How can physicians heighten awareness of HPV-related head and neck cancer?

Recognize the new patient population.

In the past, the traditional patient diagnosed with head and neck cancer was aged 65 to 70 years and was a heavy smoker and heavy drinker. This demographic is changing; an increasing proportion of patients seen now are younger.

Patients with HPV-related head and cancer may be in their early 40s, have young children and may be of higher social economic stature. This distinct patient population accounts for an increasing percentage of patients seen in head and neck cancer clinics.

Additionally, this cancer historically affected predominantly men and rarely women. HPV-related cancer, however, affects both sexes. So we are seeing a shift in demographics.

Robert I. Haddad

There is currently no screening technique because it is a difficult virus to find, but clinicians and researchers are investigating ways to do this.

An appealing method and simple method is to check saliva for HPV infection. Although that test is being researched, it is not very reliable and is not ready for prime time at this stage.

Another possibility for screening is a blood test. This is also still at the research level and is not available to the general population. To be able to take a blood sample and test for HPV, like we do for HIV or other viral infections, would be ideal, but we just are not there yet.

One of the limitations for all these tests is how reliable they are in predicting future cancer development. Being positive for HPV infection does not necessarily mean the patient will go on to develop cancer. All that it gives us at this stage is a marker of increased risk.

Robert I. Haddad, MD, is an associate professor of medicine, Harvard Medical School, Boston.

Educate the public.

Head and Neck Cancer Awareness Week takes place each April. At the University of Wisconsin, we conduct a free oral screening clinic during this week. The clinic attracted 171 people this year. We had 15 physicians volunteering their time for this clinic and educating the public.

Most women know to have a mammogram and a Pap smear, and now most men know they should have their prostate checked after the age of 50. However, the public is not as familiar with head and neck cancers. This is a much less understood field, so efforts to promote head and neck cancer awareness and oral screening are highly valuable.

Paul M. Harari

The most common places for HPV-associated cancers are the tonsil and base of tongue. Although the base of tongue is a bit difficult for the general practitioner to visualize, we can easily see the tonsil region by simply having someone open their mouth and examining them with a light and tongue blades.

Oral screening is valuable and provides an important opportunity to identify early stage head and neck cancers where the cure rate is highest. With HPV and other head and neck cancers, it is important to make patients aware that if they have a sore in their mouth, a change in their voice, a lump in their neck, they should come in and see their physician.

The more we raise awareness, the more we will find cancers at an earlier stage. Head and neck cancer, like many other cancers, tends to be diagnosed at a more advanced stage, and often times, we just do not see people early enough.

Paul M. Harari, MD, is professor and chairman, department of human oncology, University of Wisconsin School of Medicine and Public Health, Madison.