A trend fuelled by low awareness, risky behaviours, ET HealthWorld

Mumbai: Dr Nancy Y Lee, MD, FASTRO, Radiation Oncologist and Early Drug Development Specialist, Memorial Sloan Kettering (MSK) Cancer Centre, interacted with ETHealthworld’s Prabhat Prakash on the rising burden of head and neck cancer cases in India, the role of HPV vaccination in HNC prevention and how low-dose radiation is demonstrating encouraging outcomes with a lower dose. Edited Excerpts:Please elaborate on the rising trend of HPV-related head and neck cancers in India, particularly among men. What are the factors contributing to this surge?

The uptick in HPV-related cancers, particularly impacting men’s head and neck areas, is quite a concern, alongside its better-known link to cervical cancer in women. Recent data from the Centers for Disease Control and Prevention (CDC) show around 25,000 cases of HPV-associated cancers in women and 19,000 in men between 2013 and 2017. Notably, more than four out of every ten cases of HPV-related cancer occur in men. Looking ahead, the projections are equally alarming. According to GLOBOCAN 2020, India is expected to see a staggering 57.5 per cent increase in new cancer cases by 2040, totalling 2.1 million cases.

Factors contributing to this surge include a lack of awareness and screening, leading to delayed diagnosis and treatment. Multiple sexual partners and oral sex contribute to the rise of this cancer. Additionally, tobacco and alcohol consumption, prevalent among Indian men, interact with HPV infection, further increasing cancer risk. Furthermore, limited HPV vaccination coverage, especially among boys and young men, perpetuates HPV transmission.

What are the challenges that head and neck cancer (HNC) patients face in India? What are the reasons for delayed diagnosis, limited access to treatment, and other related issues?

In India, one in 33 males and one in 107 females are at risk of developing HNC. Every step of cancer care has hurdles, right from diagnosis to follow-up. There is an increased diagnostic delay in these patients among the Indian population, either due to limited access to healthcare, a lack of understanding of the gravity of the situation, or financial constraints.

According to the Indian Council of Medical Research (ICMR), over 60 per cent of HNC cases are diagnosed at an advanced stage, primarily due to the absence of widespread screening programmes and low awareness levels. Tobacco and alcohol consumption, prevalent cultural practices, are significant risk factors; the World Health Organisation (WHO) estimates that nearly one-third of all cancer-related deaths in India are attributed to tobacco use. Furthermore, a study published in the Indian Journal of Cancer highlighted the disparities in healthcare infrastructure, with rural areas facing a shortage of trained medical professionals and diagnostic facilities.

What has been the global impact of the International Federation of Head and Neck Oncologic Societies (IFHNOS) on the advancement of head and neck oncology and surgery knowledge worldwide? In what ways has IFHNOS helped to address the particular difficulties that HNC patients face worldwide?

IFHNOS has revolutionised head and neck cancer care on a global scale, uniting experts from 70 countries to share cutting-edge research, techniques, and best practices. One of the key ways in which IFHNOS has made an impact is through its international conferences, workshops, and educational programmes. These events provide a platform for experts from diverse backgrounds to share their insights, discuss challenges, and explore solutions in the diagnosis, treatment, and rehabilitation of head and neck cancer patients.

In a recent collaboration with MSK and its Chennai centre, IFHNOS introduced a HNC summit. Additionally, MSK offers a Head and Neck Oncology Fellowship accredited by IFHNOS, showcasing its dedication to excellence in head and neck cancer care.

How do you envision next-generation technologies changing the face of head and neck cancer treatment and care, given the speed at which technology is advancing?

We’re observing a notable shift in HNC care, moving away from traditional invasive procedures toward more precise and patient-friendly approaches. Techniques like microsurgery and minimally invasive procedures such as transoral laser and robotic surgery are preserving vital functions and enhancing outcomes. Advanced radiation therapies like proton beam and intensity-modulated radiation therapy deliver targeted treatment, minimising collateral damage. Immunotherapy is also revolutionising cancer care by leveraging the body’s immune system to combat tumours, while genomic testing allows for personalised treatment plans, optimising efficacy. Furthermore, participation in clinical trials provides access to cutting-edge therapies, offering hope for patients.

Looking forward, these advancements will continue to redefine the head and neck cancer care landscape, emphasising personalised treatment and improved quality of life for patients.

A 70 Gy radiation dose has long been the norm for the treatment of head and neck cancer. Recent clinical trials, however, have demonstrated encouraging outcomes with a lower dose of 30 GY, found by FMISO PET. One such trial involved MSK patients with throat cancer. What effects will these findings have on HNC treatment methods going forward?

Recent clinical trials have revealed promising outcomes with a lower radiation dose of 30 Gy for head and neck cancer (HNC) patients, diverging from the conventional 70 Gy dose. Our research at MSK has shown that this innovative approach not only effectively controls cancer but also significantly reduces treatment-related side effects, improving patients’ quality of life. Looking ahead, these findings will profoundly shape HNC treatment methods by underscoring the importance of personalised approaches. Utilising FMISO PET scans empowers oncologists to tailor treatment doses to individual patients’ needs. By alleviating the burden of side effects associated with higher radiation doses, this approach optimizes treatment outcomes and enriches the overall patient experience.

We are dedicated to further exploring and implementing these advancements in head and neck cancer treatment. We aim to lead the way in revolutionising global treatment strategies, offering hope and relief to patients facing this challenging disease. Through ongoing research and innovation, we strive to elevate patient outcomes and enhance their quality of life in the battle against head and neck cancer.

Are there any ongoing clinical trials investigating the potential role of HPV vaccination in the prevention or treatment of head and neck cancer, particularly in women? What possible effects do you think these findings might have on clinical practice, and how might they affect future HNC prevention strategies?

Recent research, exemplified by a study in JAMA oncology, has highlighted the heightened risk of subsequent head and neck cancer among individuals detected with oral HPV, emphasising the importance of HPV vaccination.

Additionally, our clinical trials at MSK explore innovative methods for monitoring HPV-related cancers, such as assessing HPV genetic material levels in the blood. These trials show promise in identifying patients who may not require post-surgery radiation therapy, potentially improving long-term outcomes. Our therapeutic trial aims to administer vaccinations to patients already diagnosed with HPV-driven head and neck cancer to reduce recurrence.

These ongoing trials have the potential to revolutionise clinical practice by introducing more effective and tailored approaches to the prevention and treatment of HPV-related head and neck cancers, particularly among women. Additionally, they may inform future strategies for HNC prevention by underscoring the importance of HPV vaccination and early detection methods.