Head and Neck Cancers Awareness Month
April 12, 2021Information
April 11, 2021
Yale Cancer Center
visit: http://www.yalecancercenter.org
email: canceranswers@yale.edu
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- 00:00Support for Yale Cancer Answers
- 00:02comes from AstraZeneca dedicated
- 00:05to advancing options and providing
- 00:07hope for people living with cancer.
- 00:10More information at astrazeneca-us.com.
- 00:14Welcome to Yale Cancer Answers with
- 00:16your host doctor Anees Chagpar.
- 00:18Yale Cancer Answers features the
- 00:20latest information on cancer care by
- 00:22welcoming oncologists and specialists
- 00:24who are on the forefront of the
- 00:26battle to fight cancer. This week
- 00:28it's a conversation about head and
- 00:30neck cancer with Doctor Aarti Bhatia.
- 00:33Doctor Bhatia is assistant professor
- 00:34of medicine and medical oncology
- 00:36at the Yale School of Medicine,
- 00:38where Doctor Chagpar is a
- 00:41professor of surgical oncology.
- 00:43Aarti, maybe you can start off by telling us a
- 00:46little bit more about head neck cancers.
- 00:48It seems like there would be a lot of
- 00:52cancers in that bucket.
- 00:53It is actually a pretty wide bucket.
- 00:56You know if you think about it,
- 00:58the head and neck is a
- 01:00pretty concise structure,
- 01:01but diagnosis, treatment follows
- 01:03like the site of origin of the
- 01:05tumor within the head neck region.
- 01:07So broadly it encompasses a lot
- 01:10of tumors which arise from the
- 01:12mucosa within the head and neck.
- 01:14But you know, they could arise in the mouth,
- 01:17so that would be oral cavity tumors.
- 01:19They could arise in the back of the throat,
- 01:22so that would be oropharyngeal
- 01:24tumors or tonsillar tumors.
- 01:25They could arise in our voice box
- 01:27that would be laryngeal tumors.
- 01:29The back of the nose is nasal
- 01:31pharyngeal tumors.
- 01:32You could also have salivary gland cancers,
- 01:34and each of those sites is treated
- 01:37differently in terms of how we
- 01:39work it up and how we manage it.
- 01:42And are they all lumped together?
- 01:45Basically because they're all
- 01:48pretty rare, or I wouldn't say
- 01:50they are rare, together head neck
- 01:53cancers always come within the top 10
- 01:56most common cancers in the United States.
- 01:58You know there's also a much larger
- 02:01proportion of tumors that arise
- 02:03outside of the United States,
- 02:05so for instance, Asia has a very
- 02:07large number of new head neck cancers
- 02:10that are diagnosed every year, but
- 02:13the reason they are lumped together is
- 02:16because they share a common Histology.
- 02:18So when we look at
- 02:20tumors under the microscope,
- 02:21most tumors arising from the head and
- 02:24neck region tend to have what we call
- 02:26a squamous Histology and based off
- 02:28that they are clubbed together as one
- 02:30entity. But they are different in
- 02:32terms of how they're treated and we're
- 02:35going to get into that in a second,
- 02:37but just take one step back,
- 02:40what is the etiology or the
- 02:42cause of these head neck cancers?
- 02:44Why are they more common in
- 02:46Asia than they are for example,
- 02:48in the United States and what
- 02:50are some of the risk factors that
- 02:52people should be watching for?
- 02:55So the common etiologies worldwide is,
- 02:58you know, tobacco exposure,
- 02:59alcohol exposure. In Asia
- 03:01there are a couple additional risk factors
- 03:04that increase the incidence of these cancers.
- 03:07So for instance, in Southeast Asia you
- 03:10know people tend to chew a lot of tobacco.
- 03:14They tend to chew betel nut and those
- 03:17natural substances can also increase their
- 03:20risk of acquiring head and neck cancers
- 03:23in countries like China. In Hong Kong,
- 03:25there is an incidence of nasal,
- 03:28pharyngeal cancers which are caused by
- 03:31the Epstein Barr virus or EBV virus.
- 03:33It's almost endemic,
- 03:34endemic proportions in those countries,
- 03:36so a lot of head neck cancers
- 03:39tend to be nasopharyngeal.
- 03:45In the United States and in
- 03:47the Western world at large,
- 03:49we also see several head and neck cancers
- 03:52arising in Association with the human
- 03:55Papilloma virus or the HPV virus.
