Oncology Nurses’ Response to the Changing Landscape of HPV-Related Head and Neck Cancer

By Elaine S. DeMeyer, RN, MSN, AOCN®, BMTCN® - April 18, 2023

Human papillomaviruses (HPVs) are a significant risk factor for a specific subtype of head and neck cancer (HNC), called squamous cell carcinoma of the head and neck area (HNSCC). HPVs can be considered “the common cold of cancer,” because almost everyone becomes infected, putting them at risk for 6 deadly cancers, including oropharyngeal cancer. Therefore, oncology nurses are vital to educating patients and partners, children, grandchildren, and the community about the CDC recommendations for HPV vaccines for people aged 11-45 years.

What Is HPV?

HPVs are a group of DNA viruses infecting epithelial cells, causing benign and malignant conditions. There are more than 200 HPV strains (often called types) with each one containing a number. Despite this large number of strains, mostly the high-risk strains can cause malignancies.

  • High-risk HPV strains include HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. The 2 most common strains responsible for most (about 90%) HPV-related cancer include HPV 16 and 18.
  • Low-risk strains, such as HPV 6 and 11, contribute to benign conditions, such as genital warts or cervical dysplasia (a precancerous condition).

A person can be infected with HPV and show no signs of symptoms. People can be HPV positive for a decade or longer before the appearance of cancer.

How Is HPV Transmitted?

People often think of HPV infection as involving only the sex organs like other sexually transmitted infections (STIs). As the most common STI, many people acquire HPV in their teens or early 20s, mostly during vaginal or anal sex, but also during oral sex. Unlike other STIs, HPV transmits through skin-to-skin contact instead of bodily fluids like semen or saliva. Rarely, HPV may pass by deep, open-mouth kissing, but research on the transmission of HPV during kissing is ongoing. Sharing drinks, straws, utensils, lip balm, or lipstick is very unlikely to transmit the virus.

What Types of Cancer Are Associated With HPV?

Overall, HPV can lead to 6 major types of cancer:

  1. Anal
  2. Cervical
  3. Oropharyngeal
  4. Penile
  5. Vaginal
  6. Vulvar

Head and neck cancer resulting from HPV infection is often the most confusing, as most people associate HNC with tobacco use.

What Is the Risk of HPV-Related HNC?

Human papillomaviruses are among the 3 most common risk factors for HNC. According to the American Association for Cancer Research (AACR), smoking and alcohol are the 2 most important risk factors for all types of HNC, with HPV infection as a risk factor for HNSCC. Risk factors can be generally associated with the specific tumor location:

  • Larynx and oral cavity – tobacco consumption, alcohol abuse, or both.
  • Pharyngeal area – HPV infection

Thus, HNSCC usually can be separated into HPV-negative and HPV-positive categories.

How Is HPV Changing the HNC Patient Population?

Margaret Rummel, RN, MHA, OCN, NE-BC, HONN-CG, from Abramson Cancer Center in Philadelphia, Pennsylvania presented at a pre-conference session of the Academy of Oncology Nurse & Patient Navigators (AONN+). She emphasized the changing paradigm of HNC because of HPV. Years ago, “there was a very standard patient [who] had HNC—an older population, primarily male, heavy drinkers and smokers, with many social determinants of health.

“Although this is still true, HPV-positive patients are changing the landscape of HNC.”

She explained that HPV-positive patients respond very differently than HPV-negative patients. For example, HPV-positive tumors are highly radiosensitive compared with HPV-negative tumors. As a result, patients may have a half-dose radiation plan resulting in fewer side effects and better quality of life.

How Should Nurses Discuss HPV Prevention?

The topic of HPV prevention can be difficult to raise, so nurses must create a trusting, non-judgmental environment. Some parents may express concerns or myths about HPV vaccination:

  • Denial that their children may be sexually active
  • Children will wait or were taught to wait to have sex until after marriage
  • Talking about sex, especially oral sex, does not take place in our family
  • Vaccination gives children permission to have sex (like providing condoms)

In addition, many preteens and teens think that oral sex is not actually sex. As with other vaccines, some patients or parents are “anti-vaxxers.”

All nurses, but especially oncology nurses, must understand the facts about HPV to be able to stress that >90% of HPV-related cancers are preventable. The critical message to communicate is that there is NO downside to vaccinating anyone against HPV, especially if it can prevent potentially disfiguring HNC. But, of course, as with any vaccine, cancer survivors need to consult their provider before receiving vaccines.


Human Papillomaviruses-Associated Cancers: An Update of Current Knowledge

HPV and Cancer

Genital HPV Infection—Basic Fact Sheet

Head and Neck Cancers

Head and Neck Cancer: Current Challenges and Future Perspectives

Low-Dose Radiation a Possible “Game Changer” for Treating HPV-Positive Throat Cancer