Men face rising threat of HPV-related cancers
Michael Whelan stared at his doctor for what felt like
hours. He couldn’t believe what he was hearing.
Whelan saw the doctor once a month to help manage arthritis
pain in his neck and back. Now, his doctor was talking about the results of a
recent scan. Whelan, then 66, was expecting to hear about his joints.
Instead, Whelan heard the doctor explain that the scan
showed a suspicious mass on the right side of his throat, which might indicate
cancer.
Whelan almost fainted.
“The first thing that I did was I touched my throat,” Whelan
told CIDRAP News. “And I could feel it.”
Whelan said he had no symptoms of cancer.
No pain, no difficulty breathing or swallowing. Until that
day in the doctor’s office four years ago, Whelan said he’d never noticed the
hard lump under his skin.
Further testing revealed that the mass was malignant and
caused by the human papillomavirus (HPV).
“Something I’d never heard of almost killed me,” Whelan
said.
‘A virus-driven cancer epidemic’
Twenty years after the approval of a safe and highly
effective vaccine against HPV, one-third of Americans have
never heard of the virus.
Many are unaware that the virus causes more than 49,000 cancers
a year, including tumors of the head and neck, cervix, vagina, vulva, penis,
and anus.
When the vaccine was first approved in 2006, it was promoted
as a way to prevent cervical cancer, which was then the most common type of
HPV-related tumor. Routine screenings and vaccinations have since reduced the
incidence of HPV-related cervical cancers.
That’s led head and neck tumors—which are mostly found in
men—to emerge as the most common HPV-related
cancer. While HPV leads to 11,100 cervical cancers each year, the virus causes 16,000 cancers in the head and
neck, according to the Centers for Disease Control and Prevention.
HPV-related head and neck cancers tend to develop in the throat, the base of the tongue, and the tonsils, said Missak Haigentz Jr., MD, an oncologist who specializes in such cancers but was not involved in Whelan’s care.
While cervical tumors can be found in early or even
precancerous stages during routine screenings, there is no established early
detection method for head and neck cancers. As result, head and neck
cancers are typically detected in
later, less curable stages, said Haigentz, a professor of medicine at Rutgers
Robert Wood Johnson Medical School.
Although doctors are seeing fewer head and neck cancers
caused by tobacco and alcohol use—the traditional risk factors for the
disease—they’re seeing more patients with HPV-related cancers. Researchers
believe that increases in HPV-related head and neck cancers are related to changes in
sexual practices that help transmit the virus. HPV is transmitted through
sexual contact; the virus can spread to the
throat and tonsils through oral sex or intimate kissing.
The incidence of HPV-related head and neck cancers tripled
from 2000 to 2017, research shows. Because head
and neck cancers take many years to appear, most cases appear in men in their 40s,
50s, and 60s—decades after they were first exposed to HPV, and long
before vaccines were available.
Haigentz described head and neck cancers fueled by HPV as a
“growing, virus-driven cancer epidemic.”
“It’s a major public health concern,” he said.
The best hope for reducing the suffering and death from
HPV-related head and neck cancers, Haigentz said, is prevention. The American
Academy of Pediatrics recommends vaccinating
children against HPV from ages 9 to 12 years. About 79% of girls
and 77% of boys ages 13 to 17 had received at least one dose of
HPV vaccine in 2024, while 64% of girls and 62% of boys had received all
recommended doses.
A golf-ball-sized tumor
Tests revealed that Whelan’s cancer was stage 4, the most
advanced phase.
In addition to the tumor in his throat, doctors also found
cancer on the base of his tongue and on his tonsils.
When doctors operated on Whelan, they removed a tumor the
size of a golf ball, along with 35 lymph nodes, which are small structures that
act as filters for the immune system, trapping germs, viruses, and abnormal
cells. Over the next 18 months, Whelan underwent chemotherapy, radiation, and
additional surgeries, including the removal of a mass on his tongue.
Therapy for head and neck cancers is notoriously difficult.
Whelan was unable to complete treatment with one of his
chemotherapy drugs, which weakened his immune system and led to an Escherichia
coli (E. coli) infection. “I was in and out of the
hospital three times,” said Whelan, who was heavily treated with antibiotics.
Although antibiotics can kill harmful bacteria, they can
also disturb the delicate balance in our gut, wiping out the good microbes that
protect us from disease. Without these microscopic protectors, dangerous
bacteria can proliferate.
After antibiotic treatment, Whelan developed an infection
with a toxic bacterium called Clostridioides difficile, or C.
diff, which led to severe diarrhea for more than a month.
Living with long-term effects
Whelan’s cancer treatments made it difficult to swallow, and
he often threw up when he tried to eat or drink. He eventually required surgery
on his stomach and esophagus, which has helped but not eliminated the problem.
Cancer therapy also took a toll on his voice, requiring
speech therapy for seven weeks. Whelan developed a dry mouth, dental problems,
and thinning bones as a result of treatment, as well. The stress and
uncertainly led to post-traumatic stress disorder (PTSD).
“You live the rest of your life freaked out,” Whelan said.
“Every time you get a sore throat or every time you sneeze or every time have
acid indigestion, you think it's cancer.”
Head and neck cancer was just one of many burdens that
Whelan has faced.
Whelan has long struggled with bipolar disorder, which led to a suicide attempt
in 1999. He changed his mind before it was too late, and said he is glad that
he survived.
Whelan also survived prostate cancer in 2013. Recently, his doctor found a lump in one of his testicles.
His wife, Rebecca, was diagnosed as having Parkinson’s
disease, a degenerative neurologic condition, in 2018. Whelan was her primary
caregiver until she passed away three months ago. High medical costs only
added to Whelan’s anxiety and depression.
“I've always believed that I got through [cancer] because
I'm just a tough son of a gun,” Whelan said. “I fight and I fight. But, to be
honest, I think I got through it because my wife needed a caretaker before she
died. I think I was saved to help her.”
Vaccines likely to transform cancer landscape
Almost everyone is exposed to HPV, which is transmitted
through sexual contact.
About 13 million Americans, including teens, become infected with HPV each
year.
In most cases, the immune system neutralizes the virus. But
a small number of people develop chronic infections,
which dramatically increase the risk of cancer. HPV also can lie dormant in cells for
years.
“My surgeon said the tumor could have been there for 30
years,” Whelan said.
Vaccinating children against HPV before they become sexually
active has already helped dramatically
reduce the risk of cervical cancer, as well as precancerous
lesions in the vulva
and vagina.
Emerging evidence suggests that HPV vaccines could be even
more transformative for head and neck cancers, Haigentz said.
Research has found that vaccinated people are 88% less likely than
unvaccinated people to have oral HPV infections, a prerequisite for head and
neck cancers. Even more encouraging, a study published earlier this year found
that vaccinated men and boys were about half as likely to
be diagnosed as having an HPV-related cancer as unvaccinated
males.
Whelan said he’s sharing his story to educate people about
HPV.
“Nobody talks about HPV,” Whelan said. “We do a poor job
educating people about it.”
He said he doesn’t want anyone to suffer the way he has.
“I made damn sure that all of my nieces and nephews know
about the vaccine,” Whelan said. “Who in the world wouldn't want to do
everything they possibly can not to get cancer? There are certain things you
have no control over. This one you do.”
If you or someone you know is in crisis, call 988 for
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