- 03:57Most commonly,
- 03:58people associate that with
- 03:59cervical cancer in women,
- 04:01but there's a rising incidence of HPV
- 04:03head and neck cancers in the Western world.
- 04:08And so when we think about risk
- 04:11factors for developing these cancers,
- 04:13and we often think about primary prevention,
- 04:16so how can we reduce getting these
- 04:19risk factors and thereby reduce
- 04:22our risk of getting these cancers?
- 04:25It seems that the two that you've
- 04:28mentioned right off the top would be
- 04:31reduce your smoking or tobacco consumption,
- 04:34whether that's chewing tobacco
- 04:36or smoking tobacco,
- 04:38and getting an HPV vaccine. Is that right?
- 04:40That is right, so you know,
- 04:43the HPV vaccine is something
- 04:45that still doesn't have a lot
- 04:47of uptake in the Community,
- 04:49and it's good to be aware
- 04:52that the sooner you get it in life,
- 04:55ideally in your preteen years before
- 04:57you have a chance of being exposed
- 04:59to the virus and the infection,
- 05:01the much better protection that the virus
- 05:04offers you against multiple cancers.
- 05:06So for women it protects you
- 05:08against cervical cancer,
- 05:09head and neck cancer, anogenital cancers.
- 05:11And for men it protects you from the head and
- 05:14neck cancers and the anogenital cancers.
- 05:16So yes, and another thing
- 05:18to be aware of is that the FDA
- 05:21has recently increased the age
- 05:22limit to which you could actually
- 05:25be eligible to get the vaccine.
- 05:27So previously it used to be about 26 years.
- 05:30Now it's up to 45 years so you
- 05:32know people who did not meet the
- 05:35initial cutoff for the vaccine are
- 05:37now eligible to get the vaccine.
- 05:40And so why do you think that
- 05:42there is so much hesitancy
- 05:44about getting the HPV vaccine?
- 05:46I mean, it seems that it would
- 05:49be a no brainer if it can reduce
- 05:52your risk of getting cancer.
- 05:55Certainly HPV vaccines
- 05:57have been around for awhile and right
- 06:00now during the covid epidemic
- 06:02we've seen some hesitancy with
- 06:04regards to vaccination for covid,
- 06:06based primarily off of the speed
- 06:09and the rapidity with which
- 06:11those vaccines were developed.
- 06:13But the HPV vaccines have
- 06:16been around for a while,
- 06:18so why aren't people getting vaccinated?
- 06:21Is it that this isn't really something
- 06:24that's been established in school programs?
- 06:27When kids get their usual measles,
- 06:30mumps, and rubella vaccine?
- 06:32Is it celebrity endorsement
- 06:34against vaccination?
- 06:34Why do you think that there is
- 06:38this hesitancy?
- 06:40I think it's a combination of factors.
- 06:42One is the lack of awareness.
- 06:45A lot of people do not know
- 06:50about the Association with HPV.
- 06:58The second is that it's not a part of
- 07:01the national immunization schedule,
- 07:03unlike the MMR vaccine, which then
- 07:05gets offered to all pediatric patients.
- 07:08But this one doesn't,
- 07:09and the third is, I think,
- 07:12a cultural hesitancy.
- 07:13You know, HPV is a sexually acquired
- 07:15infection,
- 07:16and I think people worry that getting
- 07:19teenagers a vaccine against a sexually
- 07:21transmitted infection will in turn then
- 07:24promote promiscuity so
- 07:25I think a lot of people worry
- 07:27about that reason as well.
- 07:30And so is that why it's not part of
- 07:33the national vaccination schedule?
- 07:36I mean, it seems as though if the
- 07:39CDC and other public health officials
- 07:43recommend getting the HPV vaccine,
- 07:45and certainly cervical cancers,
- 07:49head, neck cancers,
- 07:50anogenital cancers are significant in
- 07:52terms of their public health consequences.
- 07:55Why isn't it part of the national schedule?
- 08:00I think one because it's
- 08:04been maybe within the last decade
- 08:05or so that we've started to see
- 08:08results from clinical trials
- 08:09establishing the efficacy of the
- 08:11vaccine against these cancers.
- 08:12And two, I think just a cultural
- 08:15uptake hasn't been that much,
- 08:17but it would be great to see it
- 08:19become a part of the national
- 08:21immunization schedule so
- 08:23people have to opt out of getting
- 08:25the vaccine instead of opting in to get it.
