Nav: Home

HPV infection may be behind rise in vocal-cord cancers among young nonsmokers

February 07, 2019

A remarkable recent increase in the diagnosis of vocal-cord cancer in young adults appears to be the result of infection with strains of human papilloma virus (HPV) that also cause cervical cancer and other malignancies. Investigators from Massachusetts General Hospital (MGH) describe finding HPV infection in all tested samples of vocal-cord cancer from 10 patients diagnosed at age 30 or under, most of whom were non-smokers. Their report appears in a special supplement on innovations in laryngeal surgery that accompanies the March 2019 issue of Annals of Otology, Rhinology and Laryngology.

"Over the past 150 years, vocal-cord or glottic cancer has been almost exclusively a disease associated with smoking and almost entirely seen in patients over 40 years old," says Steven Zeitels, MD, director of the MGH Division of Laryngeal Surgery, senior author of the report. "Today nonsmokers are approaching 50 percent of glottic cancer patients, and it is common for them to be diagnosed under the age of 40. This epidemiologic transformation of vocal-cord cancer is a significant public health issue, due to the diagnostic confusion it can create."

The researchers note that the increase in vocal-cord cancer diagnosis appears to mimic an earlier increase in the diagnosis of throat cancer, which has been associated with infections by high-risk strains of HPV. After initially attributing incidents of vocal-cord cancer in nonsmokers, which they began to see about 15 years ago, to increased travel and exposure to infectious diseases, Zeitels and his colleagues decided to investigate whether HPV infection might explain the diagnosis in younger nonsmokers.

To do so they examined the records of patients treated by Zeitels either from July 1990 to June 2004 at Massachusetts Eye and Ear Infirmary or between July 2004 and June 2018 at MGH. Of 353 patients treated for vocal-cord cancer during the entire period, none of the 112 treated from 1990 to mid-2004 were age 30 or younger. But 11 of the 241 patients treated from 2004 to 2018 were 30 or younger - 3 were age 10 to 19 - and only 3 of the 11 were smokers. Analysis of tissue samples from the tumors of 10 of the 11 younger patients revealed high-risk strains of HPV in all of them.

The authors note that these high-risk-HPV-associated vocal-cord cancers greatly resemble recurrent respiratory papillomatosis (RRP), a benign condition caused by common, low-risk strains of HPV. One of the 11 patients treated by Zeitels had previously been diagnosed at another center with vocal-cord cancer, and when it recurred after being surgically removed, she was misdiagnosed with RRP and treated with a medication that made the cancer worse, leading to the need for a partial laryngectomy.

"Benign RRP of the vocal cords has been a well-known HPV disease for more than a century, and it is very remarkable that there is now an HPV malignancy that looks so similar, creating diagnostic and therapeutic confusion," says Zeitels, the Eugene B. Casey Professor of Laryngeal Surgery at Harvard Medical School. "It should be noted that these HPV-associated vocal-cord carcinomas are not a malignant degeneration of the benign disease."

Zeitels adds that HPV vocal-cord cancers are amenable to endoscopic treatment with the angiolytic KTP laser that he developed. "Large-scale studies are now needed to determine the pace of the increase in glottic cancer among nonsmokers, the incidence of high-risk HPV in these cancers and changes in the age and genders of those affected," he says.
-end-
The lead author of the Annals of Otology, Rhinology and Laryngology paper is Semirra Bayan, MD, previously a fellow in laryngeal surgery at MGH and now at University of Chicago Medicine; William Faquin, MD, PhD, MGH Pathology, is a co-author. The study was supported by the Voice Health Institute, the National Philanthropic Trust, and the Eugene B. Casey Foundation.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $900 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2018 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."

Massachusetts General Hospital

Related Cervical Cancer Articles:

How have HPV vaccines affected cervical cancer screening?
A new review looks at cervical cancer screening in the era of HPV vaccination.
New tech promises easier cervical cancer screening
Duke University researchers have developed a handheld device for cervical cancer screening that promises to do away with uncomfortable speculums and high-cost colposcopes.
Women should continue cervical cancer screening as they approach age 65
While current guidelines indicate that cervical cancer screening can be stopped for average risk patients after age 65, many women lack the appropriate amount of screening history to accurately assess their risk.
$1.5 million grant to prevent cervical cancer in West Texas
Navkiran Shokar, M.A., M.P.H, M.D., has received nearly $1.5 million from the Cancer Prevention and Research Institute of Texas (CPRIT) to reduce the burden of cervical cancer in West Texas.
Study finds not all women get appropriate care for cervical cancer
Fewer than three out of five women with cervical cancer received guideline-based care, a new study finds.
Cervical cancer mortality rates may be underestimated
A new analysis reveals that for most women, the risk of dying from cervical cancer is higher than previously thought.
Cervical cancer screening could be less frequent, start later
Women may only need cervical cancer screening every 5-10 years -- instead of every three years, as currently recommended -- and may be able to start the screenings later in life, according to Harvard T.H.
Pap screenings linked to less cervical cancer in elderly women
A new study from the University of Illinois confirms a link between Pap smear screenings and a lower risk of developing cervical cancer in women over age 65.
Lupus confirmed as risk factor for cervical cancer
Lupus confirmed as risk factor for cervical cancer
'This enormous burden': Controlling cervical cancer in Latin America
Cervical cancer is an 'enormous burden' for Latin-American society, and the third leading cause of cancer deaths among women in the region, say Dr.

Related Cervical Cancer Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#529 Do You Really Want to Find Out Who's Your Daddy?
At least some of you by now have probably spit into a tube and mailed it off to find out who your closest relatives are, where you might be from, and what terrible diseases might await you. But what exactly did you find out? And what did you give away? In this live panel at Awesome Con we bring in science writer Tina Saey to talk about all her DNA testing, and bioethicist Debra Mathews, to determine whether Tina should have done it at all. Related links: What FamilyTreeDNA sharing genetic data with police means for you Crime solvers embraced...