Throat Cancers Caused by HPV Are on the Rise, But It’s About More Than Oral Sex

Rates of oropharyngeal cancer — a type of cancer that affects the tonsils and back of the throat — have been rising rapidly over the past two decades.

About 70 percent of cases of this kind of throat cancer are caused by the human papillomavirus (HPV), according to the Centers for Disease Control and Prevention (CDC), which is a virus that also causes cervical and anal cancers. While some are quick to blame increased acceptance of oral sex over the past few decades, some experts warn there’s more to it.

“One of the biggest misconceptions is that HPV-associated throat cancer is all related to oral sex,” says Neil Gross, MD, director of clinical research in the department of head and neck surgery at MD Anderson in Houston, and a specialist in HPV-associated cancers of the head and neck.

According to Dr. Gross, people can get HPV from any intimate contact, including deep kissing — but not just a peck on the lips.

“You will find active oral HPV asymptomatic [without symptoms] in as much as 8 percent of the population,” he says, noting that only a fraction of the more than 150 strains of HPV have the ability to cause cancer.

Other HPV-Related Cancers Are on the Decline

Oropharyngeal cancer is usually diagnosed in people ages 64 and older, but about 20 percent of the roughly 66,000 cases in the United States every year are diagnosed in people younger than 55, per the American Cancer Society (ACS). And after decades of decline, oropharyngeal cancers linked with HPV increased by 1.3 percent in women and nearly 3 percent in men in the United States every year between 2015 and 2019, the ACS reports.

At the same time, cases of cervical cancer, 90 percent of which are caused by HPV, have been declining sharply since 2005. It’s not completely clear why HPV-associated throat cancers are on the rise while other cancers are falling, but it’s likely a combination of factors, says Mary Roz Timbang, MD, an assistant professor of clinical otolaryngology at the Keck School of Medicine of USC in Los Angeles.

Regular pap smear screenings can catch precancerous cells, so they can be treated before turning into cervical cancer, but no such screenings exist for throat cancers. Vaccination against the virus in women is also likely driving the decline, especially in recent years, according to the ACS.

People may also be using protection such as condoms during vaginal or anal sex but not oral sex.

“I think there is just a lag in both understanding of the fact that unprotected oral sex is a risk factor for getting oropharyngeal cancer and people are likely more knowledgeable of using condoms for other types of sex,” Dr. Timbang says.

Again, HPV can be transmitted orally through kissing as well and doesn’t always involve sex. Some older research found that the risk of HPV infection increases with sexual partners, though that is simply due to increased chances for exposure, which could be mitigated by safe sex practices.

“We don’t have great data on it because clinics aren’t great at asking questions about sexual habits, but some of the data we have suggest that plenty of patients who get HPV-related throat cancer have never had oral sex,” Gross says.

Vaccines Could Turn the Tide Against HPV-Related Throat Cancers

The U.S. Food and Drug Administration (FDA) now recommends everyone start the two-dose Gardasil 9 HPV vaccine by age 12, though it has been shown to be safe in kids as young as 9. Anyone who starts the series after age 14, and those who are immunocompromised, will need three doses.

Although the original guidelines approved the vaccine for females ages 9 to 26, in 2018, the FDA expanded these recommendations to include everyone ages 27 to 45. Since HPV is more common in men than in women, it’s important that boys are getting vaccinated as well.

According to the CDC, about 10 percent of men and 3.6 percent of women have oral HPV, and infection is more common as a person ages since there are more chances for exposure.

While it’s unclear how strong of a benefit vaccination will provide people who have already likely been exposed to many different strains of HPV, Gross says the vaccine has been found to be extremely safe and it’s still a good idea to get it.

“By the time people get past puberty and through their twenties, they’ve likely already been exposed to many different types of HPV. That’s why the vaccine is recommended before puberty for girls and boys,” says Gross.

Gross compares HPV with other viruses, such as the virus that causes shingles and chickenpox, that can lay dormant in the body decades after a person is exposed. The body clears the virus, but its effect on your cells can remain for years.

“It used to be, everybody got chickenpox and then a certain portion of people will develop shingles later in life. We don’t know why, but it likely has something to do with a chink in the armor of the immune systems,” Gross says. HPV likely works in a similar way. While many people can pass the virus without ever developing health issues, some will develop cancer related to the infection.

Should You Get the HPV Vaccine if You’re in Your Thirties or Forties?

For unvaccinated people who are post-puberty and had an early exposure to HPV, getting vaccinated in their thirties or forties could act as a booster for protection against future exposures if their natural immunity is waning.

“I don’t really see a downside to getting it, particularly if you think you may be at higher risk,” Gross says — for example if you anticipate having new sexual partners in the future.

What Are the Symptoms of Throat Cancer?

HPV-associated throat cancer most commonly affects people in their fifties or sixties because the cancer develops decades after exposure to the virus, but because of changing demographics, cases are occurring more often in even older patients now, too. Gross says.

“Unlike cervical cancer, where the pap smear has greatly reduced the incidence of cervical cancer, we don’t have that for the throat,” Gross explains. “So there is nothing to do but be aware of the early symptoms, live a healthy lifestyle, and avoid risky behaviors.”

According to the CDC, smoking and chewing tobacco can also cause oropharyngeal cancer.

Symptoms of throat cancer include a painless lump in the neck or a lymph node that is the size of a plump grape or larger that won’t go away. A growth on the tonsil, especially if it causes ear pain, is also a reason to see a healthcare provider.

“Be aware of these signs because it sneaks up on folks and they’re often late to get treatment,” Gross says.