Causes of head and neck cancer

We are learning more about what the risk factors or causes of head and neck cancers are every year. In many cases the cause of a cancer is not clear and difficult to understand, hence why clinicians prefer to categorise these as "risk factors" to reflect the ambiguity found in case data.

Head and neck cancer incidences are expected to increase by 30% over the next 10 years. Anyone can get the disease, cancer does not discriminate, so it is important everyone does everything they can to reduce their risk.

There are some key things that everyone should be aware of that can help reduce the risk of cancers in the head and neck and other areas. They include:

Getting the HPV Vaccine to block the human papilloma virus (HPV)
Stopping use of tobacco (including smoking, use of paan and betel leaf, chewing tobacco, e-cigarettes)
Limiting alcohol use
Monitoring and taking care of your oral health

Viral Infections are key risk factors

The Human Papillomavirus (HPV) which is the leading cause of cervical cancer is also a leading risk factor of throat cancer (within the oropharynx). It is estimated that up to 70% of all Head and Neck cancers are classed as "Human Papillomavirus positive" (HPV+). In the UK today there are more cases of HPV linked throat cancers than there are HPV linked cervical cancers and they are the fastest growing segment of Head and Neck cancers at 47%. HPV+ cancers generally affect the tonsils, base of tongue and throat. We are now starting to see younger patients (40-60s) presenting with HPV driven cancers as well as people in their 60-70 s. There is a free vaccination programme available to 12 to 13 year olds to reduce future occurrences of cancers associated with HPV.

Another common viral infection that can, in some in some rare cases, cause a type of throat cancer is the Epstein–Barr virus (EBV). The Epstein-Barr virus can increase the risk of nasopharyngeal cancer. As with HPV, most people carry EBV and it does them no harm.

It does not usually cause any problems. But, in some rare cases and for certain population groups, an EBV infection can cause genetic changes in cells that make them more likely to become cancerous in the future. In the UK, 80 out of 100 cases of nasopharyngeal cancer (80%) are caused by EBV. But many people will be infected with EBV and not develop cancer. This virus is linked to other cancers including Hodgkin lymphoma.

The main causes or risk factors

Alcohol and tobacco (smoking and chewing) greatly increase the risk of developing head and neck cancer. Using alcohol and tobacco together increases this risk even more. The table below highlights, in order of risk, the main causes.

Tobacco

Tobacco use includes smoking cigarettes, cigars, or pipes; chewing tobacco; and using snuff. It is the single largest risk factor for head and neck cancer. The amount of tobacco use may affect the chance of recovery.

If a person smokes or has smoked in the past they have a higher risk of getting Head and Neck cancer than someone who has never smoked. Prolonged exposure to second hand smoke may also increase a person’s risk of developing head and neck cancer.

Alcohol

Human Papillomavirus

Research shows that infection with HPV is a significant risk factor for head and neck cancer. Sexual activity with a person who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Generally, HPV related tumours react well to Radiotherapy/Chemotherapy with high recovery rates in patients.

There is an NHS vaccination programme available for free to all children aged 12 to 13 years (school year 8), to reduce future occurrences of cancers associated with HPV.

If you missed getting vaccinated when you were 12 or 13, the HPV vaccine is available for free on the NHS for:

all girls under 25
boys born after 1 September 2006

Contact your school nurse, school vaccination team or GP surgery if you or your child were eligible for the HPV vaccine but did not get vaccinated.

Gay, bisexual and other men who have sex with men are at higher risk from HPV. If you’re a man under 45 who has sex with men and you attend a sexual health or HIV clinic, you can get vaccinated against HPV. You’re eligible for the vaccine up until your 45th birthday.

The HPV vaccine is also sometimes recommended for other people at higher risk from HPV, such as:

any transgender people who are felt to have the same risk as men who have sex with men
sex workers
people with HIV

Epstein-Barr virus (EBV)

Gender

Age

Prolonged sun exposure

Environmental or occupational inhalants

Inhaling asbestos, wood dust, paint fumes, and certain chemicals may increase a person’s risk of head and neck cancer, particularly Nasal cavity and paranasal sinus cancer. Breathing in certain chemicals or dust that may cause cancer including wood dust (hard and soft wood), leather dust (e.g. shoe making), chromium, nickel, heavy metal exposure, formaldehyde, cloth fibres (e.g. textile manufacturing) and mineral oils (used in metal work and printing).

Poor Oral care and dental hygiene issues

Marijuana use

Poor diet, nutrition and obesity

A diet low in vitamins A and B can raise a person’s risk of head and neck cancer. Eating a lot of salt, cured fish and meat has been shown to increase the risk of throat cancer.

8% of Thyroid cancer cases in the UK are caused by being overweight or obese. The risk is 23% higher per 5-unit BMI increase. CRUK estimates that being overweight is now responsible for at least 1 in 20 cancers, and plays a significant role in a number of different types, including cancers of the bowel, breast, ovary and pancreas. The strength of the link varies but, in general, the heavier you are, the greater the risk, with an obese woman being at least twice as likely to develop womb cancer than a slim peer, and 30 per cent more likely to get bowel cancer.

The mechanism behind the link with weight is complex but excess fatty tissue can encourage metabolic and hormonal changes that promote cancerous change and growth, and impair the ability of the immune system to spot and destroy cancer cells before they become established. Not all fat is equal in this regard. While peripheral fat stores, such as those under the skin and around the buttocks and hips, can affect hormone levels, the most dangerous type is “visceral” fat stored around your midriff (and organs). It is apple-shaped men and women, rather than pears, who are most likely to develop obesity-related cancers.