- 08:27And so for the people who are
- 08:31listening to this show and are thinking,
- 08:33it seems as though
- 08:36this vaccine is safe.
- 08:37It's highly efficacious as I understand it,
- 08:40can prevent over 90%,
- 08:42maybe even higher, of these cancers,
- 08:45especially cervical cancer.
- 08:46But also other forms of cancer.
- 08:49Why wouldn't I get it?
- 08:51How do they go about doing that?
- 08:54Is that something that they can
- 08:56get through their doctors offices?
- 08:59Is it covered by insurance?
- 09:02What are the other potential barriers
- 09:04that people can address?
- 09:07It shoud be fairly straightforward to get
- 09:08it so it is covered by insurance
- 09:11right from the preteen years.
- 09:13So age 9-10 until someone gets to
- 09:15the age of 45 years and it should be
- 09:18fairly straightforward to call your
- 09:20pediatrician or your primary care doctor,
- 09:23and you know, go in and get the shot.
- 09:26Most clinics offer the vaccine.
- 09:30And really it's been efficacious
- 09:32and minimal side effects, right?
- 09:33Well, there are some side effects. Nothing
- 09:36like the covid vaccine.
- 09:37So you know right off the bat,
- 09:39that's something a little bit better
- 09:41tolerated than the covid shot so
- 09:43if people could deal with the covid shot,
- 09:45they can definitely deal with
- 09:46the HPV vaccine,
- 09:48but there are minimal side effects.
- 09:50Most of them are short term, they
- 09:53dissipate within a day or two.
- 09:56OK, great so aside from getting the
- 10:00HPV vaccine the other risk
- 10:02factors are really tobacco,
- 10:04which has gone down in this country,
- 10:07at least in terms of smoking.
- 10:09The other question that people may
- 10:12have is with regards to E cigarettes.
- 10:14We found that
- 10:17as people's smoking in terms
- 10:19of smoking tobacco has gone
- 10:21down in the United States,
- 10:23E-cigarettes seem to have gone up.
- 10:26Does that increase your
- 10:27risk of head and neck cancers?
- 10:31There isn't a lot of data
- 10:32that's looked at that.
- 10:34Again, E cigarettes are a new phenomenon.
- 10:35It's really only been
- 10:37within the past few years.
- 10:39It theoretically would have a lower
- 10:41risk than regular cigarettes and
- 10:42causing head and neck cancers,
- 10:44but I'm not sure that it totally
- 10:46eliminates the risk altogether.
- 10:49And then the other
- 10:51thing that people often put
- 10:53together is smoking and alcohol.
- 10:55What's the impact of alcohol
- 10:57on head and neck cancers?
- 11:00Almost the same as smoking,
- 11:02so you know smoking.
- 11:05when you inhale the smoke,
- 11:07it goes down all the way from your head
- 11:10and neck passages down to your lung
- 11:12passages and with alcohol, similarly it goes
- 11:14down your mouth, the back of your
- 11:17throat and then into the food pipe.
- 11:19So we do see a significant proportion
- 11:21of patients who've never smoked but
- 11:23have a significant alcohol history
- 11:25who then go on to develop head and neck cancers.
- 11:28So I would say the risk is about the same.
- 11:31It's also cumulative,
- 11:32so the more the exposure to either
- 11:34substance or both substances,
- 11:35the higher your chance
- 11:37of developing a cancer.
- 11:40The next question that
- 11:42everybody is going to ask is,
- 11:45is there a safe limit? Is it okay to have 1
- 11:48drink at dinner or is there
- 11:52a certain threshold at which
- 11:55people should really be cautious?
- 11:59Of course you want to avoid
- 12:01binge drinking,
- 12:02and there are these thresholds
- 12:04that are set by the CDC as well.
- 12:06and that
- 12:07needs to be double checked,
- 12:09but maybe it's 2 drinks a day for women
- 12:12and three drinks at a time for men.
- 12:15The safest is to minimize though,
- 12:17'cause I think everyone has a personal
- 12:19body threshold that's different,
- 12:20we see some people
- 12:22who've smoked 100 pack years and
- 12:24do not get head and neck cancers,
- 12:26and then we see some people have
- 12:28smoked just ten years and then
- 12:30have a head and neck cancer
- 12:32that's not virus associated,
- 12:33so is presumably smoking associated.
- 12:35So I think everyone just has
- 12:37a different threshold.
