Could HPV be transmitted orally?

Source: Bright Hub
Author: Kira Jaines

Can a kiss transmit HPV? Or oral sex? Studies conducted by researchers at Johns Hopkins University found that not only can human papilloma virus be transmitted orally, it can also increase the risk of oropharyngeal cancer.

Can HPV Be Transmitted Orally?

In a word, yes. Once thought to be uncommon, the oral transmission of human papilloma virus (HPV) through oral sex and even French kissing has been documented and linked to an increasing rate of oropharyngeal cancer. The oropharynx consists of the base the tongue, the tonsils, the back of the mouth and the walls of the throat. Results of a study by Johns Hopkins researchers published in the New England Journal of Medicine in 2007 linked HPV exposure and infection to an increased risk of cancer of the mouth and throat. HPV infection has rapidly caught up with tobacco and alcohol as a risk factor for oral cancer, and has, in fact, become one of the leading causes of oral cancer in men, independently of smoking and drinking.

About HPV

Over 120 different HPV viruses have been identified, according to the Oral Cancer Foundation. Different types of HPV infect different parts of the body. Some cause warts on the skin. Some cause warts on the genitals. Some are harmless. Some cause cancer. The HPV virus is easily passed via skin-to-skin contact or sexual contact. HPV viruses cause no early identifiable symptoms and most are fought off by the body’s immune system. In fact, sexually-active adults have a 75 percent chance of acquiring HPV during their lifetimes though they may never know they are infected and the infection often resolves without treatment–even infection with high-risk strains of HPV. But prolonged infection with a high-risk strain can develop into cancer. These are the sexually-transmitted strains that cause cervical, anal and penile cancers and are now known to cause oral cancer as well. Can HPV be transmitted orally? Absolutely.

Oral Transmission of HPV

Open-mouthed kissing, or French kissing, can transmit the HPV virus, as can oral sex. Like cervical cancer, the oropharyngeal cancer associated with HPV infection is slow-growing and silent. It may take 10 to 20 years for an oral HPV infection to progress to cancer, according to Dr. Maura L. Gillison of Ohio State University, Columbus. Her 2009 study of both adult and college-aged men found that 4.8 percent of the adults and 2.9 percent of the college-aged men did have oral HPV infection. Among the adults, the odds of HPV infection were significantly greater in smokers and those who had more than 10 oral sex partners or more than 25 vaginal sex partners. In the college-aged men, the chance of oral HPV infection increased significantly with having at least six recent oral sex or open-mouthed kissing partners. Even for the 28 percent of college-aged men who had never performed oral sex, the risk of HPV infection was also significantly increased if they had at least 10 lifetime or five recent open-mouthed kissing partners.

Gillison’s study also found that oropharyngeal cancer linked to HPV can be distinguished from that linked to prolonged use of tobacco and alcohol, and the two types respond differently to treatment. Study participants whose oropharyngeal tumors tested HPV positive had a better chance of survival compared to patients whose tumors tested HPV negative.

HPV Prevention

Vaccines like Gardasil and Cervarix are preventive but will not treat HPV infection. Both protect against the HPV type linked with cervical and oral cancer. In 2010, Cervarix is approved only for females, but Gardasil is approved for males ages 9 through 26 and females ages 13 through 26. In addition to vaccination, limiting the number of sexual partners and choosing partners with few or no prior partners will decrease the chance of contracting the HPV virus. Annual oral cancer screenings with a dentist can also detect early HPV changes that may otherwise go unnoticed for years.


National Cancer Institute: HPV a Risk Factor for Oropharyngeal Cancer

MSNBC: HPV Increasingly Causes Oral Cancer in Men

Oral Cancer Foundation: The HPV Connection

Reuters: “French” Kissing Ups Risk of Oral HPV Infection

National Cancer Institute: HPV Status Can Predict Outcome in Oropharyngeal Cancer

Centers for Disease Control and Prevention: Sexually Transmitted Diseases: HPV

UC Davis probes into oral cancer

Source: theaggie.org
Author: Eric C. Lipsky

UC Davis is searching for new and more effective methods to deal with oral cancer.

Researchers have begun using a fluorescent oral probe to aid in the detection of malignant tissues. The probe allows doctors to differentiate between healthy and malignant tissue, along with having the capacity of working as a screening device. Although still a prototype, the fluorescent probe is showing that it can be helpful to doctors both prior to and during surgery.

“The big picture is to improve the ability to diagnose tumors at an earlier stage,” said Dr. Gregory Farwell, a head and neck surgeon at the UC Davis Medical Center.

Farwell said that people’s ability to survive oral cancer is significantly increased if the cancer is detected at an early stage. He said that oral cancer is primarily caused by smoking, drinking and human papillomavirus (HPV). Farwell said oral cancer through HPV usually takes 10 to 20 years to develop.

