oral sex

HPV is changing the face of head and neck cancers

Source: www.healio.com
Author: Christine Cona

A drastic increase in the number of HPV-associated oropharynx cancers, particularly those of the tonsil and base of tongue, has captured the attention of head and neck oncologists worldwide.

In February, at the Multidisciplinary Head and Neck Cancer Symposium in Chandler, Ariz., Maura Gillison, MD, PhD, professor and Jeg Coughlin Chair of Cancer Research at The Ohio State University in Columbus, presented data that showed that the proportion of all head and neck squamous cell cancers that were of the oropharynx — which are most commonly HPV-positive cancers — increased from 18% in 1973 to 32% in 2005.

9ea467bbf8646a69da2a432f8fcc5452Maura Gillison, MD, PhD, Jeg Coughlin Chair of Cancer Research at The Ohio State University, said screening for HPV in the head and neck is years behind cervical screening for HPV.


In addition, studies from the United States, Europe, Denmark and Australia indicate that HPV-positive patients have a more than twofold increased cancer survival than HPV-negative patients, according to Gillison.

With the rising incidence of HPV-related oropharynx cancers, it will soon be the predominant type of cancer in the oral or head and neck region, according to Andy Trotti, MD, director of radiation oncology clinical research, H. Lee Moffitt Cancer Center & Research Institute, in Tampa, Fla.

“We should be focusing on HPV-related oropharyngeal cancer because it will dominate the field of head and neck cancers for many years,” he said during an interview with HemOnc Today. “It is certainly an important population for which to continue to conduct research.”

Because HPV-associated oropharyngeal cancer is emerging as a distinct biological entity, the recent rise in incidence will significantly affect treatment, and prevention and screening techniques, essentially reshaping current clinical practice.

Social change driving incidence

In the analysis performed by Gillison and colleagues, trends demonstrated that change in the rates of head and neck cancers was largely due to birth cohort effects, meaning that one of the greatest determinants of risk was the year in which patients were born.

The increased incidence of HPV-related oropharyngeal squamous cell carcinoma started to occur in birth cohorts born after 1935, indicating that people who were aged in their teens and twenties in the 1960s were demonstrating increased incidence, Gillison said.

“Two important and probably related events happened in the 1960s. In 1964, the surgeon general published a report citing smoking as a risk factor for lung cancer, and public health policy began promoting smoking cessation along with encouragement not to start smoking,” she told HemOnc Today.

If you were 40 years old between 2000 and 2005, your risk for having HPV-related cancer is more than someone who was between the age of 40 and 45 years in 1970, according to Gillison. Social changes that occurred among people born after 1935, for example, a reduction in the number of smokers, is consistent with the increasing proportion of oropharyngeal cancers that were HPV-related.

“The rates for HPV-related cancers began to increase and the rates for HPV-unrelated cancers started to decline, consistent with the known decline in tobacco use in the U.S. population,” she said.

Now, most cases of head and neck squamous cell carcinoma in non-smokers are HPV-related; however, oral HPV infection is common and is a cause of oropharyngeal cancer in both smokers and non-smokers, research shows.

In addition to a decrease in tobacco use reducing HPV-unrelated oral cavity cancers, the number of sexual partners may have increased during this time and have helped to increase HPV-related oropharyngeal cancers, according to Gillison.

Determining the cause of the elevated incidence is only a small piece of the puzzle. Screening, establishing who is at risk, and weighing vaccination and treatment options are all relevant issues that must be addressed.

Screening is problematic

A critical area for examination and research is the issue of screening for oral cancers. In contrast to cervical cancer, there is no accepted screening that has been shown to reduce incidence or death from oropharyngeal cancer, according to Gillison.

Not many studies have examined the issue of screening for HPV-unrelated oral cancers, and the few that have, tend to include design flaws.

Gillison said there is a hope that dentists would examine the oral cavity and palpate the lymph nodes in the neck as a front-line screen for oral cancer; however, in her experience, and from her perspective as a scientist, this has never been shown to provide benefit for oral cancer as a whole.