- 12:38Doing away with smoking altogether
- 12:39is healthy for everyone,
- 12:40and minimizing how much alcohol
- 12:42you drink is also the best thing
- 12:44you could do for yourself.
- 12:47And so when we move away
- 12:50from now primary prevention,
- 12:51we've kind of talked about the risk factors
- 12:55and things we can do to minimize that.
- 12:58The next thing that people often talk
- 13:00about is secondary prevention or screening.
- 13:03Now, unlike a lot of other cancers,
- 13:06breast cancer, colon cancer,
- 13:08where we really have good screening tests,
- 13:10do we have good screening tests
- 13:13for head and neck cancer?
- 13:16So screening hasn't shown to
- 13:18save lives for patients who
- 13:20go on to develop head neck cancer,
- 13:23but in our own experience,
- 13:25the way head neck cancer
- 13:27is most commonly diagnosed is
- 13:29when someone notices a lesion,
- 13:31say in the oral cavity or in the back
- 13:34of the throat and is then referred
- 13:37to the oncology team.
- 13:38So that tends to be found
- 13:41serendipitously by somebody's doctor or
- 13:43dentist who looks in their mouth.
- 13:46Yes, but I hear that
- 13:48you were about to say that you
- 13:51organize community screening
- 13:52programs that might be helpful,
- 13:54and I'd love to delve a little
- 13:57bit more into that.
- 13:58But first we need to take a medical minute,
- 14:01so please stay tuned to learn
- 14:03more about head and neck
- 14:05cancers with my guest doctor
- 14:07Aarti Bhatia.
- 14:09Support for Yale Cancer Answers comes from AstraZeneca, working
- 14:12to eliminate cancer as a cause of death.
- 14:14Learn more at astrazeneca-us.com.
- 14:17This is a medical minute about lung cancer.
- 14:21More than 85% of lung cancer diagnosis
- 14:23are related to smoking and quitting, even
- 14:26after decades of use can significantly
- 14:29reduce your risk of developing lung
- 14:31cancer. For lung cancer patients,
- 14:33clinical trials are currently underway
- 14:35to test innovative new treatments.
- 14:37Advances are being made by utilizing
- 14:40targeted therapies and immunotherapies.
- 14:42The BATTLE II trial aims to learn
- 14:44if a drug or combination of drugs
- 14:47based on personal biomarkers can help
- 14:49to control non small cell lung cancer.
- 14:52More information is available
- 14:55at yalecancercenter.org.
- 14:56You're listening to Connecticut Public Radio.
- 15:01Welcome back to Yale Cancer Answers.
- 15:03This is doctor Anees Chagpar
- 15:05and I'm joined tonight by
- 15:07my guest Doctor Aarti Bhatia.
- 15:09We're talking about head and neck
- 15:11cancers and right before the break,
- 15:13you made a comment that
- 15:15I found really interesting.
- 15:17You said that
- 15:18screening for head neck cancers has
- 15:21not been shown to improve survival.
- 15:23That for many people,
- 15:25I think would seem counter
- 15:27intuitive for most cancers.
- 15:28We think if we pick it up early,
- 15:31the earlier we pick it up,
- 15:33the easier it is to treat,
- 15:35the better the survival rate is.
- 15:37So why do you think that is that
- 15:40that screening really hasn't
- 15:41been shown to affect survival?
- 15:44Well, I think a large part of that
- 15:47is because patients present with
- 15:48symptoms pretty early on.
- 15:51I mean, if you have a bleeding ulcer
- 15:53in the mouth, you have sore throat,
- 15:56you have trouble swallowing or chewing,
- 15:58you notice a neck lump,
- 16:00most people aren't going to
- 16:01sit on it for months or years.
- 16:04They're going to go see a doctor
- 16:06and figure out what's going on.
- 16:08So because of the
- 16:10location of these tumors and how
- 16:12early they present with symptoms,
- 16:14most people are diagnosed early on,
- 16:16and in early stages.
- 16:17So the vast majority of our patients
- 16:20come in with curable cancers,
- 16:22so I think there isn't much
- 16:24more that screening does.
- 16:26Screening picks up early cancers,
- 16:28but then people come in
- 16:30with early cancers anyway,
- 16:32so for that reason it hasn't
- 16:34been shown to improve survival.
- 16:36But we still think it's helpful to
- 16:39engage in community wide screening efforts,
- 16:41especially in the high risk population.
