Smoking and drinking have always been risk factors when it comes to oral cancer. But these days, the human papillomavirus (HPV) is playing a greater role in triggering oral cancer as well as cancers elsewhere in the body. According to the Centers for Disease Control and Prevention (CDC), an average of 15,738 HPV-associated oropharyngeal squamous cell carcinomas (SCCs) were diagnosed each year from 2008 to 2012.
“Based on the available data, the incidence of HPV-positive oropharyngeal cancers could surpass the leading number of HPV-associated cervical cancers in the United States by 2020,” said Jo-Anne Jones, president of RDH Connection Inc. “The virus is commonly transmitted through sexual activity, namely oral sex.”
About 79 million Americans now have HPV, including 10% of men and 3.6% of women with oral HPV, with about 14 million new infections each year. It is the most common sexually transmitted infection, and nearly all sexually active men and women get it at some point. While most people clear it without any symptoms, persistent infections with one of 13 HPV types can progress to precancer or cancer.
“Today, younger sexually active patients including women are at greater risk—specifically for oropharyngeal cancer, which is on the rise thanks to the HPV virus,” said Michael Ventriello, owner of Ventriello Communications LLC. “Yes, it’s a lot more uncomfortable asking patients about risky behavior when it comes to their sex lives. But it has to be done. It’s the new reality of being an oral clinician.”
Part of the increase in HPV-associated oral cancers may come from a lack of awareness. According to a consumer survey by Vigilant Biosciences in conjunction with the Head and Neck Cancer Alliance and Support for People with Oral and Head and Neck Cancer, 58% of American adults know little or nothing about oral cancer.
“Oral, head, and neck cancer—particularly HPV-related oral cancer—is increasing at an alarming rate, and many people are not diagnosed until the cancer has progressed to a later stage,” said Holly Boykin, executive director of the Head and Neck Cancer Alliance. “Early diagnosis is significant to the successful treatment of these cancers.”
Only 23% of respondents recalled discussing these risks at their last dental checkup, but more than 86% want their dentist to help them learn how to reduce these risks. And while most respondents were aware of the risks of tobacco and alcohol consumption, only 65% knew that exposure to certain types of HPV, particularly HPV-16, is another risk.
In fact, a study by the Albert Einstein College of Medicine found that patients who have the HPV-16 strain in their mouths are 22 times more likely to develop a type of head and neck cancer. The CDC says HPV-16 is the most likely to persist and progress to cancer, with HPV-16 and HPV-18 causing 63% of all HPV-associated cancers in the United States.
Of the 15,738 oropharyngeal SCCs diagnosed on average each year, 12,638 are among males and 3,100 are among females. Also, rates of oropharyngeal SCCs in both makes and females were higher among whites (8.0 and 1.8 per 100,000) compared to blacks (6.9 and 1.5) and among non-Hispanics (8.0 and 1.8) compared to Hispanics (4.2 and o.9).
“We know the statistics. Now it is time to beat the odds and sound a call to action for every one of us to perform a head and neck examination including an oral cancer screening on every adult every year,” said Jones. “We also must utilize the best tools to elevate the opportunity to discover this disease in its early stages.”
For example, the Baylor University Medical Center at Dallas has launched a 3-year pilot study in using saliva to diagnose oral cancer. The metabolomics-based research will compare biomarker levels in the saliva or oral cancer patients, healthy volunteers, and those with oral inflammatory diseases. It will focus on oral SCC, which comprises more than 90% of oral cancers.
Also, Dr. Jennifer Webster-Cyriaque of the University of North Carolina School of Dentistry is working with InSilixa Inc. to develop a rapid oral HPV test that could play a key role in timely diagnosis and treatment. It combines the company’s disposable biochip technology with Webster-Cyriaque’s work in the lab.
“It is really a DNA analysis instrument on a small chip,” said Webster-Cyriaque. “It uses 32-x-32 semiconductor-integrated and miniaturized biosensor arrays to detect unique DNA markers of HPV and its high-risk strains electronically.”
While early detection and diagnosis are key to survival, prevention will play a role as well. The CDC reports that 28,500 of the 30,700 HPV-caused cancers that are diagnosed on average each year are attributable to HPV types that are preventable with the 9-valent HPV vaccine.
In fact, the rates of HPV infection among adolescent girls and young women have declined significantly since the 2006 release of the vaccine, the CDC reports. The CDC also recommends vaccinations for all girls and boys ages 11 or 12 years, though only Virginia and Rhode Island along with the District of Columbia require them.
According to the CDC, full vaccination coverage of the US population could prevent future HPV-attributable cancers. Ongoing surveillance of HPV-associated cancers using high-quality population-based registries also is needed, the CDC says, to monitor tends that might result from increasing use of HPV vaccines.
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