Another caveat with regard to HPV detection is that head and neck HPV screening is about 20 years behind the cervical field.

“Clinicians screening for HPV in the field of gynecology were incredibly fortunate because Pap smear screening was already an accepted cervical cancer screening method before HPV was even identified,” she said. “There was already a treatment algorithm: If there were cytologic abnormalities, patients were referred to the gynecologist, who in turn did a colposcopy and biopsy.”

A similar infrastructure does not exist for oropharyngeal cancer. People with HPV16 oral infection are at a 15-fold higher risk for oropharynx cancer and a 50-fold increased risk for HPV-positive head and neck cancer, yet there is no algorithm for treatment and management of these at-risk individuals, Gillison said.

In 2007, WHO said there was sufficient evidence to conclude that HPV16 was the cause of oropharynx cancer, but with no clinical algorithm already established, progress in this area is much further behind.

Another problematic aspect of HPV-related oropharyngeal cancer screening is that the site where the cancer arises is not accessible to a brush sampling, according to Gillison.

“To try to find this incredibly small lesion in the submucosal area that you cannot see and cannot get access to with a brush, highlights that we need to develop new techniques, new technologies and new approaches,” she said.

The near future consists of establishing the actual rates of infection in the oral cavity and oropharynx, and then screening for early diagnosis, according to Erich Madison Sturgis, MD, MPH, associate professor in the department of head and neck surgery and the department of epidemiology at The University of Texas M.D. Anderson Cancer Center.

“I am not extremely hopeful because the oropharyngeal anatomy makes screening complicated, and these cancers likely begin in small areas within the tonsils and the base of the tongue,” Sturgis told HemOnc Today. “I am hopeful, however, that preventive vaccines will eventually, at a population level, start to prevent these cancers by helping people avoid initial infection by immunity through vaccination earlier in life.”

Much of the currently known information surrounding the issue of HPV-related oral cancers is new, so researchers continue to conduct research in various relevant areas. One key question to answer is who may be at higher risk for HPV-related oropharynx cancers.

Who is at risk?

As mentioned earlier, the number of oral sex partners seems to play a role in the risk for contracting the HPV virus.

In one study published in The New England Journal of Medicine in 2007, findings demonstrated that a high lifetime number of oral sex partners (at least six partners) was associated with an increased risk for oropharyngeal cancer (OR=3.4; 95% CI, 1.3-8.8).

In addition to a higher number of oral sex partners, other still unknown factors may be contributing to risk. This is an area that needs further research, according to Barbara Burtness, MD, chief of head and neck oncology, and professor of medical oncology at Fox Chase Cancer Center in Philadelphia.

The effect of smoking status is another area that needs further research. According to Burtness, smokers with HPV-associated oropharynx cancer have less favorable outcomes.

When discussing the prognosis of HPV-associated cancers, Sturgis said low risk is defined as low or no tobacco exposure and positive HPV status, and intermediate risk is defined as significant tobacco exposure but an HPV-positive tumor, and the highest risk group appears to be the HPV-negative group.

Although HPV-negative cancers are overwhelmingly tobacco-related cancers and tend to have multiple mutations, it appears that HPV-positive cancers, particularly those in patients with low tobacco and alcohol exposure, tend to lack mutations and to have a better prognosis, and this may ultimately help to guide treatment practices, according to Sturgis. Yet, there is still much to learn about HPV-related oropharyngeal cancers on various fronts.

Vaccination a hopeful ally

In HPV-related head and neck cancer, particularly oropharynx cancers, more than 90% of patients who have an HPV-type DNA identified, have type 16, according to Sturgis.

The two current HPV vaccines, Gardasil (Merck) and Cervarix (GlaxoSmithKline), which are approved for cervical cancers, include HPV types 16 and 18; therefore, in theory, they should be protective against the development of infections in the oropharynx and protective at preventing these HPV-associated cancers from occurring.

The presumption is that if there was a population-wide vaccination against HPV, there would be less person-to-person transmission, and this would lead to fewer oropharynx cancers, according to Burtness, who said this theory still needs further research.

