April is Head and Neck Cancer Awareness Month. Famous survivors include Michael Douglas (http://www.webmd.com/cancer/news/20100901/throat-cancer-faq) and Peter Tork of the Monkees (http://www.headandneck.org/site/c.8hKNI0MEImI4E/b.6281225/k.BDD9/Home.htm). As we remember these survivors and loved ones with the disease in 2012, it’s helpful to know how to minimize our future risk for this group of diseases. “Head and neck cancer” describes cancers of the mouth, throat, and voicebox (larynx). Cancers of these areas are diagnosed in about 40,000 patients per year in the U.S. When viewed under the microscope, the most common type of head and neck cancer is called squamous cell carcinoma (abbreviated HNSCC). This cancer type usually develops in the setting of chronic irritation or inflammation over years. There are three main causes of HNSCC in America:
1. Tobacco products – Cigarette smoking and the use of smokeless tobacco products (“dipping”) is still the most common source for developing HNSCC. If we are able to completely eliminate the use of tobacco products in the U.S., we will cut the number of patients diagnosed with HNSCC by more than 50%! We would save approximately 5,000 lives per year!
2. Alcohol – Most people are aware that chronic alcohol use can cause permanent liver damage (cirrhosis) and even cancer of the liver. However, chronic use over many years can also result in chronic irritation of the lining of the throat similar to that caused by years of chronic cigarette smoking.
3. Human Papillomavirus (HPV) – As I discuss in When Cancer Hits Home, this link between certain strains of HPV (the same virus that causes cervical cancer) and the development of HNSCC has become quite clear: http://www.nlm.nih.gov/medlineplus/news/fullstory_123723.html. The rise in diagnoses of HPV+ HNSCC over the past few years has been dramatic. Sexually transmitted infection with HPV is extremely common, though most people are able to clear the virus from their immune system. Those that do not may develop chronic changes in the lining of their throat as a result of the HPV infection that leads to HNSCC. The classic patient with HPV+ HNSCC is a non-smoker with no history of alcohol abuse who presents to the doctor with a painless lymph node (or multiple) in the neck that has been present for several weeks. Fortunately, most patients who are diagnosed with HPV+ HNSCC have a very good prognosis even when the cancer has spread to multiple lymph nodes in the neck. While we don’t have good evidence for effective action to take against prior HPV infection in older adults, the anti-HPV vaccines (Gardisil is approved in the U.S.) are highly effective and approved for both GIRLS AND BOYS ages 9-26.
By minimizing our chronic exposure to these three cancer-causing agents, we can dramatically reduce our risk of developing head and neck cancer.
- Patrick Maguire MD