Nick Mulcahy

March 27, 2017

CORRECTED March 27, 2017 // ORLANDO, Florida ― At the end of a data-driven session on human papillomavirus (HPV) and related cancers here at the National Comprehensive Cancer Network (NCCN) 22nd Annual Conference, David Pfister, MD, of the Memorial Sloan Kettering Cancer Center in New York City, opened the floor for questions from the audience.

A female oncologist, who did not identify herself by name, approached a microphone after a long walk from the back of the auditorium.

"How do you handle the situation where you have a couple that's been married for 40 to 50 years and they're HPV positive [HPV+]?" she said, suggesting that one partner had an HPV-related cancer, which led to each learning about the other person's HPV status.

The couple, who are now in the oncologist's office, are ready to address the newly discovered facts of their lives.

"Let's talk about the realities about how you have that conversation when the couple goes [to each other]: 'Have you been unfaithful?' " she finished, emphatically shrugging her shoulders to express uncertainty about the entire set of circumstances.

"That's an excellent question," said Dr Pfister, whose talk centered on HPV-related head and neck cancers and outcomes. He said that in his talk, he was unable to address psychosocial issues as well as HPV communicability.

Dr Pfister acknowledged that HPV+ head and neck cancers are associated with oral sex, but he also said HPV can be passed along by any kind of mucosa-to-mucosa contact. "This is a very easily spread virus," he said.

Furthermore, there is a "big inverted pyramid" that depicts the large number of people with HPV infections and the relatively few who go on to develop either anogenital or head and neck cancers that are related to HPV. Many are infected (bottom of pyramid), but most clear the virus, and few develop a related cancer down the road (top of pyramid).

Dr Pfister said he has been caring for head and neck cancer patients for a "pretty long time" and had yet to see a couple who both had an HPV-related cancer. In other words, he had not encountered the worst-case scenario for couples who are both HPV+.

Christina Chu, MD, of the Fox Chase Cancer Center, Philadelphia, Pennsylvania, who gave a talk about HPV and related cancers of the cervix and vulva, also fielded the question.

HPV infection is nearly ubiquitous, she said: "Almost everybody has HPV."

Her concern is whether or not there is a high-risk type of HPV infection and disease-related sequelae. She also said that the latency period between cervical dysplasia and cancer can be 20 years. HPV-related precancerous lesions or even a cancer should not result in long-term changes in intimacy, she suggested.

"You shouldn't really change your long-time habits with your partner," she advised.

Dr Pfister told Medscape Medical News that not much has been known about how patients feel about having a cancer that is related to HPV infection, so he and colleagues at Memorial Sloan Kettering conducted interviews with survivors of HPV-related oropharynx cancer, which is the most common HPV-related head and neck cancer, in 2013.

The interviews with 10 men were transcribed, and recurring themes were identified. Patients worried about their partner's risk. "There's a lot of anxiety," said Dr Pfister.

Also, uncertainty about transmission, latency, and communicability colored the dialogue about HPV, according to the results, which were published in Head and Neck.

Per NCCN guidelines, all oropharyngeal tumors should be tested for HPV, given the fact that the prognosis is better for patients whose tumors are HPV+. The 2-year survival rate for HPV+ oropharynx cancer is 94%, compared to 58% for HPV-negative (HPV-) oropharynx disease, said Dr Pfister.

So, for oncologists, discussing HPV+ head and neck cancers is at once easier (because of a better prognosis) and more difficult (because of the potential awkwardness of discussing a sexually transmitted virus) than discussing HPV- cancers, he suggested.

To that end, Memorial Sloan Kettering developed an online list of the most common questions (and answers) about HPV and head and neck cancers. Oncologists who find discussions about sexually transmitted diseases difficult may want to peruse this helpful material, said Dr Pfister.

Dr Pfister has financial ties with multiple pharmaceutical companies, which are almost all related to grant/research support. Dr Chu has disclosed no relevant financial relationships.

National Comprehensive Cancer Network (NCCN) 22nd Annual Conference. Presented March 24, 2017.

Editor's note: HPV-positive oropharyngeal tumors are associated with better median survival than HPV-negative tumors; an earlier version of the story was incorrect.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

For more from Medscape Oncology, follow us on Twitter: @MedscapeOnc


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