There is excitement at the possibility that therapeutic vaccines could be developed, and various groups are investigating this, Burtness added.

“There is reason to think that the vaccines may be helpful; however, when HPV infects the tonsillar tissues, it exerts control in the host cells by making two proteins: E6 and E7; so another potentially exciting therapeutic avenue would be to target those specific viral proteins,” she told HemOnc Today.

Anxiety about protection from the HPV virus is palpable, according to Sturgis. He described the worry that many patients experience about contracting and transmitting HPV infection.

“Many patients are concerned they will put their spouses and/or children at risk in ways such as kissing them; and we need to tone down those worries until we have better data,” he said.

Screening and vaccination are fundamental aspects of current ongoing research, but of equal importance is determining what clinicians should do to treat a population of patients with HPV-related oropharyngeal cancers.

HPV status may influence treatment

With rates of HPV-related cancers escalating, determining the appropriate treatment for these patients is crucial.

During the past 10 years, findings from retrospective studies have shown that patients with HPV-related cancers have a much better prognosis than patients who test negative for HPV. Findings from several retrospective analyses from clinical trials conducted during the past 2 years have come to the same conclusion, according to Gillison: HPV-positive patients have half the risk for death compared with patients negative for HPV.

Therefore, there may be several alternative treatment options, including the possibility of reducing the dose of radiation given to patients after chemotherapy, thereby reducing toxicity.

Comparing HPV-negative and HPV-positive patients may not be enough to determine proper treatment, researchers said. Data between different cohorts of HPV-positive patients also needs to be examined. Smoking, for example, may play a role in patient outcome.

In a prospective Radiation Therapy Oncology Group clinical trial (RTOG 0129), presented by Gillison at the 2009 ASCO Annual Meeting and recently published in The New England Journal of Medicine (see page 53), researchers conducted a subanalysis of the effect of smoking on outcome in uniformly staged and treated HPV-positive and HPV-negative patients while accounting for a number of potential confounders. HPV-positive patients who were never smokers had a 3-year OS of 93% compared with heavy smoking HPV-negative patients who had an OS of 46%.

The study found that smoking was independently associated with OS and PFS. Patients had a 1% increased risk for death and cancer relapse for each additional pack-year of smoking. This risk was evident in both HPV-positive and HPV-negative patients. Gillison said smoking data must be paid attention to, and she encouraged cooperative group research on the topic.

Most of the findings demonstrate improved outcomes for patients with HPV-positive oropharyngeal cancers vs. patients with HPV-negative oropharyngeal cancers, according to the experts interviewed by HemOnc Today.

Dose de-intensification for less toxicity

To date, there is no evidence that HPV-related cancers should be managed differently than HPV-unrelated cancers, but it is a hot topic among clinicians in the field, according to Burtness.

The superior outcomes for HPV-associated oropharynx cancer have suggested the possibility of treatment de-intensification. The use of effective induction chemotherapy may permit definitive treatment with a lower total radiation dose. In theory, this would reduce the severity of late toxic effects of radiation, such as swallowing dysfunction. Such a trial is being conducted by the Eastern Cooperative Oncology Group. Burtness said this is currently pure research question.

“There is still much research that needs to be done before clinicians can safely reduce the dose of radiation administered to HPV-positive patients,” Burtness said.

Currently, she and colleagues in the ECOG are conducting a study of patients with HPV-associated stage III or IV oropharynx cancers to examine the possibility of tailoring therapy to these patients. Patients are assigned to one of two groups: low-dose intensity-modulated radiotherapy 5 days per week for 5 weeks (27 fractions) plus IV cetuximab (Erbitux, ImClone) once weekly for 6 weeks, or standard-dose intensity-modulated radiotherapy 5 days per week for 6 weeks (33 fractions) plus IV cetuximab once weekly for 7 weeks.

If patients have a very good clinical response to chemotherapy, which is likely to happen with HPV-associated cancers, they are eligible to receive a reduced dose of radiation, and hopefully, they would experience less adverse effects, Burtness said.

