HPV & throat cancer

The human papillomavirus, or HPV, is a common virus that can be passed from one person to another during sex. At least half of sexually active people will have HPV at some point in their lives.

Most of the time, HPV goes away by itself within two years and does not cause health problems. The immune system can fight off HPV naturally. If the body does not clear the virus, over time it can cause cervical and other cancers, including vaginal, vulvar, anal, penile, and some head and neck, or oropharyngeal, cancers.

Oropharyngeal cancer arises in the head or neck region, including the nasal cavity, sinuses, lips, mouth, thyroid glands, salivary glands, throat or larynx (voice box).

It is the sixth most-common form of cancer in the world. More than 100,000 cases (including thyroid) are diagnosed annually in the United States.

Over the past 10 years, an increasing number of people with human papillomavirus (HPV) who were young, non-smokers have developed cancer of the tonsils and back of the tongue. Annually in the U.S., more than 10,000 new cases of oral, head and neck cancer can be attributed to a particular strain of HPV.

Symptoms of cancers of the oropharynx include sore throat or ear pain that doesn't go away, constant coughing, pain or trouble swallowing or breathing, weight loss, hoarseness or voice changes that last more than two weeks, and/or a lump or mass in the neck.

Sources: Centers for Disease Control and Prevention; Head and Neck Cancer Alliance

Monday of last week almost seemed like any other.

Local commercial real estate broker Kit Regnery and attorney Alice Paylor were preparing to head to off to work from the couple's Sullivan's Island home.

But in a quiet way, it was far from normal, because the next morning Regnery was scheduled to start what he considers to be his second, and for the time-being, more important job over the next few months.

Regnery was scheduled for his first of many chemotherapy and radiation treatments for Stage IV throat cancer caused by the human papillomavirus, or HPV.

As he was interviewed, his eyes and face had the classic look of a "game face," prepared for battle with a formidable foe.

"I'm apprehensive, but I'm ready" admits Regnery, who has read four books on cancer since his diagnosis in December. "But I'm treating this (fighting the cancer) like a job. I've got a job to do. I want to do everything I'm supposed to do and more, the holistic things, too."

Stepping forward

Regnery feels another duty as part of his journey ahead: raising the awareness of HPV, a sexually transmitted disease, and its effects on men, in what is increasingly being considered a classic quiet epidemic.

The 69-year-old was shocked to find out he had throat cancer. He eats a healthy diet and exercises, often vigorously, every day. His 5-foot-7 frame is a lean 140 pounds. Paylor, his wife of 25 years, says she often jokes that he is the local version of fitness guru Jack Lalanne.

"I had heard about HPV and cervical cancer in women," says Regnery, "but not throat cancer."

When he found out, he, like many, recalled the headlines that actor Michael Douglas made in June 2013 when he revealed his throat cancer was caused by HPV contracted through oral sex.

Regnery says he thinks the awareness of the serious problem, notably knowing the symptoms and getting treatment, as well as the need for teen males to get vaccinated, got lost in the sensationalism of the moment.

"I think Michael Douglas did a lot ... (but) I just think he was being light about it," says Regnery. "I'm almost 70 years old. I've had a great life and I've always been very transparent and honest with people. If I can do anything to bring awareness, I want to do it."

Regnery's decision to spread the word about HPV is fully supported by Paylor, a prominent attorney and president of the S.C. Bar Association. She even announced his diagnosis at a recent convention of the bar at Kiawah Island.

"He (Regnery) is going to do fine," says Paylor, noting his optimism and willingness to fight. "I know that it's not going to be fun. In fact, it's going to be hard, but it's just going to take time to get through the treatments."

Like him, she was surprised to hear that there is an HPV vaccine for boys. Their daughter has received the vaccine and they plan to urge their son, who recently graduated from college, to get it as well.

HPV cancers

The virus is linked to an array of cancers. Besides cervical and throat, or oropharyngeal, HPV is responsible for more than 90 percent of anal and more than 50 percent of vaginal, vulvar and penile cancers, according to the Centers for Disease Control and Prevention.

Dr. Terry Day, director of the head and neck cancer program at the Medical University of South Carolina Hollings Cancer Center, applauds Regnery for stepping forward to shine a light on an important issue.

"We (health professionals) can't make a difference if our cancer patients and survivors don't speak out about it," says Day, who serves as president of the Head and Neck Cancer Alliance.

"It (HPV-related throat and tongue cancers) is occurring in healthy people who have never smoked and don't drink excessively," says Day, noting the long-held risk factors for the cancers. "It also seems to be occurring in younger patients, as well."

Day adds, however, that the cure rates for HPV- related throat and neck cancers appear to be higher than those with similar cancers linked to smoking cigarettes and drinking alcohol excessively.

He says one notable trend for HPV throat and neck cancers is that the incidence appears higher in people who are well-educated and have a higher socio-economic status.

For now, Day says the most important thing is for parents to have their children vaccinated to prevent HPV before they are sexually active.

The CDC recommends vaccines, Merck's Gardasil or GlaxoSmithKline's Cervarix, both licensed by the Food and Drug Administration, for girls and boys starting at age 11 or 12.

For boys and men specifically, the CDC says Gardasil works by preventing four common HPV types, two that cause most genital warts and two that cause cancers, including anal cancer. It protects against new HPV infections; it does not cure existing HPV infections or disease (like genital warts).

The CDC recommends the HPV vaccine for all boys ages 11 to 12, and for males through age 21, who have not already received all three doses. The vaccine is also recommended for gay and bisexual men, or any man who has sex with men, and men with compromised immune systems (including HIV) through age 26, if they did not get fully vaccinated when they were younger.

Treatment journey

For now, Regnery says the awareness of throat and tongue cancer symptoms and treatments is key for the estimated 79 million Americans currently infected with HPV. Because it is so common, the CDC says nearly all sexually active men and women will get at least one type of HPV during their lives.

The CDC says among those symptoms are a sore throat or ear pain that doesn't go away for two weeks, constant coughing, pain or trouble swallowing or breathing, weight loss, hoarseness or voice changes, or a lump or mass in the neck.

For Regnery, who believes a severe case of flu last winter gave the HPV virus an opportunity to spread, the first signs of trouble came when he started getting sick on trips over the course of last year. He rarely gets sick.

Then, in December, he suffered from a sore throat that wouldn't go away. He got checked before going on a two-week family cruise in December and received a definitive diagnosis after returning.

While Day says that the best treatment for tumors is removal using robotic surgery, Regnery will be getting a combination of chemotherapy and radiation because the cancer had spread to his lymph nodes. Day is not Regnery's surgeon, but consulted with him, as did noted specialists at Emory University.

Regnery expects to be OK for two weeks after his initial treatment, but knows what to expect from the side effects, from fatigue to losing his sense of taste and appetite.

"I'm ready," he says. "I'm trying to figure out how I'm going to work and keep up the pace, but we'll see. I think I'll do better than most. Plus, I've got a lot of love and prayers going around."

Reach David Quick at 937-5516 or dquick@postand courier.com.