April is National Oral, Head, and Neck Cancer Awareness Month. Although oral, head and neck cancer is the 6th leading cancer by incidence worldwide, it does not get as much publicity as other types of cancers. We turned to the Head and Neck Cancer Alliance to shed light on public perception, symptoms, risk factors, prevention, and the importance of screening of oral, head, and neck cancer.
Oral, head and neck cancer tends to be sidelined in the public perception. What is the reason for this neglect?
Although head and neck cancer is the 6th most common cancer by incidence worldwide, few people know enough about it. There may be a few reasons for this. First, while other cancers like breast cancer or colorectal cancer affect one anatomical part of the body, head and neck cancer can affect many parts (e.g., the tonsils, tongue, sinuses, etc.). Head and neck cancer is more of a “family” of cancers rather than a cancer affecting one area. Since we’re talking about cancer that affects many parts of the body, the public likely doesn’t see it as “one” cancer.
The second reason likely has to do with its historical risk factors. In the past, the majority of head and neck cancers were caused by tobacco use and heavy alcohol consumption, so there is a stigma that may be associated with this cancer. In the public perception, we believe that many people still harbor the idea that patients “did it to themselves”. Although this has never been a fair perception, nor an accurate one (especially today), it likely impacts the public’s perception about how much attention they need to pay to it, particularly if they do not use tobacco or consider themselves heavy drinkers.
“Since we’re talking about cancer that affects many parts of the body, the public likely doesn’t see it as “one” cancer.”
What are the symptoms of oral, head and neck cancer?
The symptoms of head and neck cancer can vary by the part of the body affected, for example:
- Mouth cancer symptoms may include a white or red patch on the gums, the tongue, or the lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.
- Throat cancer symptoms may include swollen lymph nodes in the neck; trouble breathing, speaking or swallowing; pain when swallowing; pain in the neck, the throat or one ear that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing.
- Cancer of the larynx (voice box) may first appear as changes in the voice, like hoarseness that doesn’t go away, pain when swallowing or ear pain.
- Paranasal sinuses and nasal cavity symptoms include sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.
- Cancer of the salivary glands may first appear as swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away.
Alcohol and tobacco are the two most important risk factors for oral, head and neck cancer. How have restrictions on the sale and consumption of alcohol and smoking bans affected cancer rates, especially the incidence of oral, head and neck cancer?
In the past several decades, we have seen a decline in head and neck cancers caused by the traditional risk factors of tobacco use and heavy alcohol consumption. This is likely due to increased awareness of health risks, improved public health and policy measures and increasing support and resources for tobacco cessation. However, while many types of cancer have been declining overall, the rates of head and neck cancer have actually been increasing overall, despite the reduction in cases caused by tobacco and alcohol use. This increase is due to infection with human papillomavirus (HPV), a major risk factor for cancer of the pharynx (throat).
“The rates of head and neck cancer have actually been increasing overall.”
With the vaccination against HPF available since 2006 the cases of cervical cancer, which are commonly associated with an HPV infection, have declined. Have the cases of oral, head and neck cancer which are due to HPV infection declined accordingly? If not, why is this and what should be done?
At this time, we have not yet seen decreases in head and neck cancer rates as a result of HPV vaccination. However, we do hope to see that occur in the coming decades as we know there is a significant latency in HPV infection leading to head and neck cancer. So, this all comes down to timing. The HPV vaccine is meant to be given to preteens, around the ages of 11 to 12 years old. Because the vaccine has only been available for 16 years, those who were among the first to be vaccinated are only in their mid to late 20s. Additionally, when it was first introduced, the HPV vaccine was heavily targeted to girls (due to its association with cervical cancer), so many boys who could have been vaccinated, were not. Unfortunately, HPV-related head and neck cancer affects males 3 to 4 times as often as females. So, there are many young men out there who are unprotected.
As head and neck cancer caused by HPV infection does not occur for many years after exposure to the virus, sometimes decades later, those who are being diagnosed today with HPV-related head and neck cancer would not have had access to the vaccine when they were preteens because it was not yet available. As the first cohorts of HPV-vaccinated individuals reach adulthood and move toward middle age, we are hopeful that there will be obvious and significant decreases in the rates of HPV-related head and neck cancer.
“At this time, we have not yet seen decreases in head and neck cancer rates as a result of HPV vaccination.”
What should be done with regard to the prevention of oral, head and neck cancer, both by individuals and by politicians?
Individuals should take an active role in reducing their risk for head and neck cancer by quitting tobacco, reducing their consumption of alcohol, and using safe sex practices to prevent infection with HPV.
Those who have children—both girls and boys—should have them vaccinated against HPV to prevent the six types of cancer that HPV can cause, including head and neck cancer. There are six types of cancer caused by HPV (oral, head and neck, penis, anus, vagina, labia and cervix) that are, effectively, vaccine-preventable. To reduce the mortality rate and morbidities caused by cancer in future generations, it is important to act now, so that we can protect as many individuals as possible. The overall effect of reducing cancer rates and related morbidities within the healthcare sector could be significant and beneficial for everyone.
“It is important to act now to reduce the mortality rate and morbidities caused by cancer in future generations.”
As with many other types of cancer, early diagnosis is key to successful treatment. What do you recommend with regard to screening?
There are currently no screening tests for head and neck cancer like there are for cervical cancer (Pap test), breast cancer (mammograms), or colorectal cancer (colonoscopy). However, individuals can conduct self-exams of their mouth and neck to look for early symptoms that should be evaluated by a physician. To learn how to do a self-exam, visit this website. Individuals can also ask their dentist or physician to conduct a head and neck exam for them during their routine preventive visits.
Thank you very much for sharing your insight!