The rates of vocal cord cancer, also known as glottic carcinoma, could be rising in teens and young adults, a trend that appears to be linked to human papillomavirus (HPV) infection, according to research published February 7 in the Annals of Otology, Rhinology & Laryngology. Vocal cord cancer is classified as cancer of the larynx and is considered relatively rare, with about 12,000 new cases each year. Its symptoms include changes in the voice or loss of voice, cough, or a lump in the neck or throat. It is often successfully treated, especially if caught at an early stage. In generations past, vocal cord cancer was linked to smoking. But the new study and other research points to infection with HPV, a sexually transmitted disease, as a significant cause. The disease may also be deviating biologically, with younger, HPV-infected patients developing the disease faster than those for whom the cancer is linked to smoking, says Steven Zeitels, MD, a head and neck surgeon at Harvard Medical School and Massachusetts General Hospital. “We’re right at the cusp of an accelerated change because we’re seeing this in younger people and nonsmokers,” says Dr. Zeitels. RELATED: Oral HPV Is a Growing Concern in Men
Vocal Cord Cancer: A Changing Demographic
Prior to the early 2000s, Zeitels says, he primarily saw vocal cord cancer in older adults who smoked. But that began to change about 15 years ago, he says, noting that his practice specializes in the treatment of disorders that threaten the vocal cords. “We were seeing a disproportionate number of younger people with vocal cord cancer. Of that group, a disproportionate number were nonsmokers,” he says. “I said, ‘What does this mean?’ I couldn’t come away with definite conclusions. But what I was seeing was a harbinger.” In a 2016 study, Zeitels and his colleagues examined 100 people with vocal cord cancer and found that 31 were nonsmokers. This finding was inconsistent with the standard statistics regarding the disease. According to the American Academy of Otolaryngology–Head and Neck Surgery, for instance, 95 percent of people with the most common type of vocal cord cancer are smokers. Moreover, he notes, in recent years, doctors have identified a significant increase in oropharyngeal cancers linked to HPV infection. About 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 spread through sexual contact to the genitals, mouth, and throat. About 10 percent of men and 3.6 percent of women have oral HPV, according to the CDC. In the new study, which was funded by the patient nonprofit group Voice Health Institute, Zeitels looked at people age 30 or younger with vocal cord cancer who were evaluated at the Massachusetts Eye and Ear Infirmary or Massachusetts General Hospital. He compared two time periods: 1990 to 2004 and 2004 to 2018. In the first time period, 112 people were diagnosed with vocal cord cancer, none of them 30 or younger. From July 2004 to June 2018, 241 people were diagnosed, 11 of whom were 30 or younger. Ten of the 11 people 30 or younger tested positive for high-risk HPV, such as HPV 16, which is one of the more common strains linked to cancer. Only 3 of the 11 patients had a history of smoking, and all three had smoked for only a few years. RELATED: 8 Ways to Prevent HPV or Detect It Early
A Potentially More Aggressive Form of Vocal Cord Cancer
The study suggests not only an uptick in vocal cord cancer incidence in younger adults but that HPV-related vocal cord cancer may develop more rapidly than smoking-related cancer, Zeitels says. “It isn’t surprising that alternate malignant pathways may 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 doctors to be aware that younger nonsmokers may be at risk for the disease. Many doctors were taught that young people and nonsmokers do not develop vocal cord cancer. People with vocal cord cancer could be misdiagnosed and mistreated as having a similar-looking benign disease called recurrent respiratory papillomatosis, Zeitels says. More research is needed to look at larger numbers of patients and to 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 end of this curve,” Zeitels says. RELATED: 8 Things You May Not Know About HPV The study, however, strengthens the case for universal HPV vaccination of children, Zeitels says. The HPV vaccine is the only vaccine to prevent certain types of cancers. Boys and girls ages 11 or 12 should get two shots of HPV vaccine six to 12 months apart, according to the CDC.
