Kevin Shields thought nothing of an unusual but persistent sensation in his throat.
A public address announcer for the Fox Chapel Area School District baseball, softball and flag football teams, Shields also is the man behind the mic for the Carnegie Mellon University Tartans teams. He chalked up the sensation to strain from using his voice so much.
“I remember doing a lacrosse game in April 2024, and it felt like something was stuck in my throat,” said Shields, 64, of Plum. “I let it go.”
Little did he know, but his age and gender put him squarely in the demographic for an alarming health threat: throat cancer.
After antibiotics and a steroid for suspected tonsillitis yielded no relief, a CT scan in August revealed Stage 2 throat cancer.
“To say I was shocked is an understatement,” said Shields, a nonsmoker with no family history of the disease. “I was blindsided.”
Oropharyngeal cancer, which affects the tonsils or base of the tongue — specifically, cases caused by the human papillomavirus and occurring in men 50 and older — has tripled since the early 2000s, according to the National Institutes of Health.
Numbers have skyrocketed from about 15,000 cases a year to nearly 42,000.
It has become so prevalent that it is considered an epidemic, according to Dr. Maie A. St. John of the Johns Hopkins School of Medicine.
HPV-associated cancer is four times more likely to occur in men than in women, data from the University of California Irvine Medical Center shows.
“As a field, we don’t know exactly why it’s more common in men,” said Dr. Dan Zandberg, oncologist and co-leader of the head and neck cancer program at UPMC Hillman Cancer Center. “It may be from differences in ways men are exposed to HPV and/or the way their immune system reacts to the virus. In the United States, 70% of new oropharyngeal cancer cases are traced to HPV-positive.”
Common and highly contagious
HPV is a common viral infection that can affect different parts of your body, depending on the strain.
Up to 90% of people become infected with HPV in their lifetime, most without ever knowing. Infections can be asymptomatic and usually clear on their own within a couple of years.
The virus typically is spread through sexual activity but also can be transmitted by skin-to-skin contact.
In women, HPV is more commonly linked to cervical cancer. When the FDA approved the original vaccine, Gardasil, in 2006, it initially was recommended only for girls.
Routine vaccinations for boys came along five years later.
Incidences of HPV-associated oropharyngeal cancer in men may continue to climb over the next couple of decades until the benefits of the preventative vaccine begin to catch up, Zandberg said.
Because the virus can be dormant for decades, people who were infected prior to the early 2000s can be experiencing adverse effects now.
“There’s a lag between infection and development of cancer, and lots of folks in their 50s and 60s are getting sick,” said Dr. Tracy Klayton, Allegheny Health Network radiation oncologist. “As time goes on, incidences will start falling as more young people are vaccinated.”
For decades, oral and throat cancers were linked to smoking and drinking, but those cases have declined as more people cut those habits, according to the American Cancer Society.
The creviced anatomy of the throat makes it susceptible to cancer-causing HPV virus cells. Tonsils can encapsulate the latent virus for years while it festers.
“It’s hard to know if you have HPV,” Klayton said. “Chances are, you’ve been exposed.”
For men of the pre-vaccine era, there’s nothing that can be done to reverse HPV-positive infections that could lead to cancer.
“At this time, the vaccine is preventive, not therapeutic,” St. John said.
It’s important to keep in mind that only a minority of those exposed will develop an HPV-related cancer, Klayton said.
Routine medical and dental visits can help identify early-stage illness. Healthy lifestyle choices that eliminate smoking and alcohol also can help fortify the immune system.
Klayton and Zandberg said vaccinating eligible preteen boys is the best weapon to thwart this type of cancer from developing in men.
Shots are highly effective and recommended by the Centers for Disease Control and Prevention for preteens but can be given up to age 26.
After this age, the likelihood of already being exposed to HPV increases, reducing the vaccine’s potential benefits, according to the Centers for Disease Control.
Rates expected to drop
Although researchers say it could be decades before overall cancer rates fall, the drop will be significant.
Oropharyngeal cancer rates are expected to drop 50% by 2045 in people 36 to 45, according to an analysis of cancer and vaccination rates by the Johns Hopkins Bloomberg School of Public Health.
A U.S. study presented at the American Society of Clinical Oncology in 2024 included about 3.4 million people. It found significantly fewer head and neck cancer cases — 21 versus 48 — in vaccinated men compared to those who had not received the vaccine.
A separate analysis of more than 1.7 million people demonstrated lower head and neck cancer rates of 2.8 versus 6.3 cases per 100,000 in vaccinated versus unvaccinated groups, St. John said.
“These findings suggest that vaccination is already having a measurable impact,” she said.
“The long-term outlook is very encouraging.”
Researchers predict most of the cancer cases after 2045 will occur in those 55 and older who were not vaccinated against HPV. Researchers expect that by 2045, vaccinations will prevent at least 1,000 cancer cases each year in people ages 36 to 55.
Routine symptoms
For Jim McCollum, 63, of Economy, Beaver County, there was no outward sign of illness, or so he thought.
McCollum disregarded a bump on his neck as a bug bite or ingrown hair. He let it go for a couple of months, and it was only happenstance that his cancer was found.
“I tripped and fell and cracked my head, and when I went to the doctor, they did a CT scan,” he said.
Tests revealed an enlarged lymph node. His physicians suspected, because of his age and gender, that it was cancer.
