intro: Duly Noted, a health and care podcast, is the official podcast series of Duly Health and Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners re-imagine and better understand an extraordinary health and care experience.

Jamie Lewis (Host): When you think of sexually transmitted infections, you probably don't immediately think of cancer. But when it comes to human papillomavirus, or HPV, the most common STI in the United States, head and neck cancer is a serious concern. In this episode of Duly Noted, we speak with Dr. Ryan Burgette, an otolaryngologist with Duly Health and Care, for insight into the connection between HPV and head and neck cancers, plus risk factors, symptoms, tips for Preventing HPV and the benefits of the HPV vaccine. This is Duly Noted, a health and care podcast from Duly Health and Care. I'm Jamie Lewis. Dr. Burgette, thanks so much for joining me.

Dr. Ryan Burgette: Thank you for having me, Jamie.

Host: Human papillomavirus, also known as HPV, is the most common sexually transmitted infection in the US. So, can you give us a little more background on what HPV is exactly?

Dr. Ryan Burgette: Sure. Like you stated, this is a very common sexually transmitted infection. There's approximately 5 to 10 million new cases in the United States per year. There's actually over 100 different varieties of this virus, with the vast majority of them causing benign warts of the skin or even the mucosa. But there are a few strains of this virus that are associated with cancer. There's approximately 40,000 to 50,000 new cases of HPV-related cancer each year. The most common of these is cervical cancer in females, but also associated with other genital cancers as well as oropharyngeal carcinoma. Last year, there was approximately 11,000 cervical cancers and almost 200,000 pre-cervical cancers associated with HPV and almost 15,000 new cases of oropharyngeal cancer.

Host: Okay. And who is at risk for contracting HPV?

Dr. Ryan Burgette: So, those at risk are anyone that's sexually active. HPV is spread through sexual contact or breaks in the skin. Those people that are more at risk are those that participate in unprotected sexual intercourse with multiple partners. This includes both anal and oral sex. There is also an association with drinking and smoking, and younger adults are typically more at risk.

Host: Okay. Here's the curveball question. How is HPV related to head and neck cancer?

Dr. Ryan Burgette: Yeah. So, something a lot of people don't really associate with. So, those same strains of HPV that can cause cervical cancer are also associated with certain head and neck cancers. These are typically associated with those of the oropharynx. And for those people that don't know what the oropharynx is, that includes the tonsils, as well as the back of your tongue and your soft palate. It's related to HPV, its associated with unprotected oral sex. Approximately 70% of new oropharyngeal carcinomas are linked with HPV versus decades ago being more associated with smoking.

Host: Wow. Okay. What are some of the symptoms and signs of HPV and head and neck cancer?

Dr. Ryan Burgette: Yeah. So, symptoms that patients typically complain of are a persistent sore throat that isn't resolving. Some patients have problems swallowing. There is an association with earaches as well due to a referred nerve pain in the back of the throat. Some signs that people show up with are some swelling in the neck, masses on the tonsils. Some patients also develop difficulty opening their mouth in more advanced stages. The majority of these times that I see these patients are typically associated with painless neck masses that aren't resolving with time and antibiotics.

Host: In terms of screening and prevention, what do you recommend for HPV and HPV-related cancers, and why is prevention so important?

Dr. Ryan Burgette: So for women, screening involves the cervical pap smear, which looks for atypical cells of the cervix. This is generally started, after the age of 21 and is done about every three years or so. Women can also choose to have HPV testing done on these cells, which looks for those high-risk HPV strains that can cause cancer. And if they're negative, then you can generally get screened every five years.

Currently, there is not an approved screening exam or test for men. Prevention involves getting the HPV vaccine, which we'll talk about here shortly, and also participating in safe sex with the proper use of condoms. The reason prevention is so important is because of how common this virus is and how preventable the HPV-related cancers can be with the vaccine.

Host: Right. So, you touched a little bit on the relationship between males and HPV. We hear a lot in the media about how females can benefit from the HPV vaccine, but can both males and females benefit from it?

Dr. Ryan Burgette: Definitely. Yeah, this vaccine is for both males and females. Like I said, for females, it's more associated with decreasing the risk of cervical cancer by an estimated 75%. Males generally are more at risk for the oropharyngeal cancer, but women can get that as well. But the vaccine has been shown to decrease the risk of that by up to 90%. So, the vaccine is meant for both men and women.

Host: Okay. Most vaccines I know are given to children and adolescents. But if an adult didn't receive the HPV vaccine as a child, can they still benefit from getting it as an adult?

Dr. Ryan Burgette: So, that depends. Most adults can get the vaccine and can benefit. Like you said, this is generally started at a younger age. The current recommendations are to start the vaccine in both boys and girls at the age of 11 and 12, with the second dose given after 6 to 12 months. But you can get the vaccine, it's recommended up to the age of 26. Between the ages of 26 to 45, their current recommendations are to have a discussion with your primary care physician and come up with your own individual health plan. If you're in a monogamous relationship, generally it's not recommended because you've probably already been exposed to the HPV virus; and therefore, the vaccine really isn't going to give you much benefit. But if you're still out there and having multiple sexual partners, again, it's probably something you could get benefit from.

Host: Well, Dr. Burgette, thank you for unpacking that relationship between HPV and head and neck cancer. I appreciate it.

Dr. Ryan Burgette: Again, thank you for having me. I appreciate it.

Host: I'm Jamie Lewis, and this is Duly Noted, a health and care podcast from Duly Health and Care. To dive deeper into this topic and many others, or to book an appointment with physicians like Dr. Burgette, please visit dulyhealthandcare.com.