identified, the treatment could involve surgery, radiation, chemotherapy—or all three, Dr. Comer says.

The good news: “The young men we treat usually respond really well,” he says. There may be some chronic after-effects—stuff like dry mouth, sore throat, or issues swallowing—but the disease isn’t typically fatal, he adds.

Roughly 43 percent of Americans aged 18 to 59 are infected with some form of HPV, the CDC reports. “HPV is so common that nearly all sexually active people get it at some point in their lives,” the CDC says.

Dr. Comer says rates of HPV infections have been rising for decades, partly because there’s no way to tell if you’re infected. There are no obvious symptoms or red flags, so people spread it without realizing it.

But just because you may be infected with HPV doesn’t mean you have to freak out about cancer. Again, there are different forms of the HPV virus, and only a few of them seem to promote head and neck cancers, Dr. Comer says.

“About 7 percent of people carry the HPV virus that causes these cancers, but only 1% of those carriers develop cancer,” he adds.

It’s the fastest growing cancer, but your relative odds of contracting lung cancer or prostate cancer are still far greater, the CDC says.

There’s an effective vaccine against HPV, and taking it can cut a young person’s risk for oral HPV infections by 88 percent, according to a recent study from Ohio State University.

But if you’re over 21 or have been sexually active for a while, the CDC doesn’t recommend the vaccine. “It tends not to work as well if you’re older,” Dr. Comer says. “It’s usually recommended for kids prior to age 12.”

Using a dental dam or a condom during oral sex may be one way to limit your risks. “We think oral sex raises the likelihood you’ll get it,” he says. “If semen or vaginal fluids are going in the throat and touching those tissues, that could lead to the infection.” If your partner is female, you could ask them to get an HPV test. But a negative test doesn't ensure your partner isn't carrying the virus, and there is no HPV test for men, according to the American Cancer Society.

As of right now, there’s no way to have yourself screened for head and neck cancers in order to identify them early. “That would be incredibly painful, and we would never do it unless there was a mass or pain, or something to indicate the presence of existing cancer,” Dr. Comer says.

“I wish I had a better solution, but there’s really nothing you can do right now to protect yourself, other than limiting your number of sexual partners, which is easier said than done,” he adds.