HPV's other cancer: a tripling in men's throats, and no test that finds it

Cervical cancer control runs on two instruments: a vaccine that keeps new infection out of adolescent cohorts, and a screening test that finds precancerous change in people already infected. Australia's expected elimination by 2035 is credited to both working together ^[14]. Cancers of the tonsils and the base of the tongue have the first instrument and, per the Live Science report, "no good screening, diagnostics or interventions" ^[10]. The missing arm is the one that does anything for people already carrying the virus.

That is most of the people in the current numbers. Roughly 80% of sexually active adults acquire HPV, about half of them a high-risk type, and most clear it within a year or two ^[16]; in some it persists and damages DNA ^[11]. Electra Paskett, a cancer epidemiologist at Ohio State, told Live Science that immune control of a chronic infection can slip as people age, with chronic stress possibly contributing ^[12]. That is the route from an exposure in the 1970s to a tumour after 65, which is where 40% of these cases now land ^[8].

The counting is worth doing carefully, because the two diseases are usually discussed as though one were much larger. On CDC annual averages, HPV-attributable oropharyngeal cancer totals about 16,000 cases a year, some 44% more than the 11,100 cervical cases ^[19]. Male cases alone run about 2,500 a year above the cervical figure ^[21], at close to six men for every woman ^[20].

Nor is the male rise an artifact of the vaccine's success in women. The American tripling closed in 2004, two years before Gardasil was licensed ^[23]. The Danish tripling ran to 2017, inside the vaccine era, but among birth cohorts never offered the shot as adolescents: a person who was 18 at launch is 37 nineteen years later ^[4][24]. Two separate curves, one of which had a programme built around it.

Why the burden sits with men is partly behavioural and partly not. In a Baltimore patient study, men were more likely than women to carry oral HPV, their risk tracked their number of recent oral and vaginal sex partners, performing oral sex was associated with oral infection in men but not in women, and men cleared these infections more slowly ^[13].

Vaccinating boys is the right instrument and the wrong timescale for the 13,600 men diagnosed each year ^[5][8]. Anal, penile, vaginal and vulvar cancer rates are rising too, and oropharyngeal cancer is already more common than any of them ^[18]. What would move the near-term count is a detection test, and the reporting says there is not one ^[10].