February 13, 2019
Rates of vocal cord cancer, also known as glottis cancer, could be rising among teens and young adults, a trend that appears to be linked to human papillomavirus (HPV) infection, according to research published Feb. 7 in the Official Gazette. Annals of Otolaryngology.
Vocal cord cancer is classified as laryngeal cancer and is considered relatively rare, with about 12,000 new cases each year. Its symptoms include voice changes, loss of voice, coughing, or swelling in the neck or throat. It is often successfully treated, especially if caught at an early stage.
In generations past, vocal cord cancer was associated with smoking. But the new study and other research point to infection with HPV, a sexually transmitted disease, as an important cause. The disease may also go awry biologically, with younger patients with HPV getting sick faster than those whose cancer is linked to smoking, he says. Stephen Zeitels, MDa head and neck surgeon at Harvard Medical School and Massachusetts General Hospital.
“We’re right on accelerated change because we see it in young adults and non-smokers,” says Dr. Zeitlis.
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Vocal cord cancer: a changing demographic
Before the early 2000s, Zettel says, he primarily saw cancer of the vocal cords in older adults who smoked. But that began to change about 15 years ago, he said, noting that his practice specializes in treating disorders that threaten the vocal cords.
We were seeing a disproportionate number of young adults with vocal cord cancer. Among that group, there were a disproportionate number of non-smokers. “I said: What does this mean? I could not come to definite conclusions. But what I saw was a harbinger.”
In a 2016 study, Zeitels and colleagues examined 100 people with vocal cord cancer and found that 31 were nonsmokers. This result was inconsistent with standard disease statistics. According to the American Academy of Otolaryngology, Head and Neck Surgery, for example, 95 percent of people Smokers are one of the most common types of vocal cord cancer.
Moreover, he notes that in recent years, clinicians have identified a significant increase in oropharyngeal cancers associated with HPV infection. Around 70 percent of oropharyngeal cancers may be linked to HPV infection, according to the Centers for Disease Control and Prevention (CDC). HPV is common and spreads through sexual contact with the genitals, mouth, and throat. About 10 percent of men and 3.6 percent of women have oral HPV, according to Center for Disease Control.
In the new study, which was funded by the nonprofit patient group Health Voice InstituteZeitels examined people 30 years of age or younger with vocal cord cancer who were evaluated at the Massachusetts Eye and Ear Infirmary or Massachusetts General Hospital. Compare two time periods: 1990 to 2004 and 2004 to 2018.
In the first time period, 112 subjects were diagnosed with vocal cord cancer, and none of them were 30 years of age or younger. From July 2004 to June 2018, 241 people were diagnosed, 11 of whom were 30 years of age or younger. 10 of 11 people 30 or less tested positive for high-risk HPV, such as HPV 16, one of the most common strains associated with cancer. Only 3 of the 11 patients had a history of smoking, and all three had smoked for only a few years.
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A potentially more aggressive form of vocal cord cancer
The study suggests that not only is the rate of vocal cord cancer higher in younger adults, but HPV-related vocal cord cancer may progress more rapidly than smoking-related cancer, says Zeitels.
“It is not surprising that alternative malicious pathways have a different timeline,” he stated in the paper. “Malignant pathways, such as high-risk HPV, may have a different and shorter timeline.”
The study is important because it alerts clinicians to the realization that younger non-smokers may be at risk of developing the disease. Many doctors have been taught that young adults and non-smokers do not develop vocal cord cancer. Zeitlis says that people with vocal cord cancer can be misdiagnosed and mistreated as having a similarly benign disease called recurrent respiratory papillomatosis.
More research is needed to look at larger numbers of patients and investigate the possible link between HPV and vocal cord cancer, he says. “We don’t know where this is going. We’re at the front of this curve,” Zeitlis says.
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However, the study strengthens the case for universal vaccination of children against HPV, says Zeitels. The HPV vaccine is the only vaccine that prevents certain types of cancers. Boys and girls ages 11 to 12 should get two injections of the HPV vaccine six to 12 months apart, according to the CDC.