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The HPV vaccine Gardasil protects against human papillomavirus, a prolific virus that causes many types of cancer. In fact, although it was initially approved to prevent cervical cancer, the most common HPV-associated cancer is head-and-neck cancer. Last month, Gardasil 9 was finally approved for the prevention of head-and-neck cancer.

That certainly took long enough! We’ve known for a long time that HPV is behind the epidemic of head-and-neck cancers, and we’ve known that the HPV vaccine guards against infection with this virus. With HPV causing more head-and-neck cancers than any other HPV-associated cancer in the United States, this approval was long overdue.

Photo: Heather Hazzan, Self Magazine

Bearing the Burden of HPV

Although its routine use in boys and men has been recommended since 2011, the HPV vaccine is still primarily thought of as a “girl’s vaccine,” invaluable for its ability to prevent cervical cancer. For the first few years of its existence, Gardasil was only FDA-approved for girls and women, and since then it has struggled to escape its gendered connotations. While this new FDA approval doesn’t change who is eligible to receive the vaccine, it does shine some awareness on head-and-neck cancer, and gives parents more evidence that this anti-cancer vaccine is important to give to sons, not just to daughters.

Gardasil 9 is now approved for the prevention of head-and-neck cancer, shining a light on this epidemic.

Head-and-neck cancers can strike anywhere from the lips to the larynx, or voice box, and up into the sinuses and nasal cavity. According to the Centers for Disease Control and Prevention, an estimated 11,300 U.S. men are diagnosed with head-and-neck cancer every year, compared to 2,200 U.S women.

Risk factors include alcohol use, tobacco use, poor oral hygiene, and infection with certain strains of HPV. In the 1980s, only 15% of head-and-neck cancers were caused by HPV, but nowadays, as smoking rates decline, the virus causes 70% of them. HPV-associated head-and-neck cancer in men has been called an “epidemic.”

HPV is so widespread, the Centers for Disease Control and Prevention says that, without the HPV vaccine, “almost every person who is sexually active will get HPV at some time in their life.” And the ubiquitous human papillomavirus can be spread through any sexual activity, including oral sex. Sexually active people can reduce risk during oral sex by using condomsdental dams, and possibly even plastic wrap. HPV is transmitted by skin-to-skin contact, which means these “barrier” methods are limited by the area of skin they cover, so they are not substitutes for vaccination.

HPV can harm anyone, regardless of gender, and when it comes to head-and-neck cancer, the gender disparities are disproportionately shouldered by men. In 2017, scientists reported that 7 million U.S. men and 1.4 million U.S. women had oral HPV infections with cancer-causing strains of the virus. This finding, that five times as many men as women have potentially cancer-causing oral HPV infections, was not surprising — previous studies have also found that oral HPV is more common in males, as are HPV-associated head-and-neck cancers.

Escaping its Gendered Origins: Good News and Bad News

Among adults age 18-26, males lag behind females when it comes to having received the HPV vaccine. The good news is that, in real time, teen boys are catching up. In 2018, 70% of teen girls had received at least one dose of the HPV vaccine, compared to 66% of teen boys. Yes, parents are still more likely to protect their daughters against cancer than they are to protect their sons, but the gap is closing: In 2013, 57% of teen girls had received at least one dose, compared to 35% of males. In just five years, teen boys went from a 22-point discrepancy to a four-point discrepancy.

That’s wonderful news, as vaccinating boys is essential in protecting the health of men who have sex with men, who are at higher risk for anal cancer, and of men who have sex with women, who are at higher risk for head-and-neck cancer.

The bad news is that HPV vaccination rates are still too low, especially when you consider the high stakes of cancer. The HPV vaccine requires two or three doses to be effective, and in 2018, only half of teens were up to date on their shots (54% of girls vs. 49% of boys).

Can I Be Screened for Oral HPV?

While the HPV vaccine is expected to contribute to further declines in cervical cancer among recipients, cervical cancer rates were already decreasing thanks to Pap testing, which can catch “precancerous” cervical abnormalities. These precancers can be removed before they have the chance to progress to cancer.

Unfortunately, there is no real equivalent to the Pap test for head-and-neck cancers. Despite the relative simplicity of screening for head-and-neck cancer, most people do not receive screening, even from dentists, who could easily incorporate it into their regular exams. A dentist could see multiple abnormal tissues in their patients’ mouths each day, but without training to identify these tissues and refer patients for follow-up care, opportunities for earlier treatment are missed. If you have a dentist, ask them if they are trained to perform head-and-neck cancer screening.

Screening for head and neck cancer is relatively noninvasive compared to many other types of cancer screening, which can involve medical instruments that are inserted into the body, such as endoscopes and colonoscopes. Head-and-neck cancer screening, on the other hand, is described as “gentle,” involving a visual exam of the mouth, tongue, gums, and lips, along with palpating the neck for any lumps and bumps. No scopes!

If you are concerned you have symptoms of head-and-neck cancer, such as patches, sores that don’t heal, or bleeding, Planned Parenthood Arizona can refer you to specialists who can evaluate your mouth and throat. Health care providers at any Planned Parenthood health center can vaccinate you with Gardasil 9, and while you’re there you can stock up on condoms and receive answers to your questions about HPV and safer sex.

Tags: virus, cancer, straight, HPV, cervical cancer, men's health, gender, Food and Drug Administration, Gardasil 9, Sexual Health and tagged age, boys, cunnilingus, dental hygiene, dentistry, head and neck cancer, heterosexual, homosexual, human papillomavirus, immunization, males, man, mouth, mouth cancer, oral cancer, oropharyngeal cancer, smoking, throat, throat cancer, tobacco, uptake, vaccination, men, oral sex, Gardasil, STD Awareness, FDA, vaccine, HPV vaccine, cancer screening

About Anna C.

Anna first volunteered for Planned Parenthood as a high school student in the 1990s. Since then, she has received a bachelor’s degree from UC Berkeley and a master's degree in epidemiology from the University of Arizona. As an ode to her fascination with microbes, she writes the monthly STD Awareness series, as well as other pieces focusing on health and medicine.