Early symptoms of throat and mouth cancer may present differently if the disease developed as a result of the human papillomavirus (HPV), many strains of which are often sexually transmitted. While the disease, also known as oropharyngeal cancer, does not make up a high percentage of cancer cases, it's nevertheless on the rise. Perhaps most alarming, rates oropharyngeal cancer are rising in people under the age of 55.

It's also rising among those who do not have a history of smoking, with oral sex habits thought to be linked - though not yet confirmed - to the development of the disease. Dr. Terry Day of Charleston's Medical University of South Carolina led the research to distinguish whether or not the presence of HPV alters symptoms of the disease. 

From 2008 to 2013, the research team looked at 88 patients with throat and mouth cancer. Of the 88, 71 were found to have HPV-positive cancers, with half of these patients presenting initial symptoms commonly manifesting as a mass in the neck area. Of the patients with HPV-negative cancer, just 18 percent had the same initial symptoms. Rather, those found to be HPV-negative tended to report sore throats (more than 50 percent) and an inability to swallow comfortably (41 percent). While some overlap occured between HPV-negative and HPV-positive patients, it was not excessive: 28 percent of HPV-positive patients experienced sore throats, while 10 percent found it difficult to swallow. 

Certain strains of HPV can be vaccinated against, with physicians recommending that all children aged 11 and over receive the vaccination. Women and girls can also receive vaccinations up the age of 26 to 'catch up.' Questions of the efficacy of the vaccine in preventing oral cancers are yet to be answered, though it is known that the vaccine protects agains the strain primarily associated with oropharyngal cancer. HPV-positive cancers, interestingly, tend to have more positive prognosis, while HPV-negative cancers are typically more aggressive, advancing faster and presenting more apparent symptoms. 

The study is promising, peers note, though larger studies will be needed to confirm the pattern. Dr. Day hopes that additional research will lead to greater awareness of oropharyngeal cancer and its causes. "When I looked at the literature and Web sites from the American Cancer Society, National Cancer Institute, and all these other places, they didn't mention what we were seeing," he said. "I decided to look back at my last 100 or so patients to see what their symptoms were when they came to the office. This was a retrospective study, and that is one of its weaknesses, but we have a prospective study ongoing now. The important thing is that we want to get the word out that this is real, this cancer exists."

The study was published in JAMA Otolaryngology - Head & Neck Surgery.

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