While the risks linked to tobacco and alcohol use are well known, many people are unaware of the link between Head and Neck cancers and Human Papillomavirus infection. How much do you know about these cancers? And, could you be at risk?
Would you ignore any of the following symptoms for longer than a month?
- A red or white patch in the mouth that does not heal
- A lump or bump or mass in the head or neck area - with or without pain
- A persistent sore throat, hoarseness, difficulties in swallowing
- Nasal obstruction and difficulty breathing or persistent nasal congestion, particularly single-sided
- Sudden loosening of teeth (or dentures that no longer fit)
- Chronic bleeding from the mouth or nose
- Chronic earache
- Tingling or numbness of part of the head
The above, are some of the early warning signs of Head and Neck Cancers (HNCs) including cancers of the mouth, lips, throat, larynx (voice box), nose, and salivary glands. “There is a serious lack of awareness that HNCs are part of the leading cancers in incidence and cause of death and disability, in most parts of the world,” says Professor Jos Hille, Oral and Head & Neck Pathologist at the NHLS (Tygerberg Hospital) and honorary secretary of the South African Head and Neck Oncology Society (SAHNOS). “Many HNCs escape proper reporting to cancer registries.”
Did you know that in 2018, it was estimated that there would be over 650,000 new cases of oral, head and neck cancers diagnosed world-wide? The World Health Organization reports that the annual, global incidence of head and neck cancers is more than 550,000 cases with around 300,000 deaths each year.
Which lifestyle behaviours put you at risk of HNC?
Globally, concern is growing around the lack of awareness and increasing incidence of these potentially debilitating cancers . “Most people associate tobacco and alcohol abuse with lung cancer and heart diseases,” explains Prof. Hille. “Yet tobacco and alcohol (used together, alcohol enhances the carcinogenic effect of tobacco) also cause oral and throat cancer. And, what few people realise is that Human Papillomavirus (HPV) infection, responsible for 99% of cervical cancers in women, is linked with cancer of the oropharynx (back of the tongue and the surrounding throat).
“HPV is the most common sexually transmitted disease. Over 85% of sexually active adults have been exposed to the virus,” says Dr Marco Torres-Holmes, Ear, Nose and Throat surgeon (ENT) and member of the multidisciplinary head and neck surgical and rehabilitation team at Mediclinic Morningside in Johannesburg. “The more vaginal and oral sexual partners one has the more you are at risk of developing oropharynx cancer. HPV often hides in the tonsils and takes a good 20 years to cause a detectable tumour in some patients. In both the first and third world, sexual practices of past decades are fuelling the current spike in oropharynx cancers.”
Prof. Hille adds that it has now been officially recognised that tongue cancer is linked to chronic irritation resulting from habitual biting and long-term irritation from sharp teeth, broken fillings and ill-fitting dentures.
HPV-linked HNC - easily missed unless you’re looking for it.
Dr Torres- Holmes explains that typically a patient, often a non-smoking male, 55 years of age or younger, is referred from the GP to an ENT. Various examinations and imaging are undertaken to locate the tumour and to biopsy the tissue in order for the laboratory to determine the nature of the mass and HPV status. His team would then optimally plan treatment (often radiation supplemented by chemotherapy but sometimes surgery followed by radiation therapy or surgery alone) to minimise the expected complications such as difficulties in chewing, swallowing, and permanent damage to the mouth, throat and face. Much research is currently underway to establish why HPV-positive cancers show a somewhat better response to treatment than do cancers caused by smoking and alcohol use.
Cancer survivor Howard Butler fights for awareness
Dr Torres-Holmes praises the work of Face Value, a support group which focuses on early detection and support for HNC patients and caregivers. Former businessman Howard Butler, an HNC survivor and one of Face Value’s founders explains: “Earlier detection would have changed so much of my journey.” From 2010 to 2012 this smoker (who also drank in moderation), visited a host of mainstream and holistic medical practitioners in a desperate attempt to treat recurring and debilitating sinusitis. “I could not breathe when lying down so had to sleep sitting upright,” he recalls. Finally, an ENT saved his life by sending him for a CT-scan and diagnosing a naso-pharyngeal cancer. Butler chooses to use his ordeal as a life-giving force: “My one passion has become early detection, and diagnosis. I personally know its value, the cost of failure and the keys to a good quality life after diagnosis.”
Cancer survivor, Howard Butler (pictured with his wife Bernice) fights for HNC awareness.
Early diagnosis of HNCs: an excellent prognosis
Mosy HNCs can be prevented by avoiding tobacco and excess alcohol use, or cured if detected very early – with some patients needing surgery alone.
The best preventative medicine for HPV-positive HNCs? “Practice excellent dental hygiene. Maintain a good dental condition. Don’t smoke. Don’t drink. Practice abstinence until married and stay faithful in marriages. And, vaccinate your pre-sexually active children,” says Dr Torres-Holmes.
Vitality members aged 16 – 65, earn 2 500 points in the year of their Pap smear and for two years thereafter. Vitality members aged 9 - 25 also earn 1000 Vitality points for having the cervical cancer vaccine. Find out more here.
The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act, and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
Howard Butler, a 46-year-old head and neck cancer survivor, is a cancer prevention and patient-support advocate. He’s outlived six bouts of cancer and lives to help reduce South Africa’s globally high incidence of Head and Neck or oropharyngeal cancers.
Three very common habits could be putting you at particular risk of a group of cancers called Head and Neck cancers (HNC). Identifying them early can save you from extended bouts of treatment and severe facial disfigurement.
Tobacco-use is the single-most avoidable risk factor for cancer. The good news is that your lungs start recovering as soon as you kick the habit. Yet, tobacco-related diseases kill over 44 000 South Africans and 6 million people worldwide every year.