“Patients who are treated with the full course of radiation for head and neck cancer are now getting 70 Gy, and they are often left with dry mouth, and speech and swallowing difficulty,” she said. “We are hopeful that if these particular cancers are treatment responsive to chemotherapy, we may be able to spare the patient the last 14 Gy of radiation.”

Immunotherapy a viable treatment

Another possible treatment technique that may benefit patients with HPV-related cancers is immunotherapy. One form of immunotherapy uses lymphocytes collected from the patient, and training the cells in the laboratory to recognize in this case a virus that is associated with a tumor and consequently attack it. This approach potentially may be used to treat HPV-related oropharynx cancers, according to Carlos A. Ramos, MD, assistant professor at the Center for Cell and Gene Therapy at Baylor College of Medicine, Houston.

“With some infections that lead to cancer, even though the virus is present in the tumor cells, the proteins shown to the immune system are limited; therefore, they do not drive a very strong immune response,” Ramos told HemOnc Today. “Training the immune system cells, T lymphocytes, may make them respond better to antigens.”

Data from ongoing trials that are taking T lymphocytes from patients and educating them to recognize antigens in patients with the Epstein-Barr virus associated tumors have shown some activity against them, according to Ramos. This adoptive transfer appears to be safe and may have the same effect on the HPV virus associated tumors. Immunotherapy does not cause the usual toxicities associated with chemotherapy, he said.

“There are currently no trials showing whether we can prevent more recurrences with this approach, but the results of trials examining viruses such as Epstein-Barr are good so far, in both patients who have no evidence of disease and in those who still have disease,” he said.

Even patients with active disease who have not responded to other therapies have responded to this therapy, Ramos said. He and colleagues are working toward compiling preclinical data to study the possibility of using immunotherapy to treat patients with HPV-related cancers.

Journey is just beginning

Much of what is known about risk, screening, prevention and treatment of HPV-related oropharynx cancers is in the early stages of discovery and much is still theoretical, according to Sturgis.

“As far as we can tell, these infections are transmitted sexually; the hope is that as we have better vaccines for prevention of cervical dysplasia, the downstream effect will help prevent other HPV-related cancers, such as anal cancers and penile cancers and oropharyngeal cancers,” he said.

Several recent studies examining new therapies that may reduce the intensity of traditional treatments while maintaining survival rates would have a major effect on the field, according to Sturgis.

Gillison said the rise in the number of cases of HPV-related cancers is changing the patient population considered to be at risk, and more research is vital.

“The most important thing for clinicians to do is be aware that trials are being developed and strongly encourage their patients to participate,” she said.  Christen Cona

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

June, 2016|Oral Cancer News|

A cancer on the rise, and the vaccine too late for Gen X

Source: www.cnn.com
Author: Martha Shade

(CNN)The vaccine given to prevent cervical cancer in women could end up saving men’s lives, too.

Evidence is mounting that the HPV vaccine is also effective in preventing other HPV-related cancers, including those of the head and neck. Although most people who get HPV do not develop cancer, rates of HPV-related head and neck cancers are dramatically rising for men aged 40 to 50, according to Dr. Maura L. Gillison, the Jeg Coughlin Chair of Cancer Research at the Ohio State University Comprehensive Cancer Center.

When Gillison recently gave a presentation showing the increasing rate of HPV-related head and neck cancer among men, her audience was shocked. “I’ve never shown a slide where the audience gasps,” she said.

Related: Yes, oral sex can lead to cancer

“The risk of getting this cancer is strongly related to when you were born. If you are currently a 40- to 45-year-old man, your risk of getting this cancer is dramatically higher than a 40- to 45-year-old man three or four decades ago,” Gillison said.

Today’s 40- to 50-year-old men have had more sexual partners and have engaged in more oral sex than previous generations, according to experts, significantly raising their risk of an HPV-related head and neck cancer.

Actor Michael Douglas made headlines in 2013 when he announced he was battling an HPV-related cancer and that he got it from performing oral sex. Douglas was 68 when he was diagnosed, but many of the men being diagnosed with these HPV-related cancers are much younger.