- 16:43So in patients who have a significant
- 16:46smoking exposure, alcohol exposure,
- 16:47multiple partners,
- 16:48it makes sense to have them
- 16:52engage with their dentist or
- 16:54oral surgeons, ENTs, to see if
- 16:57they have any lesions that can be
- 16:59intervened in an early
- 17:01course in the disease
- 17:03I think that's one of the
- 17:06beauties of head neck cancers is that
- 17:08because the lesions
- 17:10in the head and neck are such that
- 17:12they will present with symptoms,
- 17:14it can be found earlier than,
- 17:16for example, other cancers that
- 17:18we've talked about on this show,
- 17:20which tend to be pretty silent and
- 17:23patients present quite late.
- 17:26So you mentioned a few of the symptoms that
- 17:29people should be looking out for, right?
- 17:33Bleeding, ulcer, nosebleeds,
- 17:34lump in the throat,
- 17:36losing your voice,
- 17:37hoarseness, cough.
- 17:38Are there other things that people
- 17:40should be looking out for?
- 17:43And seeing their doctor about?
- 17:47Sometimes you may even have
- 17:50oral lesions which tend not to bleed,
- 17:52but they've just been there for awhile.
- 17:55Some of those can be precancerous,
- 17:57some precancerous lesions will then
- 17:59go on to transform into cancer,
- 18:01so even if it isn't a very bothersome lesion,
- 18:04but just has been there around for awhile,
- 18:07you want to make sure
- 18:08you see someone about it
- 18:10and get it checked out.
- 18:12Yeah, and for many people,
- 18:14going to your doctor for
- 18:16a regular checkup once a year,
- 18:18or seeing your dentist once or twice a year
- 18:22is a really good thing to
- 18:23do because as you mentioned,
- 18:25it's often on these visits that
- 18:28people can pick up on lesions that may
- 18:30not have been bothersome to you.
- 18:36They can then see it as suspicious
- 18:38and move on to the next step.
- 18:41So when you do go to your
- 18:43dentist or your doctor and they
- 18:45find something,
- 18:48what's the next step in terms of making a
- 18:51diagnosis and moving on with treatment?
- 18:54So if the dentist
- 18:56finds something that's suspicious,
- 18:58they will either refer you to
- 19:00an oral surgeon or an ENT,
- 19:02and both those kind of physicians
- 19:04can make a diagnosis with a biopsy,
- 19:06so we need to typically get some
- 19:08of that tissue out with a needle.
- 19:11Look at it under the microscope
- 19:13and see what's going on,
- 19:14and if that diagnosis is cancer,
- 19:16the next step is usually
- 19:18scans where we try to find out to
- 19:21what extent has this cancer spread.
- 19:23Is it involving adjacent structures?
- 19:24Is it involving some neck nodes?
- 19:27Is it a local tumor or has it
- 19:30spread and then from
- 19:32then on you get involved with the
- 19:34rest of the oncology team so you
- 19:37meet a radiation oncologist.
- 19:38You made a medical oncologist,
- 19:40which is someone like me,
- 19:42and usually treatment will then be planned,
- 19:44involving a course of radiation
- 19:46or chemotherapy or surgery,
- 19:47or a combination of these so
- 19:50multidisciplinary management is
- 19:51key to treating and formulating
- 19:53a good treatment plan for head
- 19:55and neck cancer patients and in
- 19:57fact outcomes are tied to being
- 19:59treated at large
- 20:00volume centers,
- 20:01so you want to make sure you see
- 20:03someone who has many
- 20:05head neck cancer patients and
- 20:07has dealt with their treatment.
- 20:10Yeah, and when
- 20:13you talk about large volume centers,
- 20:15I think part of that may have to do
- 20:18with the expertise of the clinicians
- 20:21themselves and the fact that they
- 20:24see these cancers day in and day out.
- 20:27But the other might be some
- 20:29of the things that they have at
- 20:31large volume centers that may
- 20:33not be ubiquitously available.
- 20:35So talk to us a little bit
- 20:38about personalized medicine.
- 20:39We find that in so many cancers now,
- 20:43especially the large volume centers
- 20:45really are tailoring care in terms of
- 20:48the genomics of a particular cancer and
- 20:51using that information, that molecular
- 20:53information, to really tailor their
- 20:56therapy in terms of that multi modality
- 20:59care that you were talking about.
- 21:01Can you talk more about that?
- 21:05Yes, absolutely.