43,000 Americans are diagnosed with oral cancer each year. While the cancer is not the most prevalent in the United States, Farwell said it is a major problem worldwide, especially in countries like India and China.

He said this probe could be of great utility for efficiently diagnosing different stages of cancer.

“It is a very effective way to discriminate between normal tissue and tumor tissue,” Farwell said. “We’re showing better results in distinguishing differences in tissue. It can even help discriminate between pre-cancer and advanced cancer.”

The probe, which is relatively small, uses a laser light to interact with the tissue in order to receive the signals indicating whether or not it is malignant.

Farwell explained that this tissue distinction by the probe is crucial when it comes to tissue in the mouth.

“Our hope is that this technology can leave more of the patient’s tissue in place because taking out an extra centimeter could be the difference in impacting swallowing, speech, or disfigurement,” he said.

Farwell believes the probe has the potential to have widespread impact on oral cancer, as there are not many light-based probes out today. This can lead the probe to have an ever-increasing influence in the field.

Laura Marcu, a biomedical engineering professor at UC Davis, has been researching the probe’s effects with Farwell for four years. She believes that the probe is helpful in terms of screening for oral cancer, but that its primary benefit comes from its assistance during surgery.

“It can increase specificity in screening and identifying patients who have malignant transformations in oral cavities,” Marcu said.

Marcu, like Farwell, said the main causes of oral cancer can be attributed to smoking primarily, but that cancerous diagnoses as a result of HPV are increasing. She believes that it is important to treat the cancer early, and that the fluorescent probe can help.

“It’s not just the fact that [oral cancer] is deadly, but that it impacts the oral cavities, causing the diminishment of the person’s life,” she said.

Marcu said that many people are developing oral cancer in their 30s as a result of HPV. Farwell said this could also be attributed to the sexual revolution of the late 20th century.

HPV, a sexually transmitted virus, is similar to the virus strain of cervical cancer that women develop, Farwell said. He believes that HPV will receive much more attention from the public in the next few years, due to the drastic increases -that are rapidly approaching tobacco in terms of figures for cases of oral cancer caused – of HPV-induced diagnoses.

Research results are already being published, as the probe has been the focus of increased attention. If successful, the probe could greatly increase the number of screenings for oral cancer by practitioners and dentists alike.

Farwell believes that the progress made with this probe is a reflection of the quality of the UC Davis Medical Center.

“It is a great example of the collaborative atmosphere we have in place here; a place where doctors from various backgrounds can work together for a common goal,” Farwell said.

Oral sex can add to risk of HPV positive cancers

Source: www.time.com
Author: Coco Masters

Oral sex can get most men’s attention. The topic becomes considerably more relevant, however, when coupled with a new study linking the human papillomavirus (HPV) to an increased risk of a kind of oral cancer more often seen in men.

The study, which appears in this week’s New England Journal of Medicine (NEJM), shows that men and women who reported having six or more oral-sex partners during their lifetime had a nearly ninefold increased risk of developing cancer of the tonsils or at the base of the tongue. Of the 300 study participants, those infected with HPV were also 32 times more likely to develop this type of oral cancer than those who did not have the virus. These findings dwarf the increased risk of developing this so-called oropharyngeal cancer associated with the two major risk factors: smoking (3 times greater) or drinking (2.5 times greater). HPV infection drives cancerous growth, as it is widely understood to do in the cervix. But unlike cervical cancer, this type of oral cancer is more prevalent in men.

HPV is ubiquitous. Of the 120 strains isolated from humans — about 40 of which are in the mouth and genital tracts — Merck’s recently FDA-approved vaccine, Gardasil, protects against four: HPV-6 and HPV-11, which cause warts; and HPV-16 and HPV-18, which cause about 70% of cervical cancers. Similarly, according to the study, HPV-16 was present in 72 of the 100 cancer patients enrolled in the study. Between 12,000 and 15,000 new cases of oropharyngeal cancer are diagnosed each year, and about 3,000 people die from it. “It is a significant health issue,” says Dr. Robert Haddad, clinical director of the Head and Neck Oncology Program at the Dana-Farber Cancer Institute. Haddad says that public awareness of the HPV virus needs to be just like that of HIV because the virus causes multiple types of cancer.

The study’s findings bring to light a part of the debate over HPV vaccination and treatment that is often overlooked: the elevated risks of cancer that being HPV-positive has for men. According to Johns Hopkins’ researcher Dr. Maura Gillison, who worked on the study: “When you look at the cancers associated with HPV in men — including penile cancer, anal squamous cell carcinoma, oral cancers — it’s very close to the number of cases of cervical cancer that occur in the U.S. in women every year. We need to adjust the public’s perception… that only women are at risk.”


