In a country where preventable diseases still claim too many lives, a new silent threat is slowly emerging: Head and Neck Squamous Cell Carcinoma (HNSCC). 

HNSCC refers to cancers that arise in the tissues of the mouth, throat, tongue, tonsils and voice box. They often begin as small sores, lumps or persistent throat discomfort, which many people dismiss as minor infections. Global statistics reveal that HNSCC is the seventh most common cancer globally, accounting for an estimated 890 000 new cancer cases and 450 000 cancer deaths per year globally. 

These cancers often remain undetected until the late stages, when treatment becomes complex and costly. Recent hospital data suggest an increasing number of Namibians, both men and women, presenting with growths or tumours in the mouth, throat or neck regions that later test positive for cancer. 

This trend signals a worrying shift in Namibia’s cancer landscape – one that requires urgent public attention and a broader national response.

Lifestyle and HPV 

The main risk factors for HNSCC include tobacco use, excessive alcohol consumption, poor oral hygiene and infection with the Human Papillomavirus (HPV). 

These risks can compound. For example, individuals who smoke or drink heavily and also contract HPV face a significantly higher likelihood of developing cancer. HPV is the most common viral sexually transmitted infection, affecting both men and women. With more than 200 known types, HPV is broadly categorised into low-risk and high-risk groups. Low-risk types typically cause skin or genital warts and rarely lead to cancer. 

High-risk types, however, can infect mucosal surfaces of the throat, mouth, cervix, vagina, vulva, penis and anus. When they persist in these tissues, they can disrupt normal cell growth and increase the risk of cancer development over time.

Challenges

One of the major barriers to successful treatment is late diagnosis. 

Many patients seek medical attention only after developing symptoms such as pain, bleeding or difficulty swallowing. These are indications that the disease is already at an advanced stage. 

Limited public awareness, stigma associated with oral and throat lesions as well as restricted access to specialised care further contribute to delays in seeking treatment. 

Additionally, pathology and molecular testing services are available only in a few urban hospitals, making confirmation of HPV-driven tumours challenging. 

The lack of a fully-integrated national cancer registry further impedes the ability to monitor trends, allocate resources effectively and plan targeted interventions.

Treatment, prevention

Treatment for head and neck cancers depends on the tumour’s size, stage and location. 

In Namibia, patients are often referred to specialised units for a combination of surgery, radiation therapy and chemotherapy. 

Early-stage cancers can sometimes be removed surgically or treated with radiation alone, but advanced cases often require aggressive multi-modal therapy, which can affect speech, swallowing and overall quality of life. Access to reconstructive surgery and rehabilitation services remains limited, especially outside Windhoek. Because of these challenges, prevention remains the most powerful tool. 

Reducing tobacco and alcohol use, maintaining good oral hygiene and increasing HPV vaccination coverage can drastically cut future cases. The HPV vaccine, already part of Namibia’s school-based immunisation programme for girls, protects against the high-risk viral strains (HPV-16 and HPV-18), known to cause not only cervical cancer but also a growing number of head and neck cancers. Maximising awareness and expanding the programme to include boys would strengthen community-wide protection, reduce transmission and protect both sexes from these preventable cancers.

Meanwhile, studies have shown that patients with HPV-associated HNSCC have an increased survival rate in comparison to non-HPV HNSCC. 

Namibian research

A recent molecular study conducted as part of my Master of Science research confirmed the presence of HPV in several tumour samples from Namibian patients with head and neck cancers. Using RNA sequencing and targeted molecular assays, the study identified key genes that may influence HPV-driven HNSCC development. The findings further indicate that HPV-driven cancers may behave differently from those associated with tobacco or alcohol exposure, underscoring the importance of early detection and improved molecular testing in Namibia. 

Additionally, the study revealed that tobacco and alcohol use may increase cellular susceptibility to viral infection, potentially exacerbating HPV-related oncogenesis. 

Thus, strengthening national diagnostic capacity would enable HPV testing to be integrated into routine cancer screening. For example, biopsy tissue already collected for diagnostic purposes could also be analysed for HPV DNA or RNA, allowing clinicians to determine viral involvement without requiring additional procedures.

Awareness to action

Reducing deaths from head and neck cancers in Namibia requires a coordinated national strategy centred on prevention, research and early detection. 

Expanding HPV vaccination to include boys, integrating HPV testing into national cancer registries where biopsy tissue is available, and strengthening molecular research capacity within research institutions and national hospitals will help identify HPV-driven tumours locally and guide tailored interventions. At the same time, public awareness efforts should highlight early symptoms and key risk factors, while training programmes for community health workers and dentists can equip frontline providers to recognise warning signs and refer patients promptly. 

Progress may unfold gradually, but each awareness session, community conversation and local research study contributes to shifting head and neck cancer from a silent killer to a largely preventable and manageable disease in Namibia.

* Linda Ratjama is a Biology Lab Technician at the Namibia University of Science and Technology. She completed her MSc in Applied Biology, researching the molecular role of HPV in Head and Neck Squamous Cell Carcinomas in Namibia. The opinions expressed here are her own.