Head and Neck Cancers Awareness Month

April 12, 2021

Information

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.