Beyond Cervical cancer: Why HPV-related head and neck cancers need greater attention

Globally, Human Papilloma Virus (HPV) related head and neck cancers have surged by more than 225 per cent over the past 50 years, even as tobacco- and alcohol-driven cases have declined in many developed nations, according to a GLOBOCAN-based analysisⁱ. In India, a systematic review and meta-analysis of over 4,600 head and neck cancer patients found the overall pooled HPV prevalence to be 33 per cent with striking regional variation, ranging from 47 percent in Eastern India to under 20 percent in Western Indiaⁱⁱ.

HPV is responsible for nearly all cervical cancer cases while an emerging and often under-appreciated dimension of HPV-related disease is its growing role in head and neck cancers, particularly cancers of the oropharynx (the tonsils and base of the tongue).

A changing disease landscape

Head and neck cancers in India have traditionally been linked to tobacco and alcohol use, with a consistent patient profile of older individuals, often with a long history of chewing tobacco, smoking, or heavy drinking. Over the past decade, however, there is a distinct shift. HPV-positive oropharyngeal cancers are being diagnosed at younger ages, with different sexual practices and multiple sexual partners. The disease biology is quite different from that of its tobacco-related counterpart in terms of better response to radiation and chemotherapy.

Many HPV-positive patients also have concurrent tobacco or alcohol habits, suggesting dual risk factors rather than a clean substitution of one cause for another. What remains consistent, though, is the clinical relevance of HPV-positive oropharyngeal cancers that tends to respond better to treatment and carry a markedly better prognosis, 5-year survival rates exceeding 80 percent in HPV-positive cases, compared to under 50 percent in HPV-negative disease.

Why it matters for India

India already carries one of the world’s highest burdens of head and neck cancers, driven largely by tobacco use. In addition HPV positivity is increasing in India over time and its very important to prevent further rise.

Layered onto this is a meaningful and measurable HPV contribution, one that gets more complicated when you look closer at the regional picture. A meta-analysis published in BMC Infectious Diseases found that HPV prevalence in head and neck cancers in Eastern India runs nearly 2.5 times higher than in the Westⁱⁱⁱ. This probably corresponds to higher occurrence of head and neck cancers in the east. It points to something we still don’t fully understand HPV’s role in Indian head and neck cancers isn’t uniform, and our current data is too fragmented to tell us why. This information helps us to identify the areas where we need to focus regarding early diagnosis and prevention.

Bridging the gaps

Closing this gap isn’t about one intervention, it requires movement on several fronts at once:

• A patient with a persistent sore throat, an unexplained lump in the neck, or something unusual in the tonsils shouldn’t be dismissed simply because they don’t fit the “typical” head and neck cancer profile, particularly in regions where we already know HPV prevalence runs high.

• HPV testing, where clinically appropriate, should be integrated into diagnostic workups for oropharyngeal cancers, helping both with prognostication and treatment planning.

• Clinician awareness needs deliberate reinforcement. Many primary care physicians and even some specialists continue to associate HPV almost exclusively with gynaecological disease. Continuing medical education must catch up with the evolving evidence base.

• Multidisciplinary care pathways, involving oncologists, ENT surgeons, radiation oncologists, and pathologists are essential to ensure that once identified, HPV-positive cases are managed with an approach suited to their distinct biology and prognosis, while accounting for the dual-risk-factor reality common in Indian patients.

Prevention beyond cervical cancer

Reframing HPV vaccination as a broader cancer prevention strategy, rather than a gender-specific intervention, could meaningfully expand its public health impact and address a population at risk that current campaigns largely not covering.

The way forward

As India continues its efforts against viral and vaccine-preventable diseases, HPV-related head and neck cancers deserve further research in terms of actual assessment of the existing regional burden identification, dedicated research into better understanding of the strains involved, wider vaccination efforts and analysis of the outcome of treatment of HPV associated oropharyngeal cancers. Unlike cervical cancer where time tested screening methods are available, screening for these cancers are difficult and hence prevention should be of topmost priority. Vaccination schedules are similar to that for cervical cancer and requires to be implemented across the country especially for high risk susceptible population.

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