In his practice, Haddad has seen an increase in the number of younger people developing this cancer, people in their 30s and 40s. He attributes it in part to a “change in sexual behavior over the last decade.” He says: “The idea that oral sex is risk-free is not correct. It comes with significant risks, and developing cancer is one of them.”

Gardasil has become a vaccine rock star, but vaccines to fight HPV are still in their infancy. Another study in this week’s NEJM points out that while the preventative vaccine works 98% of the time to protect girls not yet infected with HPV-16 and HPV-18, the vaccine is only 17% effective against cancer precursors overall. These findings could undercut the argument ensuing in more than 15 states to make the vaccine mandatory for young girls.

Gardasil and some vaccines in clinical trial are preventative, but drug companies such as MGI Pharma are studying therapeutic vaccines to treat those already infected with the virus. “We need to come up with better vaccines — and we need to study them in men,” says Haddad. Gardasil has not been tested against oral HPV, but Dr. Douglas Lowy, laboratory chief at the National Cancer Institute, says that there is every reason to think that, in principle, “the vaccine should be able to have an impact on oral cancers attributable to HPV.” Lowy says that the next studies might start with a look at the rate of acquisition of oral HPV in those who are vaccinated and those who aren’t.

“There’s no question that the debate needs to go further than where it is now,” says Haddad. “Men are carriers and that is one way of transmitting this virus.”

March, 2010|Oral Cancer News|

Alcohol’s hidden effects revealed in new National Health Service campaign

Source: www.medicalnewstoday.com
Author: staff

A new 6 million pound NHS campaign to reveal alcohol’s hidden effects warns people of the unseen damage caused by regularly drinking more than the advised limits and highlights drinkers’ affected organs while they sup their drink in the pub or at home.

The campaign was launched recently by Public Health Minister, Gillian Merron. It forms part of a government-wide strategy to tackle the harmful effects of alcohol and is backed by major health charities.

Merron said in a press statement that:

“Many of us enjoy a drink – drinking sensibly isn’t a problem.” But, she warned that:

“If you’re regularly drinking more than the NHS recommended limits, you’re more likely to get cancer, have a stroke or have a heart attack.”

The Department of Health developed the campaign with Cancer Research UK, the British Heart Foundation and the Stroke Association. Part of it entails showing a series of strong messages on TV, in the press and outdoor posters, showing how much harm drinking more than the NHS advised daily limit can do to your body.

In the TV campaign, one advert of three men drinking in a pub, shows one of them with a semi-transparent body, and as he sups his beer, different organs are highlighted to show which parts the narrator, who is explaining the risks of drinking alcohol, is talking about (for example, when high blood pressure is mentioned, the heart becomes more visible).

The NHS advises that women should drink no more than 2 to 3 units of alcohol a day (about 2 small glasses of wine) and men should drink no more than 3 to 4 a day(about two pints of lager).

In the UK, a unit of alcohol is 10 millilitres of ethanol (ethyl alcohol) and the strength of an alcoholic drink (the amount of ethyl alcohol it contains) is shown in percentage ABV (alcohol by volume). So every increase of 1% ABV adds another unit of alcohol to a litre: one litre of a drink of 1% ABV contains one unit of alcohol, one litre of 2% per cent ABV drink is 2 units, one litre of 3% ABV is 3 units, and so on.

However, most alcoholic drinks are stronger than 1 or 2% ABV and you don’t have to drink a litre to consume several units. For instance, one pint (just over half a litre) of beer at 4% ABV contains 2.3 units, and half a 0.75 litre bottle of wine at 13% ABV contains 4.9 units.

A recent YouGov poll of more than 2,000 adults showed that more than half (55 per cent) of drinkers in England mistakenly believe that alcohol only does harm if you regularly binge or get drunk.

The survey also revealed that 83 per cent of adults who drank more than the NHS advised daily limit don’t believe their drinking is putting their long- term health at risk.

This suggests that 8.3 of the 10 million adults in England who regularly drink above the recommended limit are probably unaware of how much damage their drinking is doing to their bodies, said the NHS.

Although the vast majority of those surveyed realised that alcohol consumption is linked to liver disease, few realised it is also linked to throat cancer, mouth cancer, breast cancer, stroke and heart disease.

This is in spite of evidence from research that shows, for example:

  • A man who regularly drinks more than two pints of lager a day is three times more likely to have a stroke or mouth cancer.
    A woman who regularly drinks more than two glasses of wine a day is 50 per cent more likely to get breast cancer, and twice as likely to have high blood pressure (which could lead to a heart attack).
  • According to figures from the Department of Health, over 9,000 people in the UK die from alcohol-related causes every year. Estimates from the World Health Organization (WHO) suggest that 20 per cent of alcohol-related deaths are from cancer, 15 per cent are from cardiovascular conditions like heart disease and stroke, and 13 per cent are from liver disease.