A tonsillectomy and biopsy confirmed it.
“I wasn’t a smoker, other than an occasional cigar,” said McCollum, who works in industrial sales. “You always think it’s gonna be someone else. When you hear the news, you just kind of go, ‘Wow.’ ”
Similarly, Shields said he dismissed the unusual feelings in his throat for weeks. He was busy planning his June wedding to his now-wife, Linda, and put off seeing a doctor.
“I remember shortly after we got back from our honeymoon in Maine, I was getting ready to go to church,” said Shields, a member at St. Margaret Mary in Lower Burrell.
His phone pinged with an AHN “My Chart” message.
“I saw the words ‘squamous cell,’ and I knew what that meant,” Shields said.
His tests showed the cancer had spread from his tonsil to his lymph nodes.
“Two months into our marriage, I got diagnosed,” he said. “I was gonna fight this no matter what.”
Common symptoms of oropharyngeal cancer can include a nodule in the throat, difficulty swallowing or swollen glands. The most common symptom is a painless bump on the neck that doesn’t clear with antibiotics.
“If you have a persistent sore throat, get it checked,” Klayton said.
High cure rate
Medical experts say HPV-related throat cancer is highly treatable. In most cases, the cure rate is up to 90%.
“Even though it makes up 70% of the diagnoses, it has a much higher cure rate, dramatically different than HPV-negative cancer,” Klayton said.
Smoking is the one caveat, Klayton said. People who smoke won’t fare as well, she said.
Treatments can include a combination of radiation, chemotherapy, immunotherapy or surgery.
Shields and McCollum underwent similar treatment. Shields received six rounds of chemotherapy and 35 consecutive doses of radiation at Forbes Cancer Institute in Monroeville.
“The first week or so, you tolerate it,” he said. “Then it starts to hit you. You have to buckle down and do everything they tell you and, oh boy, did I listen.”
McCollum had two rounds of chemo and 36 radiation sessions at UPMC Hillman Cancer Center in Shadyside. Radiation takes only 10 minutes but requires a special mesh mask to be worn for precision targeting and to ensure no other tissue is damaged.
McCollum documented his journey through photos and had the staff sign a T-shirt midway through treatment.
“You have to keep a positive attitude and follow the plan of attack,” he said. “You see people who are in worse shape and you think, ‘What do I have to complain about?’ ”
Despite the favorable prognosis, treatment takes its toll on the body.
Both men described losing their sense of taste as well as their appetite. The deeper into treatment, the more challenging it becomes to eat. They both lost about 40 pounds, which is the threshold before a feeding tube is considered.
“He got really skinny,” said McCollum’s wife, Natalie. “The cumulative effects of radiation left his mouth without any saliva. He developed mouth sores and had difficulty opening his jaw. The scar tissue always felt stiff.”
Being comfortable became a struggle, McCollum said. Sometimes it felt better not to talk, which “wasn’t easy for me,” he said, with a laugh.
Even soft foods had to be forced.
“They give you this Lidocaine spray, and you hurry up and try to get something down while your throat is numb,” McCollum said. “It started to be a regular menu of oatmeal and scrambled eggs. Even that took me a gallon of water to get down.”
Future therapies
Researchers are seeking ways to reduce the intensity of therapy in certain HPV patients to decrease the long-term toxicity of chemo and radiation, Zandberg said.
Eligible patients can participate in reduced intensity clinical trials, including those focused on a less invasive surgical technique called transoral robotic surgery.
UPMC researchers also lead a National Cancer Institute-designated program on head and neck cancer. The Specialized Programs of Research Excellence (SPORE) grant is a collaborative initiative to develop trials for treatment based on scientific discoveries and population studies.
In the meantime, physicians say it is critically important to raise awareness about the cancer and eliminate stigma.
Klayton said that because HPV-related cancer doesn’t get the spotlight that breast or lung cancers receive, people are unaware of the prevalence of HPV and its link to throat cancer.
Raising the profile can help normalize discussions about HPV and its health implications, she said.
“We know they’re facing the greatest adversity in their life,” Zandberg said. “Besides the physical, there’s a mental effect and an economic effect. It’s a massive change to everything in their life.
“We want them to be cured of their cancer and also to get to the point where they have their lives back, where during an office follow-up visit, we spend more time talking about what they’re doing in their life than the cancer they had.”
McCollum said he feels like he has reached that point.
“I went from nibbling ham like a mouse — that was the start of getting back to eating, getting back to normal — to little by little feeling better,” he said.
His mouth still gets dry, and there are days when he takes an out-of-character nap, but McCollum is back to work and mostly back to his old self, he said.
“There’s not a lot of cancers that you can prevent,” his wife said. “Our generation didn’t have the vaccination. So if this happens to you, know that there is light at the end of the tunnel.”
Shields also is not taking his clean bill of health for granted. His last radiation treatment was in October 2024. In January 2025, his doctor delivered the good news: There was no sign of cancer on his scans.
Having announced sports events since his high school days in the 1970s at Central Catholic, Shields was eager to get back to work after walking away from the mic for a year.
“The first game I did back at CMU, I announced the Kiltie Band before the football game and I got through the opening,” he said. “But thank goodness there was a little lull after that. I had to get the Kleenex out. It was all emotion.”