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World Head And Neck Cancer Day

Joint media release from the Head & Neck Cancer Foundation Aotearoa (HNCFA) and the Sexually Transmitted Infections Education Foundation (STIEF).

27th of July marks the World Head and Neck Cancer Day. The Head and Neck Cancer Foundation Aotearoa (HNCFA) and the Sexually Transmitted Infections Education Foundation (STIEF) would like to take this opportunity to raise the awareness to New Zealanders about the devastating health impacts of head and neck cancers, including oropharyngeal (throat) cancer caused by Human Papillomavirus (HPV) and to remind everyone that prevention is available in the form of the Gardasil vaccine. This highly effective and safe vaccine prevents infection with HPV, and massively reduces the risk of developing many different forms of cancer, including oropharyngeal cancer, cervical cancer and penile cancer.

HPV is thought to be the most prevalent sexually transmitted infection (STI) in the world: the “common cold” of being sexually active. Without immunisation, around 80 per cent of people who have ever had sex (vaginal, oral, or anal) will be infected by at least one type of HPV at some point in their lives. Unfortunately, condom use during sex doesn't reliably prevent transmission of this virus.

Although there are over 150 types of HPV, only a small number of these are ‘high-risk HPV’ strains that have the potential to lead to cancerous changes in cells. HPV is a bit of a "lucky dip" really: many people who are infected will eliminate the virus, some will retain the virus but have a low-risk strain that may lead to genital warts, whilst others may have the high-risk strains and develop devastating cancers decades later, having never known about the original infection.

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The virus is most commonly associated with cervical cancer, but can also cause other cancers in the genital area of both men and women, specifically the vagina, vulva, penis, and anus. In recent years, medical professionals have also observed a rapid rise in HPV-related oropharyngeal cancer in heterosexual men and women who are otherwise healthy. For this group, the main risk is oropharyngeal cancer, which affects the throat (tonsils, base of tongue and soft palate). Although this type of cancer has traditionally been linked to smoking and heavy drinking, in recent years HPV has become the leading cause. Oropharyngeal cancers caused by HPV are rapidly rising in developed countries. In New Zealand 95 new cases of HPV-related oropharyngeal cancer with 25 deaths were estimated for 2018. In 2020, there were 334 oropharyngeal cancer cases caused by HPV.

Doug Russell, an otherwise healthy 57-year-old, is one of those affected by HPV-related oropharyngeal cancer. He describes the lead-up to “the single toughest day” of his life in 2017. “I had a shave one lazy Sunday morning and there was nothing wrong with me. And at lunchtime, I was sitting in the kitchen having a sandwich, and I put my hand on my throat and I said to my wife Sarah “what is that lump?” And there was a big lump. So on Monday, I went to the doctor and that started this whole thing, it just appeared overnight like that.”

Doug had a high-risk strain of HPV, which he had never been aware of until it led to his cancer. “I thought I was living my life to the fullest, and I thought cancer was something that happened to other people. I really struggled, and still do struggle a little bit, to understand why this happened to me, and what the implications would be for my family.”

Doug’s experience of it happening ‘overnight’ is not uncommon. Head and neck cancers including oropharyngeal cancer are notoriously difficult to detect and, as a consequence, are often only discovered in advanced stages. Symptoms will often be very mild initially and will depend on where exactly the cancer is situated, how big it is and how far it has spread in the body.

The most common symptoms are:

  • a painless lump in the neck or in front of the ear
  • a lump or ulcer in the mouth, for example, on the tongue, gum, or inside the cheek
  • a persistent white or red patch in the mouth
  • a one-sided sore throat which can be associated with earache
  • pain or difficulty with swallowing
  • a hoarse voice, especially in a smoker
  • difficult or noisy breathing
  • a lump or sore on the face
  • numbness or weakness on one side of the face
  • one sided blocked nose with bleeding

Many less serious conditions (apart from cancer) can cause these symptoms, but if they persist for more than 3 weeks, it is important to consult your doctor.

Although many people with HPV-related oropharyngeal cancer survive, for some, the damage caused by treatment can be long-lasting.

Unlike cervical cancer, which can be screened for with a smear test, there is no simple way to screen for oropharyngeal cancer - but the great news, especially for young people, is that HPV infection and the cancers it causes are largely preventable. Vaccination against HPV infection has been available for many years and is highly effective and safe, with millions of doses administered worldwide. In New Zealand the HPV vaccine, known as Gardasil, is free for people aged from 9 years up to their 27th birthday. For those who have missed the school vaccination programme (year 8 students), the vaccine is available free of charge through their GP or health care provider. As Dr John Chaplin, head and neck cancer surgeon and board member of the HNCFA, says “HPV-related oropharyngeal cancer affects both men and women. It is a devastating disease that can be prevented by HPV vaccination.”

Dr Cathy Stephenson, a GP with a special interest in youth health, says “I truly can’t think of a single reason not to get this vaccine. It’s safe, it’s free, it’s been extensively used and analysed around the world, and it prevents cancer. The average 21-year-old is unlikely to be thinking, ‘If I don’t get this vaccine now, I’m going to be at risk of cancer in 20 years’ time.’ But that is the reality – that’s when it’s going to hit you. Ask one of the increasing number of middle-aged men being diagnosed with cancers directly caused by exposure to HPV in their teens and 20s if it’s a vaccine worth having – had it been available for them, they wouldn’t be suffering now.”

Despite the free HPV vaccination programme provided in New Zealand, we have yet to reach the target of 75% coverage across the country, which the Ministry of Health hoped to achieve by December 2017.

So, on Tuesday, as the world acknowledges the impact that head and neck cancers have on so many lives, HNCFA and STIEF urge you to talk to the young people in your lives – if they haven't had their Gardasil immunisations, encourage them to book in now!

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