    Chief Medical Officer for England, Professor Sir Liam Donaldson, said that it was important for people to “realise the harm they, unknowingly, can cause to their health by regularly drinking more than the recommended daily limits.”

    “This campaign gives people the facts about the effect alcohol can have on their body and provides support for people who choose to drink less,” he added.

    Director of Communications for The Stroke Association, Joe Korner, said:

    “We are pleased to be involved in this campaign because it alerts people to the long term health risks of regular heavy drinking.”

    Korner said that stroke is the biggest cause of severe disability in adults and affects about 150,000 people every year in the UK, so it is vital that people understand that regularly drinking above the recommended daily limit means they are more likely to have high blood pressure, the single biggest risk factor for stroke.

    The British Heart Foundation’s Associate Medical Director, Dr Mike Knapton, urged that while there is some evidence that sensible drinking in moderation appears to offer some protection against heart disease, this should not be seen as a reason to take up drinking:

    “There are better ways to protect yourself from heart disease,” he said.

    “The evidence is clear, regularly drinking above the recommended daily limits harms the heart as well as causing a host of other harmful effects,” said Knapton.

    Sara Hiom, director of health information for Cancer Research UK said that decades of research has shown that alcohol can raise the risk of several cancers, including cancer of the bowel, breast, liver, mouth, foodpipe (oesophagus), voicebox (larynx) and throat.

    “Our bodies convert alcohol into a toxic chemical called acetaldehyde which can lead to cancer by damaging DNA and stopping our cells from repairing this damage,” explained Hiom, adding that another side effect of alcohol consumption is raised levels of estrogen which increases the risk of breast cancer.

    “The simple message is that the more you drink the greater your cancer risk but the more you cut down the more you reduce that risk,” said Hiom.

    March, 2010|Oral Cancer News|

    Drinkers underestimate harm from alcohol

    Source: www.onmedica.com
    Author: OnMedica staff

    More than half (55%) of people in England who drink alcohol wrongly believe that alcohol only damages your health if you regularly get drunk or binge drink, a poll by YouGov has shown.

    YouGov questioned more than 2,000 adults and found that 83% of those who regularly drink more than the NHS recommended limits – 2-3 units a day for women and 3-4 units a day for men – don’t realise that their drinking is risking their long-term health.

    An estimated 10 million adults in England are drinking above the recommended limits, so about 8.3 million people are potentially unaware of the damage their drinking could be causing.

    Although 86% of drinkers surveyed said they knew that drinking alcohol is related to liver disease, far fewer realised it is also linked with breast cancer (7%), throat cancer (25%), mouth cancer (28%), stroke (37%) and heart disease (56%), along with other serious conditions.

    The government has funded a £6 million campaign, backed by charities Cancer Research UK, the British Heart Foundation and the Stroke Association, to warn drinkers of the unseen health damage caused by regularly drinking more than the NHS advises. Billboard, press and TV adverts will show drinkers the damage that is being done to their organs while they are drinking, whether in a pub or at home.

    More than 9,000 people in the UK die from alcohol-related causes each year. The World Health Organisation estimates that 20% of alcohol-related deaths are from cancer, 15% are from cardiovascular conditions such as heart disease and stroke, and 13% are from liver disease.

    Research shows that a man regularly drinking more than two pints of strong lager a day could be three times more likely to have a stroke and three times more likely to get mouth cancer. A woman regularly drinking two large glasses of wine or more a day is 50% more likely to get breast cancer and twice as likely to have high blood pressure, which could lead to a stroke or a heart attack.

    Joe Korner, director of communications for The Stroke Association, said: “We are pleased to be involved in this campaign because it alerts people to the long-term health risks of regular heavy drinking.

    “Stroke is the biggest cause of severe adult disability and hits 150,000 people a year. So, it’s vital that people understand that women who persistently drink more than three units of alcohol a day and men who drink more then four, are more likely to get high blood pressure, the single biggest risk factor for stroke.“

    Dr Mike Knapton, associate medical director at the British Heart Foundation, said: “While sensible drinking in moderation has been shown to offer some protection against heart disease, this should not be seen as a green light to start drinking.

    “There are better ways to protect yourself from heart disease. The evidence is clear, regularly drinking above the recommended daily limits harms the heart as well as causing a host of other harmful effects.”

    The campaign website, www.nhs.uk/drinking, launches on Monday 1 February and will feature interactive tools to arm people with the information they need to make healthier choices.

    January, 2010|Oral Cancer News|

    Tongue reconstruction

    Source: www.wsoctv.com/health
    Author: staff

    Tongue cancer accounts for about 25 percent of all oral cancers. According to the National Cancer Institute, about 10,530 cases of tongue cancer will be diagnosed in the U.S. this year. Although the cancer can occur at any age, it’s most commonly diagnosed in older people, with a median age at diagnosis of 61. Men are affected about twice as often as women.