- 21:06So you know that's valid for patients
- 21:09who have more advanced disease or
- 21:11incurable disease at our center.
- 21:13And I'm sure at many other large
- 21:16volume centers with expertise,
- 21:17we do what we call molecular
- 21:20sequencing or profiling of tumors.
- 21:22So the biopsies are analyzed for their
- 21:25genes that are present
- 21:26in the tumor and
- 21:29we then determine is this gene something
- 21:32that was inherited by the patient,
- 21:34or is it something that
- 21:36originated in the oral cavity
- 21:39or in the mucosa of the head neck
- 21:42and then went on to cause a tumor,
- 21:46and sometimes knowing what these genetic
- 21:49defects or mutations are in the tumor,
- 21:51help us identify drugs or
- 21:54targeted therapies,
- 21:55which then will specifically go and
- 21:58target or inhibit that aberrant
- 22:00protein or aberrant mutation so the
- 22:03cancer can come under better control.
- 22:05Some of these drugs are
- 22:07FDA approved in these settings and
- 22:09some of these drugs are available
- 22:12on clinical trials and clearly more
- 22:14clinical trials will be available
- 22:16at the larger volume centers where
- 22:18we have the patient still offer
- 22:20these studies too,
- 22:21but even for patients who have
- 22:24curable disease,
- 22:25like we mentioned,
- 22:26head and neck cancers tend to present
- 22:28most often in the curative stage,
- 22:32Therapeutic modalities like
- 22:34robotic surgeries,
- 22:35advanced radiation techniques are
- 22:37sometimes available only at the
- 22:40large volume centers and
- 22:45along with improving your prognosis or
- 22:47outcomes for treating these cancers,
- 22:49it also helps minimize the side
- 22:51effects that you have and you
- 22:53have to then live with for the
- 22:55rest of your life as a result
- 22:58of undergoing cancer treatment.
- 22:59So there are
- 23:00many advantages to being
- 23:02seen at large volume centers.
- 23:03One of the things I think that
- 23:06you mentioned which many people
- 23:08might find curious is that
- 23:10when you talk about genomics,
- 23:12and tailored therapy,
- 23:14that's mainly for people who
- 23:16present with advanced cancers.
- 23:17So is it the case that in more
- 23:20early stage cancers the systemic
- 23:23therapy or the chemotherapies tend
- 23:25to be uniform across patients?
- 23:30That is probably true for
- 23:32head and neck cancers.
- 23:34That might change in the
- 23:36future though, so for instance,
- 23:38immunotherapy is currently approved only
- 23:40in the treatment of advanced cancers.
- 23:43But we now have many trials which
- 23:45are looking to move immunotherapy
- 23:47into the curative setting and see if
- 23:50we can improve cure chances for our
- 23:53patients with locally advanced disease.
- 23:55So there are biomarkers which we
- 23:57use to predict which patients
- 24:00will respond to immunotherapy in the
- 24:02advanced setting and that might become
- 24:04standard of care for even patients who
- 24:07are in the locally advanced settings.
- 24:09So we're using chemo and
- 24:11standard radiation for cure,
- 24:13but we're maybe adding on a partner
- 24:15drug like an immunotherapy drug based on
- 24:17what trials show us in the next few years.
- 24:21There is a chance that we may not
- 24:23be using that for everyone but
- 24:26personalizing it for patients
- 24:28who have these positive biomarkers
- 24:30which then predicts for a better
- 24:32outcome with
- 24:33immunotherapy.
- 24:35In general, what is the prognosis
- 24:37for patients who present with
- 24:39early stage head neck cancers?
- 24:42So a large part of that depends on whether
- 24:45or not they are associated with HPV,
- 24:48so having the HPV virus associated
- 24:50cancer confers a much better
- 24:52prognosis and in the early stage,
- 24:5480 to 90% of these patients can be
- 24:56cured five years out in patients
- 24:59who have HPV negative disease,
- 25:01that number is a little bit lower,
- 25:03but if you compare with a lot of other
- 25:06cancer types it's still pretty good.
- 25:08You know we are able to cure about on
- 25:12average 60% of HPV negative patients.
- 25:14Early stage with curative intent treatment.
- 25:16Of course, we're always trying to
- 25:18do research and clinical trials to
- 25:20see if we can move that bar up and,
- 25:23you know, get a higher proportion
- 25:25of our patients cured.
- 25:26And that's also the advantage
- 25:28of being seen at a
- 25:29larger centers that
- 25:30has these trials to maybe make
- 25:32treatment more aggressive.
