HPV and Oral Cancer

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HPV or the Human Papillomavirus is the most common sexually transmitted infection today. The CDC reports that “80% of Americans will have HPV infections in their lifetime with 99% of the infections clearing without consequence.”  With over 100+ strains of the virus identified, approximately 40 types have been most identified with genital infections and two, HPV16 andHPV18, more known to be responsible for causing cancer, more specifically of the cervix, mouth, and throat.

Most types of HPV infections are fought by the body’s immune system, and most people do not know they have been infected. There is no cure for HPV, but generally, the virus runs its course and is out of the immune system within two years (oralcancerfoundation.org). Some strains, however, are suspected of lying dormant in the body and then spread to other partner’s years later, unbeknown to the carrier. HPV is spread through skin to skin contact. There is no pain or symptoms associated with the infection, but it can lead to genital warts and cervical cancer in the case of Genital HPV or oropharyngeal cancer in the case of Oral HPV. Though the virus can resonate in different parts of the body, it is the same virus that can infect all parts of the body. They can be carried from one area to another, most often through oral sex.

Research indicates that sexual practices have changed over the years and that oral sex is more common now than decades ago leading to the rising incidence of Oral HPV and oral cancers. HPV 16 is the leading cause of oropharyngeal cancers. The fastest growing population of oral cancers is healthy nonsmokers between the ages of 25-50 years old. Also “white nonsmoking males 35-55 years old are most at risk, 4 to 1 over females”(oralcancerfoundation.org, CDC.gov).  According to researchers at Mountsinai.org, 90% of adults have been exposed to HPV 16 (linked to cancer). 70% of these exposed develop antibodies for the virus, meaning they have been infected but had not resulted in a positive cancer diagnosis. Not all HPV 16 infections lead to cancer, but it is not clear why. In fact, a small number of the infected will result in oropharyngeal cancer, but unfortunately, that number is increasing by 10% every year. And “according to the National Cancer Institute, with the increasing occurrence of HPV-related oropharyngeal cancers (throat and base of tongue), the cases in MEN is expected to exceed cervical cancer cases by the year 2025”. (mountsinai.org) Currently, for every one woman diagnosed, there are nine men diagnosed with HPV-related oral cancer. Again, though not completely understood, it is thought that possibly the male immune system is not as equipped to fight this infection.  Some studies point to college-age white males as the most common carrier of this virus. Though oral sex practices are directly linked to Oral HPV, it is unclear if the virus can be further spread by open mouth (French) kissing as well.

How can this be prevented?

The best protection against HPV and all STD’s is don’t have sex or sexual contact.  Not new in prevention is continuing to practice safe sex which includes abstention, testing with your partner for antibodies for HPV and other STD’s and the use of condoms, even with oral sexual activity. Being monogamous is also very important in reducing the risk of exposure. Developing cancer from HPV does not necessarily mean there have been a high number of sexual partners because so much of the population has been exposed. However, a high number of sexual partners WILL increase the risk. The odds of HPV-related throat cancer doubled with 1-5 oral sex partners (in a lifetime) but increased 5-fold with 6 or more oral sex partners compared to those with no oral sex history(mountsinai.org).  Avoiding alcohol and drug use can also help reduce risk as these substances contributed to more uninhibited behavior.

VACCINATE!

Fortunately, vaccinations are available for HPV. Because the vaccine prevents the infection, it is not effective for those who have already been infected. It is very important then to have tweens and teens vaccinated as young as 11 years old for girls and nine years old for boys and up to 26 years old if there has been no exposure. The reality is kids are experimenting with sex at younger and younger ages. Some girls and boys, worried about the stigma of losing their virginity, may find it more acceptable to have oral sex. For older teens, there can be pressures to lose their virginity and engage in sexual activity. In fact, it is estimated that 65% of high schoolers have had sex by the 12th grade and even more startling, 1 in 5 have had more than four partners (Ashasexualhealth.org).

Gardasil and Cervarix are two examples of available vaccines that protect against HPV 16 and HPV 18, both identified with cancer. Though these vaccines eliminate the concern for genital cancers, there has not been enough research to support their effectiveness against other types of cancers as well, i.e. Oral HPV infections and cancers of the mouth and throat. The hope is that there is a crossover effect that will reduce the risk of oropharyngeal cancers as well.
There is no test to identify an HPV infection. And as stated earlier, there is no cure for the virus itself. In cases with a cancer risk, Pap smears help to diagnose cervical cancer while regular exams by a dental professional may help to catch early evidence of oropharyngeal cancer. Unfortunately, this cancer is more difficult to detect as visibility to the throat and base of the tongue is limited. An ENT can be a great source for evaluation by using a small scope or camera. It is important to see your dentist regularly and report any unusual lumps or a chronic sore throat. With early intervention and treatment, there is an 85-90% survival rate over five years (mountsinai.org).

The reality is there are 79 million Americans infected with the Human Papillomavirus (Teensource.org) and an estimated 14 to 20 million new cases diagnosed annually.  Half of those cases occur in people between the ages of 15-24 years old.  Educating our children on safe sex practices and having them vaccinated before they begin exploring with sexual activity can help to reduce the risk of being infected and being exposed to the risk and diagnosis of oropharyngeal cancer in the future.

HPV and Oral Cancer julia

 

-By Julia Guerra, RDH, BA

julia@randolphnjdentist.com