The Importance of Screening for Head and Neck Cancers

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Patient Power Founder and Host, Andrew Schorr, discusses cancer screening with MD Anderson Cancer Center’s Head and Neck Surgeon and Specialist, Dr. Erich Sturgis.  Dr. Sturgis carefully explains the benefits of screening, particularly with the HPV vaccination.  Screening allows specialists to identify cancer early enough in the process to increase the patient’s chance of successful treatment.

This content was sponsored, in part, by a pharmaceutical company.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Hello and welcome to Patient Power. I'm Andrew Schorr. When it comes to head and neck cancer, it is personal for me.  Unfortunately, I've lost two friends to head and neck cancer, and we all know how debilitating it can be.  It's a really tough cancer fight. 

But we are making progress, and we're also learning about screening and even preventative measures. Joining us now is a leading expert in the field, a surgeon, that's Dr. Erich Sturgis from MD Anderson Cancer Center in Houston.  Dr. Sturgis, welcome to Patient Power. 

Dr. Sturgis:

Thank you for having me.

Andrew Schorr:

Dr. Sturgis, when it comes to vaccinations what can make a difference, and who should have a vaccination?

Dr. Sturgis:

So HPV vaccination in the United States is recommended by the CDC for kids beginning at age 9, and a three?dose series of the HPV vaccination is recommended to be completed by age 13. So this is recommended in both boys and girls, and unfortunately currently our vaccination rates are quite low for boys and still quite low for girls.  So only about one in five boys is getting vaccinated in the United States, and only about two in five girls is completing an HPV vaccine.

Andrew Schorr:

So just to dig a little deeper on that, why are the rates so low? 

Dr. Sturgis:

Well, I think it's for various reasons. Firstly, providers, and that principally being for this age group pediatricians and family practice physicians, have not been consistent in recommending the vaccination. There's been some lack of knowledge among providers that boys are recommended by the CDC to have vaccination. So that's an issue that we can address through education, education of providers and professionals about the importance of HPV vaccination.  

And then a second big issue among parents has to do with safety.  So parental concerns about safety of the vaccine, parental concerns that their child will not be exposed to HPV and doesn't need the vaccine are the two big ones from the parents' viewpoint.  It's important to understand that these vaccines have been studied in very large studies when they were—before they were originally approved by the FDA, but they also—we now have large amounts of data from the population once these vaccines were starting to be rolled out. 

So over 70 million doses of these vaccines have been given.  Our government has an excellent reporting mechanism to look at any potential side effects related to these vaccines. And both in the clinical trials and now in the population level data, there is no link to these vaccines with any medical conditions. So the vaccines are extremely safe, and parents should feel completely comfortable in giving these vaccines.

Also for the recommended group to be vaccinated for HPV are young adults and adolescents who may have missed the vaccine as a child.  So that would be ages 14 through 26, both girls and boys is recommended what's called catch?up vaccination. So we would encourage young adults who may not have received the vaccine when they were a child and teenagers still under their parents' care to also go through the vaccine, because there do seem to be benefits even if you get vaccinated at a later point in time. 

Andrew Schorr:

HPV, of course, is a hot topic when it comes to head and neck cancers.  Are these cancers increasing or decreasing, and why? 

Dr. Sturgis:

First of all, HPV is associated or is a causative factor for cancers of the cervix in women, vaginal and vulvar cancers in women, anal cancers in both men and women, but the cancer type that I see most commonly related to this is essentially throat cancer.  So these we call—scientifically, we call them oropharynx cancers. These are cancers of the tonsils and the very back of the tongue, the part of the tongue you cannot see. And these are increasing in numbers at 5 percent each year, so 5 percent more of these cancers every year in the United States, particularly in men. 

This is a problem that's projected to be the number one HPV?related cancer in just a few years but the end of this decade.  There's already a higher incidence of these cancers, meaning the rate of these cancers among men is already higher than the rate of cervical cancers among women. So this is an emerging problem, and we really need to think about preventing infection, and the way we prevent infection is we use vaccination.  So if we can prevent infection of the throat, we can prevent the later development of these throat cancers. 

Andrew Schorr:

Dr. Sturgis, what are you and your colleagues doing to ensure that screening for head and neck cancers becomes more widespread? 

Dr. Sturgis:

So when we talk about screening, the whole purpose is to identify cancers earlier in the process so that they're easier to treat and the treatment is more successful.  Or we're trying to identify premalignant process, so something that's happening actually before it's a true invasive cancer. 

Now, we have very good evidence that screening in women—this has been through Pap smear testing, it's been through now HPV testing in women to screen for cervical cancer—the success of this is clearly evident.  In the United States, cervical cancer was one of the top three most common cancers around the time of World War II.  Pap testing began to become widely available starting in the ‘50s and the ‘60s, and now we see that cervical cancer is a relatively rare disease, relatively rare cancer in the United States.  And this is really attributable to a broad?based screening program in the United States.

Now, this relies upon us being able to see the precancers in women or very early cancers in women, so we can prevent these cancers becoming advanced and prevent women from dying of cervical cancer.

The problem with head and neck cancer is—and in particular what I'm talking about here is HPV?related head and neck cancer, cancers again of the tonsils and the very back of the tongue. These cancers hide down in these small, cryptic areas of the tonsils and the base of the tongue. Unlike the cervix, it's very hard to identify the precancerous process.  I personally have never seen with my eyes an HPV?related precancer of the tonsil or base of tongue. 

I have seen them under the microscope when we took out the tonsils in an attempt to find where a cancer may have begun, but actually being able to in my clinic examine a patient, say, hey, you've got a precancer here, you have a risk that you're going to develop a true cancer of this tonsil, that has not been feasible. 

So—and people develop these cancers in their 50s, so we're looking at a problem that's rising in numbers of these cancers and an inability to screen for them and pick them up earlier. So another reason it's imperative that we get this generation of children vaccinated is so we're not continuing to deal with this rising problem of oropharyngeal cancers. 

Andrew Schorr:

Dr. Eric Sturgis, surgeon at MD Anderson Cancer Center in Houston, thank you for sharing with us your expertise and your passion in helping families touched by head and neck cancer.

Dr. Sturgis:

Thank you very much for having me.

Andrew Schorr:

I'm Andrew Schorr. Please sign up for alerts on our website, so you'll know whenever we post something new.  Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on June 2, 2016