    Two important risk factors for tongue cancer are smoking and drinking. For people who smoke and drink, the risk may be up to 100 times that of those who neither smoke nor drink. Another risk factor for tongue cancer is HPV (human papillomavirus) infection. Douglas Chepeha, M.D., Microvascular Reconstructive Surgeon with the University of Michigan, says doctors are also seeing cases of tongue cancer in young and older women who neither smoke nor drink. The reasons for these cases are not clear.

    Overall five-year survival rates for tongue cancer are about 59.5 percent. However, the cancer has the potential to spread fairly quickly. If the cancer is detected when the condition is still localized, 5-year survival rates are over 77 percent. Once the cancer spreads regionally, survival rates drop to about 55 percent. Thus, early diagnosis is important. Patients who develop a sore on the tongue that doesn’t heal or bleeds easily should see a physician for evaluation.

    Treating Tongue Cancer: Reconstruction After Surgery

    Tongue cancer typically occurs on one side of the tongue. The main treatment is surgery, which can require removal of a significant amount of tissue. Chepeha says doctors typically allow the remaining portion of the tongue to heal or place a skin graft over the area. But that can leave patients with trouble speaking, eating and swallowing.

    Chepeha and his colleagues are using a reconstructive technique, using a graft from the patient’s own body, to improve the aesthetics and function of the tongue. The natural tongue contains areas of thin and thick tissue. So doctors take tissue from areas of the body that best match the varying degrees of thickness. The most common donor site on the body is the forearm. For very skinny or overweight patients, the abdomen may provide a better match in tissue thickness.

    To create the tongue graft, the surgeons look for the area that best matches the size and shape of the original section of tongue. Chepeha compares it to using a fabric pattern to cut out material for a piece of clothing. Once the ideal area is selected, surgeons carefully cut away skin, fat and piece of nerve (no muscle is removed). Then blood vessels and nerve in the graft are connected to those in the mouth. Chepeha says the first 72 hours are the most critical time after the transplant. If the blood vessels are not connected precisely, a clot can form and the transplanted tissue will die.

    After the surgery, the nerve in the graft provides some sensation in the transplanted tissue. However, the graft doesn’t have enough muscle control to move on its own. Therefore, patients need to learn how to maneuver the remaining natural half of the tongue for speaking and eating. Taste is not affected much by the surgery because taste buds on the remaining half of the tongue and those located in other areas of the mouth continue to function.

    December, 2009|Oral Cancer News|

    Drinking epidemic ‘fuels surge in cancer’

    Source: www.dailymail.co.uk/health
    Author: Jenny Hope

    Round-the-clock drinking and cut-price alcohol are to blame for an ‘appalling’ rise in cancers, experts warned today. Cases of cancer of the mouth have gone up by half in the past decade, with a 43 per cent rise in liver tumours. There have also been big rises in breast and colorectal cancer. Many experts are blaming alcohol consumption, which has doubled in the UK since the 1950s and has been fuelled by Labour’s decision to relax licensing laws.

    They are calling for tougher measures to crack down on 2 for 1 offers and price-cutting by supermarkets, as well as the current 24-hour drinking culture. The latest official figures, obtained from parliamentary questions by the Liberal Democrats, show almost 5,000 in England are diagnosed each year with oral cancers – a 53 per cent increase on 3,225 cases in 1997. There was a 20 per cent jump in cancer of the gullet (oesophagus) from 5,397 to 6,487.

    Both types of cancer are linked to heavy drinking, with a fourfold rise in risk for men consuming more than seven drinks a day and women having five drinks or more a day.

    Liver cancer cases went up over the same period from 1,925 to 2,754 – with this cancer two and half times more likely to affect heavy drinkers compared with people who do not drink.

    Female breast cancer cases rose 33 per cent from 28,618 to 38,048. Heavy drinkers run a 60 per cent extra chance of developing the disease.

    Colorectal cancer increased by 14 per cent from almost 27,000 cases to 30,727, with heavy drinking responsible for a 50 per cent rise in risk. Only cancer of the larynx registered a reduction of 8 per cent over the period, down from 1,871 to 1,714.

    Smoking and alcohol are the two main risk factors for oral cancers, which kill around 1,800 a year. Other contributing factors may be a diet lacking in fruit and vegetables and the sexually transmitted human papillomavirus, which can also cause cervical cancer.

    The figures follow Cancer Research UK data earlier this year which showed an alarming rise of a quarter in oral cancer rates among men and women in their 40s.

    Liberal Democrat spokesman Don Foster, said: ‘Excessive drinking has been on the rise for years, and these shocking figures show how dramatically the health problems of booze Britain are escalating. Ministers cannot turn a blind eye to the terrible problems alcohol is causing.

