The common virus fuelling a 'tsunami' of cancers, particularly in men

Written by Henrietta Cook

January 7, 2025 - 11.51am

A common virus transmitted during oral sex is fuelling a worrying rise in throat cancers among middle-aged Australians.

Health experts are warning of a "tsunami" of throat cancers, with overall cases rising by 254 per cent over the past two decades.

While oropharyngeal (throat) cancer is still considered rare, it's predicted that 1055 Australians will be diagnosed with the potentially deadly disease this year. There were just 298 diagnoses in 2004.

While this type of cancer used to be mainly caused by smoking and excessive alcohol consumption, the human papillomavirus, or HPV, is now linked to the development of 64 per cent of these cancers in Australia.

"Clinicians often talk about HPV causing a tsunami of head and neck cancers," said Head and Neck Cancer Australia chief executive Nadia Rosin.

About 90 per cent of Australians will become infected with HPV at some point during their lives. The majority will clear the virus within one to two years and never know they have it.

But for a few people, the virus will linger and cause cancerous changes to the cells in their throats.

Tiel Lillehagen was among this unlucky cohort. In 2016, the general manager of a property development company developed a sore throat that would not go away for four months.

"I took myself off to the GP. He didn't think much about it and prescribed me some antibiotics," the SO-year-old said.

"I went back to him over the course of four months, and he eventually referred me to an ear, nose and throat specialist."

Lillehagen received a diagnosis just days before he, his wife and their two young children were due to host Christmas lunch.

"I hadn't even heard about head and neck cancer. It was quite a shock," he said.

Lillehagen initially felt some stigma about his diagnosis due to its link to a sexually transmitted infection. But this has since evaporated, thanks to his role as secretary of the Victorian Head and Neck Cancer Education and Support Group. The group meets monthly to discuss everything from treatment and their fear of the cancer returning to football.

"I've met 150 other survivors like me. That stigma is gone. I understand that HPV really is the common cold of STis," he said.

Lillehagen suspects he caught HPV while he was at university, more than 20 years before his diagnosis of a cancerous tumour in his throat.

His treatment involved 35 doses of radiotherapy over seven weeks and chemotherapy. If his cancer had been picked up earlier, he might have been able to treat his tumour with just surgery.

"It's a very lonely treatment process," he said. "It's a gruelling treatment regime with high morbidity. You suffer from fatigue and are in pain from the burning. You come out of the other end feeling quite isolated."

He has been left with some long-term side effects from this treatment: he suffers from a dry mouth, struggles to swallow certain foods like chicken breast and cake, and has cramping and stiff neck muscles. But he's grateful to be alive and has been cancer-free for eight years.

Associate professor Annika Antonsson, from the QIMR Berghofer Medical Research Institute, said the rollout of the HPV vaccine to high school girls in 2007 and boys in 2013 would reduce the prevalence of HPV-related throat cancers, as well as cervical cancer.

But the benefits of this program may not be apparent for some time because there is a 20- to

30-year lag between contracting HPV and potentially developing throat cancer. The average age of diagnosis is about 61.

Antonsson said the rising popularity of oral sex was driving the rise in HPV-positive throat cancers. Research has found that more than 90 per cent of Australians have performed and received oral sex, up from 85 per cent a decade ago. HPV can also spread through kissing.

"Changing sexual behaviour is driving this change," Antonsson said. "People with HPV-positive cancer have more oral-sex partners."

Antonsson conducted research that found people who don't clear the HPV virus - which heightens their risk of throat and cervical cancers - are often smokers.

About 85 per cent of throat cancer cases in Australia involve men, Antonsson said. Researchers have theorised that this could be because clearing a cervical or anal HPV infection provides a stronger immune response against the virus than having a HPV infection on the penis or the mouth.

"You get better lifetime protection," Antonsson said of people clearing a HPV infection. There are no formal screening tests for head and neck cancer.

"The best thing people can do is to be aware of the signs and symptoms," said Rosin.

These can include a lump in the neck, hoarse voice, unexplained ear pain and a sore throat that persists for more than three weeks. Rosin recommends seeing a GP and getting a referral to a head and neck cancer specialist for further investigation. "These can be really fast-moving cancers," she said.

The key way to prevent the virus, which is spread through skin-to-skin contact, is by getting the HPV vaccine before starting sexual activity.

Head and Neck Cancer Australia also recommends using condoms for any sexual activity with new partners. People can reduce their risk of contracting non-HPV related oropharyngeal cancer by not smoking and reducing their alcohol consumption.

Treatment depends on what stage the cancer is picked up, according to Dr Matthew Magarey, a surgeon from Peter Mac.

It might involve surgery to remove a person's tonsils and the side of their throat impacted by the cancer - often using a robotic platform. Radiation and/or chemotherapy are used for throat cancers picked up at a later stage.

"People can be very easily treated with surgery, if it is picked up in the early stage," he said. "People who have had surgery return to work earlier than people who have had radiation."

Magarey said HPV-related throat cancer had an 80 per cent cure rate, and was more treatable than smoking-related throat cancer.

He operates on up to 30 people with throat cancer every year; his patients are typically male and in their 50s and 60s.

He said most people with throat cancer didn't experience symptoms during the early stages, but might later present with a lump on the side of their neck, often below the angle of the jaw. Some people might have had ongoing throat pain.

"We don't want to create panic that if you have a sore throat, you have cancer," he said. "But you need to have it investigated if the sore throat persists for more than three weeks."

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