- 25:33To intensify your treatment so we can
- 25:36move that bar up for our patients.
- 25:39That was going to be one of my questions,
- 25:42which is, for many patients, they
- 25:45hear about clinical trials and they think
- 25:48I have a fairly early stage cancer,
- 25:51prognosis is reasonably good,
- 25:56clinical trials always sound a little scary.
- 25:58Do I really want to be a
- 26:01Guinea pig in the early stage?
- 26:04So what do you say to patients who
- 26:06might be contemplating whether they
- 26:08really ought to be in a clinical trial?
- 26:12If they have potentially curative
- 26:14cancer or not?
- 26:17Two things.
- 26:18One, it's always good to remember
- 26:20that what is standard treatment today
- 26:22was a clinical trial some years ago,
- 26:25so we would have not gotten to the
- 26:28treatments that we are at today
- 26:30if we had not
- 26:32used some other patients in
- 26:34the past on clinical trials.
- 26:35The second thing is that we always try
- 26:38to carefully match and screen patients
- 26:40to the available trials that we have.
- 26:43So we're always
- 26:45thinking about what benefit does
- 26:47it directly offer that patient.
- 26:48And even if there is a chance
- 26:51of some benefit,
- 26:51then that's the ideal patient
- 26:53to be matched to a clinical trial.
- 26:56So of course,
- 26:56if we think that there is no
- 26:58possible benefit to someone,
- 27:00we're not going to put them on a trial,
- 27:02so we're
- 27:03carefully screening patients.
- 27:04It's also a mutual decision,
- 27:06so it's not something that's
- 27:07going to be forced on anyone,
- 27:09but it's worth at least hearing
- 27:11out your options and then
- 27:13making an informed choice.
- 27:14And I think it's so important for
- 27:17people to realize that
- 27:19on average patients who participate
- 27:21in clinical trials tend to do
- 27:23better than patients who don't.
- 27:25Because we're always testing what
- 27:27we think is tomorrow's therapy,
- 27:28the next great therapy,
- 27:30how we can move that bar,
- 27:32as you said to standard
- 27:34of care today and so on.
- 27:36Average people tend to do better.
- 27:38The other question that I want
- 27:40to circle back to before the
- 27:42show closes is an important one,
- 27:45and that is,
- 27:46you mentioned that people who have
- 27:48HPV positive cancers tend to do
- 27:50better than people who have HPV
- 27:53negative cancers and I want you to
- 27:55kind of dispel a misconception that
- 27:58some people might have then, which is,
- 28:01why should I get the HPV vaccine,
- 28:03if that then would prevent me from
- 28:06getting an HPV positive cancer.
- 28:08So then I would be more likely to
- 28:11get an HPV negative cancer and
- 28:13do worse.
- 28:16Getting the vaccine does not increase your risk of getting
- 28:19the HPV negative cancer and HPV
- 28:21Positive cancers actually tend to
- 28:23occur earlier in life so where
- 28:26HPV negative cancers need a certain
- 28:29degree of tobacco and alcohol exposure
- 28:31for them to develop and usually occur
- 28:33in the 6th or 7th decade of life.
- 28:36HPV positive cancers can occur
- 28:38as early as the third, fourth,
- 28:41fifth decades of life and think about it.
- 28:44Now you have a highly curable cancer,
- 28:46but the
- 28:47treatment is just as aggressive
- 28:49as HPV negative cancers by the
- 28:51current standard of care,
- 28:53so you're going to live out all
- 28:55these decades
- 28:56dealing with the side effects of
- 28:58treatment and for anyone who's known
- 29:00someone going through head and neck cancer
- 29:02treatment or has gone through it themselves,
- 29:05it's probably
- 29:05a nightmare to live
- 29:08through and something that stays
- 29:10with you for the rest of your life.
- 29:13The side effects can be
- 29:14pretty disabling for many,
- 29:16many years afterwards.
- 29:17Doctor Aarti Bhatia is assistant
- 29:18professor of medicine and medical
- 29:20oncology at the Yale School of Medicine.
- 29:22If you have questions,
- 29:24the address is canceranswers@yale.edu
- 29:25and past editions of the
- 29:27program are available in audio and
- 29:29written form at yalecancercenter.org,
- 29:31we hope you'll join us next week to
- 29:33learn more about the fight against
- 29:35cancer here on Connecticut Public Radio.