    ‘The Government’s failure to cut alcohol consumption now is storing up problems for later. The appalling rise of alcohol-related health problems will only continue unless we crack down on reckless retailers and irresponsible drink offers.’

    Recent research by Dr John Foster of Greenwich University, for the Alcohol Education and Research Council, found drinking at home is now routine behaviour for millions. He said: ‘Supermarkets are ” normalising” the purchase of a drug for adults that over time is likely to have major health costs, including rising cancer rates.

    ‘Two-for-one offers and discounted bulk buys should be banned.’

    Alcohol Concern chief executive Don Shenker said: ‘Many people are not aware of the connection between alcohol and cancer yet it can be a major contributor or cause of the disease.’

    December, 2009|Oral Cancer News|

    Human papillomavirus infection and cancers of the oropharynx

    Source: www.ajho.com
    Author: Robert Haddad, MD

    Dana Farber Cancer Institute, Boston, MA
    The author was invited to contribute his thoughts on the topic of human papillomavirus and cancers of the oropharynx.

    Squamous cell carcinoma of the head and neck (SCCHN) is a major public health problem, affecting nearly half a million individuals worldwide each year. These cancers can arise from the oral cavity, oropharynx, nasopharynx, hypopharynx and larynx.1 Treatment of head and neck cancer is often multidisciplinary, involving chemotherapy, radiation therapy, and surgery. Patient symptoms can include a sore throat, ear pain, odynophagia, or hoarseness. Most patients will present with stage III or IV disease. The major risk factors are smoking tobacco and alcohol abuse. A large number of patients diagnosed with oropharynx cancer, however, have no history of smoking or drinking, and increasing epidemiological, molecular, and clinical evidence suggests that high-risk human papillomavirus (HPV), especially HPV-16, account for the development of these cancers.2-5 Most individuals are unaware of their infection and have no symptoms.

    HPV is one of the more common virus groups in the world, and more than 80 types of HPV have been identified. Some types (eg, HPV 6 and 11) are known to cause benign conditions such as genital warts, while other types (eg, HPV 16 and 18) are known to be associated with malignant, cancerous transformation. Although different types of HPV are known to infect different parts of the body, HPV usually infects the epithelial cells of skin and mucosa. The epithelial surfaces include all areas covered by skin and/or mucosa such as the tonsil, tongue base, vagina, penis, and anus. Transfer of the virus between individuals can occur with any type of skin-to-skin or skin-to-mucosa contact. HPV infection is known to be a necessary infection for the development of cervical cancer in women and is a risk factor for the development of anal, penile, and vulvar cancer. It is noteworthy that the site mainly associated with HPV infection in the head and neck area is the oropharynx, particularly the tonsils and tongue base. Other sites, including the oral cavity and larynx, are not. Nasopharynx cancer is associated with another type of virus, Epstein Barr Virus (EBV). It is not clear why the oropharynx is more susceptible to HPV transformation. It is well established that the transmission of genital HPV infections is associated with sexual contact and its prevalence increases among individuals with multiple sexual partners. The means by which HPV is transmitted to the oral cavity is less well understood at this stage but sexual behavior and practices are one possible mode of transmission.3 Oropharynx cancer can be placed in the category of “virally mediated cancers” along with cervical cancer, anal cancer, vulvar cancer, and penile cancer (all associated with HPV), and nasopharyngeal cancer and lymphomas (both associated with EBV).

    There is an emerging consensus that 2 pathways exist in oropharynx cancer’s development, one caused by smoking and/or alcohol and another caused by HPV infection. The absence of genetic changes in HPV-positive head and neck cancer contrasts to what is observed in HPV-negative head and neck cancer. In the typical squamous cell carcinomas not caused by HPV, p53 mutations are frequently present. In contrast, HPV-related carcinomas usually do not contain any p53 mutations, and predominantly occur in patients with no excessive tobacco and/or alcohol consumption history, implying that HPV-positive and HPVnegative head and neck cancer represent distinct entities. Furthermore, it has been shown that the outcome of patients with HPV-related tumors is better compared to those with a smoking-related tumor. Indeed, we have enough evidence at this stage to support the notion that patients who have an oropharynx cancer related to HPV will have a longer survival than those whose cancer is not related to HPV. This is likely due to a higher response to chemotherapy and radiation than is seen with HPV-associated tumors. Recently, new evidence has emerged showing that African Americans have a lower incidence of HPV infection, likely accounting for the worse prognosis seen in head and neck cancer affecting these patients.6

