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Index of suspicion ‘must be higher’ for oropharyngeal cancers

Ms Orla Young, Consultant ENT Surgeon at Galway University Hospitals, said HPV infection is associated with oropharyngeal cancer in patients with or without tobacco or alcohol use. 

“It means our index of suspicion has to be higher. We are not reassured anymore when we see an ulcer in a 33-year-old female who doesn’t smoke — we have to keep an eye on that just as much as ‘Jimmy’ who is 77 and having 40 a day,” Ms Young told the recent Annual Conference of Rural, Island and Dispensing Doctors. 

She said US studies had found that up to 60 per cent of oropharyngeal cancers are HPV-positive. However, HPV status is a favourable prognostic factor for patients and there is growing debate about potential over-treatment. 

In Australia and around half of US states, the policy is that boys and girls receive vaccination against HPV, but it has not been extended to boys in Ireland. “In this country, sexism is in operation because the guys are not getting the preventative vaccination that the girls are getting… ”

It is known from the cervical experience that vaccine administration before sexual debut is most likely to confer most benefit and Ms Young said there is no reason to suspect its administration would not also prevent oropharyngeal HPV. 

Speaking to the Medical Independent (MI), Ms Young said there is “no question” that HPV-associated oropharyngeal cancers are on the rise. She reiterated that doctors need to be alert to patients who traditionally would have not have fitted the typical profile for these cancers. “They are not only not smokers and drinkers, but they are younger — much, much younger.” 

Ms Young also expressed concern about the negative media publicity about the HPV vaccine. Feedback from the gynaecology community is that the vaccine is “safe and proven”, but the message on its cancer-preventing nature is now becoming obscured, she warned. 

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