TMC PULSE

T M C » P U L S E | J U N E 2 0 1 8 34 In many cases, HPV is cleared by the immune system and does not cause health problems, but it can also persist and show up decades later alongside conditions such as genital warts and cancer—including cervical cancer, anal cancer and oropharyngeal cancers. For reasons not well understood, oropharyngeal cancers predominately affect men. Currently, there is no annual screening test for men to deter- mine whether they have the virus. Women, on the other hand, are advised to get regular pap smears. The Papanicolaou test, com- monly known as the pap smear, involves collecting cells from inside a woman's cervix to detect pre- cancerous changes. It is performed during a woman's annual exam and has been widely credited for detecting early signs of HPV-related cervical cancer and saving countless lives. No such screening test has been successfully developed for oro- pharyngeal cancer—another reason cited for its steady rise. "We're at a huge disadvantage," said Sikora, who, in addition to his research, treats patients at the Michael E. DeBakey VA Medical Center in Houston. "The pap smear, in terms of global health impact, is probably one of the best, most cost-effective things ever invented in terms of just the sheer number of women who have not had advanced cancers because of it. We have nothing like that for men." Sikora explained that anatomy is, in part, to blame. Whereas the cervix is easily sampled, the tonsils are full of "nooks and crannies," he said, and scientists have yet to develop a reliable technique for obtaining a representative sample of cells inside the throat, tonsils and back of the tongue. "It's sort of a holy grail for researchers in the field," Sikora said. "It would be a game-changer in terms of prevention and early detection of cancer." Scientists at MD Anderson, where Courville was treated, may be closing in on some answers. Researchers, including Erich M. Sturgis, M.D., MPH, the Christopher & Susan Damico Chair in Viral Associated Malignancies, are currently conducting a clinical trial for an antibody test that could be used to screen for HPV-related throat cancer. The HOUSTON study, an acronym for "HPV-related Oropharyngeal and Uncommon Cancers Screening Trial of Men," is looking to recruit 5,000 men ages 50 to 64 years to provide blood and saliva samples for serologic HPV testing and oral HPV testing, respectively. If a subject is found to have a positive antibody test, he will be asked to participate in a second phase of the study, which includes an intensive screening program run through MD Anderson's oral pre-cancer clinic. "A researcher at Arizona State University, Dr. Karen Anderson, developed a serologic test that predicts extremely well the risk for HPV-related oropharyngeal cancer," Sturgis explained. "We have been able to show that serum antibodies to HPV early proteins, which are rare in the general population, are markers for oropharyngeal cancer. Specifically, we found that those who had antibodies to certain HPV antigens have a greater than 450-fold higher risk of oropharyn- geal cancer compared with those who do not have the antibodies." The hope is that this study will reveal that serological HPV anti- body testing is an effective screen- ing tool for HPV-related cancer in men: the equivalent to a pap smear. A lump in the neck If and when HPV-related cancer does develop, men often notice a pain in their jaw or throat, trouble swallowing, change or loss of voice that lasts more than a week or two, a sore spot on the tongue and, most often, a lump in the neck. "There's often a very small, pri- mary tumor, which is the tumor that is in the tongue or in the tonsil, and it travels early to the lymph nodes," Sikora explained. "Depending on what your neck looks like, lymph nodes can get pretty big before they become noticeable. But a lump in the neck is by far the most common symptom, and unfortunately it's often detected much later than we would like." Even more troubling, many individuals who have these symp- toms are commonly misdiagnosed and handed antibiotics, as in Courville's case. "The most important message I can convey is that if you have a lump in your neck, go see an ear, nose and throat doctor," Karni said, emphasiz- ing the importance of an informed Ron J. Karni, M.D., is Chief of the Division of Head and Neck Surgical Oncology at McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center. Credit: McGovern Medical School at UTHealth Credit: F. Carter Smith for MD Anderson Erich M. Sturgis, M.D., MPH, is the Christopher & Susan Damico Chair in Viral Associated Malignancies at MD Anderson. Andrew Sikora, M.D., Ph.D., is Vice Chair for Research and Co-Director of the Head and Neck Cancer Program at Baylor College of Medicine. MEN ' S HEALTH

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