    The first prospective report of improved outcome in HPV-positive SCCHN comes from the Eastern Cooperative Oncology group (ECOG).7 In a single-arm phase 2 study performed by ECOG, 96 patients with stages III or IV oropharynx or larynx cancer received induction chemotherapy with carboplatin and paclitaxel followed by concurrent chemoradiotherapy with weekly carboplatin and paclitaxel and standard radiation. The presence or absence of HPV oncogenic types in tumors was determined by multiplex polymerase chain reaction (PCR) and in situ hybridization. The authors were able to show that patients with HPV-positive tumors had higher response rates after induction chemotherapy (82% vs 55%) and after chemoradiation treatment (84% vs 57%) compared with patients with HPV-negative tumors. After a median follow-up of more than 3 years, patients with HPV-positive tumors had significantly improved overall survival (2-year overall survival, 95% vs 62%) and, after adjustment for age, tumor stage, and ECOG performance status, lower risks of progression and death from any cause than those with HPV-negative tumors.

    A surrogate for HPV infection, p16 positivity, has also recently been found to have a major impact on treatment response and survival in patients treated with radiotherapy alone in the Denmark. Indeed, patients with p16 positive tumors had a 5-year survival of 62%; the survival for those with p16 negative tumors was only 26%.8

    RTOG 0129 is a large randomized study comparing chemoradiotherapy with 2 different radiation fractionation schedules. A correlative study presented at the 2009 American Society of Clinical Oncology meeting looked at the association of tumor HPV status and survival for the oropharynx group in this phase 3 study.9 HPV status was evaluable for 73% of oropharynx cases and 60% were HPV16 positive. After median follow-up of 4.4 years, cases with HPV-positive oropharynx cancer had better overall survival (2 year, 87.5% vs 67.2%) and progression-free survival (2 year, 71.9% vs 51.2%). Overall, patients with HPV-positive cancer had a 59% reduction in risk of death and a 46% reduction in risk of progression or death. Second primary tumors were less common among HPV-positive cases and patterns of first failure were similar. Another interesting finding from this study is that smoking status is important for patients with HPV-positive tumors. Mortality was higher for those patients that were smokers compared with nonsmokers in the HPV-positive group. It is likely, based on recent data, that 3 categories of oropharynx cancer patients exist:

    Group 1: Oropharynx cancer, HPV positive, no active or prior smoking history. These patients have an excellent prognosis and the vast majority of those are cured with radiation-based therapy. Cure rate: 80% to 90%.

    Group 2: Oropharynx cancer, HPV positive, current or former smoker. This is considered an intermediaterisk group with survival that is better than the HPV negative group but inferior to group 1. Cure rate: 50% to 60%.

    Group 3: Oropharynx cancer, HPV negative. This group has a poor prognosis and is clearly different than the first 2 groups. Cure rate: 30% to 40%.

    The findings regarding HPV and head and neck cancer have yet to be translated into clinical practice. Indeed, treatment recommendations have not changed so far and chemotherapy/radiation therapy and surgery remain mainstays of therapy. Currently, we do not recommend that treatment be tailored to HPV status unless this is done as part of a clinical trial. Going forward, HPV stratification should and would be required in all head and neck cancer clinical trials. There will also be HPV-related oropharynx trials where only patients with this entity are enrolled. This is important since this group is clearly distinct for the HPV-negative group and has a different prognosis. The most interesting option will be “dose de-intensification” for chemotherapy, radiation therapy, or both. Many imminent clinical trials will be looking at a lowered radiotherapy dose or at a radiation therapy alone option (without chemotherapy) for patients. The implications are significant in term of side effects and quality of life. Decreasing the radiation dose will have significant positive impact for patients. It will be crucial as these trials develop to make sure that the high cure rates for these patients are not compromised. HPV-related oropharynx cancer could be the equivalent of Hodgkin disease, for which radiation dose has been lowered significantly or even eliminated from treatment paradigms. Until this is studied in prospective, well-designed clinical trials, oncologists should continue to treat patients with the current standards and only use HPV status as a prognostic factor. Testing for HPV is rapidly becoming a standard approach with oropharynx cancer and in situ hybridization (ISH) appears to be the preferred method, even though a much simpler and more easily performed test (p16 immunohistochemistry) is likely to be as reliable as ISH.

    Finally, HPV vaccination is an important tool in fighting cervical cancer in women and undoubtedly will become a tool in the fight against oropharyngeal cancer. Clinical trials looking at expanding vaccination strategies to boys and girls will be crucial in this fight.

