2 Epidemics Impacting the Young: HPV Throat Cancer and Thyroid Cancer
An Interview with Eric Genden, MD
Just last month, we interviewed Mount Sinai experts, Dr. Henschke and Dr. Flores on the importance of screening early for lung cancer, regardless of whether you smoke. This month, our medical director, Louis DePalo, MD is continuing the conversation with world-renowned head and neck surgeon, Dr. Eric Genden, diving deeper into two epidemics – HPV associated throat cancer and thyroid cancer.
These cancers are unfortunately growing at rates that will make them household names, if they aren’t already – and they are affecting younger individuals, many who have never smoked and only engage in minor social drinking. Similarly to the more common cancers of breast, prostate, skin, and colon cancer, everyone needs to be aware of these cancers so you can take the steps to protect yourself from serious disease.
Epidemic 1: Throat Cancer
Human Papillomavirus (HPV), the most common sexually transmitted disease, is at the center of younger individuals developing cancer. If you have an active HPV infection, you are 340 times more likely to develop throat cancer – and for quick comparison, a heavy drinker is just 5.5 times more likely to develop throat cancer. HPV infection among younger individuals has contributed to HPV related cancer to surpass cervical cancer in prevalence. Fortunately, there is an HPV vaccine, introduced in 2006, but more education needs to be done to increase the adoption rate.
Epidemic 2: Thyroid Cancer
Moving on to thyroid cancer, the other epidemic we will discuss today, we are still learning about all of the causes of this cancer, but we know it can be influenced by your environment and the tragedy of the world trade centers validated that theory. The group most prone to developing thyroid cancer is women between the ages of 25 and 50. Thyroid nodules, which if located should be monitored annually for growth, are found in two-thirds of all women. If you are a woman in your forties and you don’t have a thyroid nodule, you are surprisingly in the minority. Thyroid cancer, like all cancers, is best caught early and can be monitored annually with an ultrasound of the neck.
Continue on to learn more and hear directly from Dr. Eric Genden, who is named one of the 20 most innovative surgeons alive today for his industry leading surgeries and most recently for performing the first tracheal transplant surgery in the world.
If you have a family history of throat or thyroid cancer or want to learn more about the HPV vaccine or screening of your thyroid, contact our Personal Health Navigators by chat through the member portal or by calling 646.819.5100 to be connected with one of our physicians.
Why should younger people who don’t smoke or drink be aware of throat and neck cancer?
Key Takeaway: The history of throat cancer is that it was traditionally found in individuals who were heavy smokers and drinkers. However, in the last 15-18 years, we started seeing throat cancer patients in their 40s and 50s who have never smoked and only engaged in minor social drinking. We found that the cancer they were developing, now considered an epidemic, was a HPV associated disease.
We are always told that drinking or smoking in excess can cause cancer and that is true. If you are a heavy drinker, you are 5.5x more likely to develop throat cancer. If you smoke 1 pack a day for 10 years, you are 19x more likely to develop throat cancer and if you do both, you are 56x more likely to develop throat cancer. However, if you have an active HPV infection, you are 340x more likely to develop throat cancer and this is what has contributed to throat cancer becoming an epidemic and changing the demographic of the people affected by throat cancer.
Can you give some background on HPV and why girls/women and boys/men should be getting the vaccine?
Key Takeaway: HPV is very communicable. It is the only known cause of cervical cancer in women and now the same virus is causing throat cancer in men. There are 200 different types, from warts on your hand to small papillomas in the throat or other areas. Only 8 or 9 of these types cause throat cancer. The vaccine protects against several of these papillomas and 9 high risk types. The vaccine was introduced in 2006 and unfortunately, adoption has been slow, likely because of the stigma around HPV, but the HPV vaccine is important in protecting people from cervical and anal cancer, but also helps with throat cancer.
Should we be doing more to screen for HPV to detect it sooner?
Key Takeaway: Unfortunately, routine screening comes down to cost and we aren’t doing enough to screen for throat and neck cancers. Fortunately, liquid biopsies, primarily through blood, will become more common in screening for cancers in the coming years. Blood tests are able to pick up tumors 6-8 months sooner than imaging tests.
From your research with the world trade center tragedy, what do we know about the environmental impact on thyroid cancer?
Key Takeaway: Thyroid cancer continues to rise and it afflicts the young. Exposure to the world trade center tragedy has left patients with a higher risk of developing cancer and potentially a more aggressive type. The question becomes, what other exposures may be partially responsible for the rise in thyroid cancer? Specifically speaking about the world trade towers, we tend to look at the aerosols and assume they are the cause of disease, but there are many endocrine access points and they are all linked. Everything we come in contact with, through our skin, air, water, and more – has some impact on our physiology. If it has even the slightest impact on our endocrine system, it can have downstream effects that are catastrophic. This speaks to the clothes we wear to possibly even the toothpaste or mouthwash we use.
What are the treatment options for throat or thyroid cancer – understanding patients don’t want to disrupt their appearance?
Key Takeaway: With head and neck surgeries, every incision you make has an impact on that patient’s self-esteem and how they express themselves. If you are able to detect cancer early when it is small, we can use minimally invasive techniques. Surgery for thyroid cancer is now less than an inch, no stitches and the patient goes home the same day. That is very different from 10 years ago when patients would have to be in the hospital for days with a 6-8 inch incision.
This is the same for other head and neck cancers. The surgeries are now done robotically and patients are eating and drinking the same day. The ability to screen and detect cancers early is making for a less invasive treatment and better outcomes.
When a nodule is found on a person’s thyroid, what are the next steps?
Key Takeaway: Two-thirds of all women have thyroid nodules. I am a strong advocate for women to get an ultrasound of their thyroid when they go in for their annual. They are highly sensitive tests. A nodule itself doesn’t need to be biopsied, unless they get to 10 mm in size or are highly irregular. An annual ultrasound can tell you that information.
Thyroid nodules are far less common in men, but when we see them, we are much more concerned. A baseline ultrasound over the age of 45 is a very good idea. If none are detected, you can likely go another five years before screening again.
In January 2021, the world’s first human tracheal transplant surgery took place. An 18-hour procedure, led by Dr. Genden and involving a team of more than 50 specialists.
About Eric Genden, MD
Eric M. Genden, MD, MHCA, FACS, is the Isidore Friesner Professor and Chair of Otolaryngology – Head and Neck Surgery, Senior Associate Dean for Clinical Affairs, and Professor of Neurosurgery and Immunology at the Icahn School of Medicine at Mount Sinai. He is Chair of Otolaryngology – Head and Neck Surgery, Executive Vice President of Ambulatory Surgery, and Director of the Head and Neck Institute at the Mount Sinai Health System.
Dr. Genden is internationally recognized as a leader and innovator in the management of oropharyngeal cancers and microvascular reconstruction of the head and neck. His clinical expertise also encompasses thyroid and parathyroid surgery. In addition to his clinical endeavors, Dr. Genden oversees a National Institutes of Health-funded basic science laboratory that studies the transplantation immune biology of the trachea and larynx. He is also co-investigator on more than a dozen clinical trials.
A thought leader in his field, Dr. Genden is a prolific author of original peer-reviewed reports, textbooks, and book chapters. He is an editor and reviewer for numerous journals, lecturing nationally and internationally on his work. Dr. Genden is a founding fellow of the International Academy of Oral Oncology, and past president of the New York Head and Neck Society.
See Dr. Genden’s full bio on Mount Sinai’s website.