TMC PULSE

T M C » P U L S E | J U N E 2 0 1 8 33 T M C » P U L S E | J U N E 2 0 1 8 The Rise of HPV-Related Cancers in Men An MD Anderson trial hopes to develop a screening test and address the impending epidemic S cott Courville admired his full beard and round belly in the mirror: He was ready for the upcom- ing holiday season. It was November 2015 and Courville, who plays Santa Claus in Lafayette, Louisiana, was too excited about his favorite time of year to worry much about the pain developing in his jaw. By February, though, the ache had worsened and was accompanied by new symptoms: white spots on his right tonsil, difficulty swallowing and lumps in his throat. He finally made his way to a walk-in clinic where he was diagnosed with tonsil- litis and prescribed antibiotics. "They sent me home and said, 'In two weeks everything should clear up,'" Courville recalled. But his symptoms only wors- ened. Courville made an appoint- ment with a local ear, nose and throat (ENT) specialist who also diagnosed Courville with tonsillitis. The doctor prescribed more anti- biotics and steroids, but two weeks later there were no improvements. Courville was referred to a den- tist—"In case they see something we don't"—but that, too, was a dead end. Courville's dentist insisted he return to his ENT, where he ulti- mately had a CT scan that revealed a mass in his throat. That was June 6, 2016. Two days later, Courville underwent a biopsy. When he awoke from the surgery, his doctor was standing over him. Courville always gets choked up retelling this part of his story. "The hardest part for me is always remembering when the doctor said, 'I'm sorry, but you've got cancer.'" Courville was referred to The University of Texas MD Anderson Cancer Center, where doctors con- firmed that he had squamous cell carcinoma of the right tonsil. But there was more: Courville learned that his cancer had been caused by the human papillomavirus—HPV. 11 million men Courville's story is becoming increasingly common, with the annual incidence of HPV-related cancers of the throat, tonsils and the base of the tongue in men in the United States now outnumbering cases of cervical cancer in women, according to the U.S. Centers for Disease Control and Prevention (CDC). A 2017 research paper authored by scientists at Baylor College of Medicine and The University of Texas Health Science Center at Houston School of Public Health, among others, found the overall prevalence of oral HPV in men in the U.S. to be upwards of 11 million—much higher than previ- ously believed. "This has implications, because pretty much everyone is exposed to HPV," said Andrew Sikora, M.D., Ph.D., one of the authors of the paper and vice chair for research and co-director of the Head and Neck Cancer Program at Baylor College of Medicine. "When we're talking about the prevalence of oral HPV infection, we're talking about that infection persisting inside the tonsils or on the base of the tongue of these men, and I think that's what sets you up for cancer later in life—it may happen decades after you were exposed to HPV." That lag time, coupled with an absence of symptoms, is part of the reason HPV-related oropharyngeal cancers, also referred to as head and neck cancers, are increasing. "What makes this cancer inter- esting is that it's one of the only cancers in the body that we're actu- ally seeing more cases of year over year," explained Ron J. Karni, M.D., who serves as chief of the division of Head and Neck Surgical Oncology at McGovern Medical School at UTHealth and Memorial Hermann- Texas Medical Center. "In the U.S., we can expect a certain number of breast cancer cases and lung cancer cases every year, but this is actually starting to look a bit like an epidemic in that we are seeing more every year. It's alarming." Holy grail HPV is the most common sexually transmitted disease in the U.S., with an estimated 79 million individuals infected. According to the CDC, HPV is so common that most peo- ple who are sexually active will get the virus at some point in their lives if they do not get the HPV vaccine. The virus is spread through vaginal, anal and oral sexual activity, and often exhibits no signs or symptoms. (continued) B y A l e x a n d r a B e c k e r If you can educate the public and educate the parents, they will vaccinate their kids. And if we can vaccinate this generation, we could eliminate these types of cancers. — SCOTT COURVILLE MD Anderson patient MD Anderson patient Scott Courville before treatment, left, and after treatment, right, for HPV-related cancer. Credit: Left: Courtesy photo; Right: MD Anderson

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