    1. Haddad RI, Shin DM. Recent advances in head and neck cancer. N Engl J Med. 2008;359(11):1143-1154.
    2. Gillison ML, Koch WM, Capone RB, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst. 2000;92(9):709-720.
    3. D’Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007;356(19):1944-1956.
    4. Gillison ML, Lowy DR. A causal role for human papillomavirus in head and neck cancer. Lancet. 2004;363(9420): 1488-1489.
    5. Chaturvedi AK, Engels EA, Anderson WF, Gillison ML. Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States. J Clin Oncol. 2008;26(4):612-619.
    6. Settle K, Posner MR, Schumaker LM, et al. Racial survival disparity in head and neck cancer results from low prevalence of human papillomavirus infection in black oropharyngeal cancer patients. Cancer Prev Res (Phila Pa). 2009 Jul 29 [Epub ahead of print].
    7. Fakhry C, Westra WH, Li S, et al. Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst. 2008;100(4):261-269.
    8. Lassen P, Eriksen JG, Hamilton-Dutoit S, et al. Effect of HPV-associated p16INK4A expression on response to radiotherapy and survival in squamous cell carcinoma of the head and neck. J Clin Oncol. 2009;27(12):1992-1998.
    9. Gillison ML, Harris J, Westra W, et al. Survival outcomes by tumor human papillomavirus (HPV) status in stage III-IV oropharyngeal cancer (OPC) in RTOG 0129. J Clin Oncol. 2009;27:15(suppl;abstr6003).

    Author disclosures: No relationships with industry were reported.

    October, 2009|Oral Cancer News|

    Port Coquitlam dentist hopes to save a life with a Velscope

    Source: www.bclocalnews.com
    Author: Diane Strandberg

    A Port Coquitlam dentist is offering to do more than fix cavities and polish teeth. Dr. Glenn Keryluk wants to save a life.

    He’s purchased an oral cancer screening device he expects will shortly become standard equipment in all dentist offices and he is offering to screen patients referred to by local doctors.

    “It’s the latest and greatest in cancer detection,” Keryluk says of the Velscope, a hand-held device that shines a blue light on oral lesions that could be cancerous.

    Manufactured by a White Rock-based company, the Velscope can show abnormal tissue below the surface, even before it becomes apparent to the clinicians’ eye. Healthy tissue glows green under the light but cancerous tissue looks black. Being able to detect oral cancer early is key to surviving the disease because the longer the cancer is around the more likely it will spread to nearby organs.

    Keryluk held a free screening day for patients at his office at 2099 Lougheed Highway recently and is cutting standard fees for the procedure or waving them entirely for people without dental coverage. The procedure is painless, takes only a few minutes and a photograph of the lesion taken by the machine can be sent to a physician for follow-up.

    “If you catch it early it could be that a person’s life is saved. I just want people to be aware of the technology out there,” Keryluk said.

    He’s only seen two cases of oral cancer in 20 years as a dentist but the Velscope may increase his chances of spotting the disease.

    Oral cancer is more common in men than women and age, tobacco use and heavy drinking are risks. But Keryluk said younger people have been diagnosed with oral cancer and the disease is on the rise. Human papillomavirus associated with cervical cancer has also been linked to oral cancer so it’s not just a disease of older people who drink and smoke.

    “The day I save somebody’s life for early detection, I’ll give you a call,” Keryluk said.

    September, 2009|Oral Cancer News|

    More evidence links alcohol, cancer in women

    Source: apnews.myway.com
    Author: staff

    A study of nearly 1.3 million British women offers yet more evidence that moderate alcohol consumption increases the risk of a handful of cancers. British researchers surveyed middle-aged women at breast cancer screening clinics about their drinking habits, and tracked their health for seven years.

    A quarter of the women reported no alcohol use. Nearly all the rest reported fewer than three drinks a day; the average was one drink a day. Researchers compared the lightest drinkers – two or fewer drinks a week – with people who drank more.

    Each extra drink per day increased the risk of breast, rectal and liver cancer, University of Oxford researchers reported Tuesday in the Journal of the National Cancer Institute. The type of alcohol – wine, beer or liquor – didn’t matter.

    That supports earlier research, but the new wrinkle: Alcohol consumption was linked to esophageal and oral cancers only when smokers drank.

    Also, moderate drinkers actually had a lower risk of thyroid cancer, non-Hodgkin’s lymphoma and renal cell cancer.

    For an individual woman, the overall alcohol risk is small. In developed countries, about 118 of every 1,000 women develop any of these cancers, and each extra daily drink added 11 breast cancers and four of the other types to that rate, the study found.

    But population-wide, 13 percent of those cancers in Britain may be attributable to alcohol, the researchers concluded.

    Moderate alcohol use has long been thought to be heart-healthy, something the new research doesn’t address but that prompts repeated debate about safe levels. U.S. health guidelines already recommend that women consume no more than one drink a day; two a day for men, who metabolize alcohol differently.

    “You have to balance all those things out,” said Dr. Philip J. Brooks, who researches alcohol and cancer at the National Institutes of Health. “This kind of information is important for people to know and to consult with their physician about the various risk factors they have.”

    February, 2009|Oral Cancer News|