Human papillomavirus (HPV) is now the main cause of head and neck cancer in the USA

There is a continuous increase in oropharyngeal squamous cell carcinoma (OSCC), due to Human papiloma virus (HPV) that accounts for over half of the new cases. HPV (most commonly type 16) was found in 45% to 100% of OSCCs in various studies. Most patients are in individuals younger than 50 years, are Caucasians, males that are non alcohol consumers and non smokers. The cancer associated with HPV is mostly oral, tongue and tonsils. New data suggests that changes in sexual practices are behind the surge in OSCC cases linked to sexually transmitted HPV. The key factors appear to be multiple sex partners, starting sexual activity at a younger age, and practicing oral sex.

According to the CDC about half of all sexually active Americans will get HPV at some point in their lives. In the US, oral cancer due to HPV infection is now more common than oral cancer from tobacco use, which is still the main cause of such cancers in the rest of the world. Scientists found a 225-percent increase in oral cancer cases in the US from 1974 to 2007, mostly among white men.  The single greatest factor associated with the cancer  is the number of partners on whom the person has performed oral sex. Individuals who had performed oral sex on six or more partners over a lifetime face an eight-fold higher risk of acquiring HPV-related head or neck cancer than those with less than six partners.

While HPV cancer growth more rapidly it is easier to treat than non-HPV cancer and patient with HPV positive cancer have a lower risk of dying compared to those with HPV-negative cancer. These patients may need less radiation and chemotherapy to get better which means that they will have less side effects. However, studies that explore these issues are ongoing and there is not yet a consensus whether less treatment is best for these patients. A review of recent epidemiological studies can be found on this site.

There is promising research that may enable one day to treat those with HPV associated cancer by vaccinating them. Preliminary studies in animals show vaccination in conjunction with chemotherapy to be effective against the cancer.

It is yet unknown if the introduction of HPV vaccination during adolescence in boys and girls that was mainly done to reduce cervical cancer in women will decrease the rate of this cancer. It is possible now to find out if the cancer is caused by HPV or not which was not the case until recently.

All these new developments hold promise for better treatments in the future.
The CDC has informative site on HPV.

Michael Douglas recent diagnosis of throat cancer

The diagnosis of throat cancer in Michael (mike) Douglas is very sad news. The potential of losing his voice will be devastating to him as an actor. I wish him success in combating his illness. He is one of my favorite actors and I would like to see him continue his career.

From my own personal experiences I can imagine how devastating it was for Mike to learn about the diagnosis of throat cancer. This has ramifications on his ability to continue to act and his family. Face ones own mortality and the potential of losing ones voice are very difficult. Many people would like to keep their illness private as I did. However, as a celebrity this impossible. Hopefully the public’s support that he may receive will help him overcome the difficult period of radiation and chemotherapy that lies ahead.

As a celebrity whose career depends on his voice, Mike Douglas is facing difficult choices about what is the best treatment for him. I am wondering if the non surgical option that was offered to him was an attempt to spare his larynx. I hope that this treatment will work for him. To hear Mike Douglas describe his condition watch his interview with David Letterman on the Tonight Show.

As sad as this news is, it is an opportunity to remind everyone about the importance of avoiding smoking and excessive alcohol consumption. Unfortunately Michael Douglas had done booth.

It is also an opportunity to remind the public about the early signs of throat cancer so that it can be detected at an early stage. These include: sputum may appear bloody, lump may appear on the outside of the neck, abnormal-sounding breathing, chronic cough, neck pain or swelling, difficulty swallowing, persistent throat or ear pain and hoarseness. Individuals with these symptoms should be examined by their otolaryngologists as soon as possible.

After months of radiation and chemotherapy for late-stage throat cancer, actor Michael Douglas announced on January 11, 2011 on an NBC Today Show that he is tumor-free. No trace of the stage 4, walnut-size tumor at the base of his tongue could be detected on medical imaging, according to Douglas which is a sign complete response to treatment. He discussed the radiation side effects that he suffered that included weight loss and reduction of saliva production.

However, even in the absence of detectable disease, there is at risk for recurrence and prognosis depends significantly on the biology of the tumor. The risk of recurrence is the highest in the first 2 years after diagnosis and treatment. Regular follow up examinations that includes CT and PET scans are very important in ensuring early detection of cancer recurrence.

Tongue-base cancers that are caused by human papillomavirus (HPV) infection have generally excellent cure rates with a five-year survival ranging 70-80%. It is, however, It is unclear whether Douglas' cancer was positive for HPV.

Article in JAMA (Brook I. Rediscovering my voice. JAMA.2009; 302; 236.)

The article I wrote that describes regaining my speech was published in JAMA in the section: A Piece of My Mind.

To request a reprint contact the author.

Article in Archives of Otolaryngolgy Head and Neck Surgery ( Brook I. Neck Cancer- A Physicians’ Personal Experience. Arch Otolaryngol Head Neck Surg. 2009;135:118. )

The article I wrote about my personal experiences as a cancer patient was published in the Reflection section.

To request a reprint contact the author.