What’s a Gen X’er to do?

HPV is usually acquired when young. It can lay dormant, and most oropharyngeal cancer (a type of head and neck cancer) is diagnosed decades later, beginning around age 40 to 50. And the more partners you have, the greater your risk.

HPV vaccines weren’t recommended and approved in the United States until 2006. And the vaccine was not even recommended for boys until 2011.

So what’s an aging Gen X’er to do?

“You’re starting to get colonoscopies; you’re starting to get checked for prostate cancer. This is one more thing to add to that list that you really have to watch for,” said Brian Hill, founder of the Oral Cancer Foundation.

Warning signs of HPV-related head and neck cancer

• Persistent lump on neck

• Persistent earache on one side

• Swelling or lump in the mouth

• Chronic sore throat

• Difficult or painful swallowing

• Change in voice

Source: Oral Cancer Foundation, Dr. Carole Fakhry

Symptoms of HPV-related head and neck cancer include a change in voice, a sore throat that doesn’t go away, an earache on one side and difficult or painful swallowing.

Hill’s story is typical: His doctors initially assumed he had an enlarged lymph node due to an infection. Two doctors gave him antibiotics before he was diagnosed with late-stage oropharyngeal cancer. His experience led him to form the Oral Cancer Foundation.

Finding the disease at an early stage is lifesaving. When it’s diagnosed early, these HPV-related cancers are survivable, according to Dr. Carole Fakhry of the Johns Hopkins Head & Neck Cancer Center. “If you have a lump in your neck, make sure to get checked.

“A very common story is: ‘I was shaving and I noticed this lump in my neck,” she said. “And he goes through two or three rounds of antibiotics and then someone finally thinks about cancer.”

‘Dental hygienists are becoming the best screeners’

Traditionally, cancers of the head and neck were often linked to alcohol or smoking, and these non-HPV cancers tend to be located at the front of the mouth and the voice box. Incidence of these cancers are dropping.

“The truth of the matter is that smoking-related cancers are declining,” Fakhry said. “On the other hand, cancers related to HPV are increasing.”

HPV-related cancers usually originate in the back of the mouth. “Most of these cancers are tonsils and back-of-tongue cancers,” she said. “Tonsils are basically these crypts, and tumors grow deep within these crypts, so these tumors can be hard to find.”

Since tumors are often hidden, dentists and dental hygienists are becoming the first line of attack. Men may also be more likely to visit a dentist regularly than a doctor, according to Hill.

“Dental hygienists are becoming the best screeners for this. They’re becoming the point at the end of the spear when it comes to screening and finding abnormalities,” he said.

Dentists and hygienists are encouraged to look for telltale signs of HPV-related cancer: asymmetrical or swollen tonsils, or a lesion in the back of the throat. But these cancers are notoriously tough to spot and tend to be diagnosed after patients develop a lump in the neck.

So what can you do?

“Make sure you get your kids vaccinated (for HPV),” Fakhry said.

Dr. Dan Beachler, lead author of a new study that found further evidence the HPV vaccine protects against multiple types of HPV-related cancers, agrees: “We still don’t know that much about oral HPV. Primary prevention through vaccination might have the most potential.”

Besides the cervix and the head and neck, some strains of HPV can also lead to cancer of the anus, penis and vulva.

A preventive HPV vaccine is most effective when given to children before they become exposed to HPV. The three dose series is recommended at age 11 or 12.

Initially recommended just for girls, the Centers for Disease Control and Prevention now recommends that boys be vaccinated, too. In addition, vaccination is recommended through the age of 26 in women and through age 21 in men who were not vaccinated previously.

“Young people do not avoid oral sex. That being a given, the best thing we can do is increase the vaccination rate. The second thing we can do is be highly aware of signs and symptoms,” Hill said.

And don’t panic. Although HPV-related cancers are on the rise, they’re still uncommon.

“Even though the rates are dramatically increasing, it’s still a relatively rare cancer. We don’t want to create a panic. We just want to raise awareness,” Gillison said.

Professor Harald zur Hausen: Nobel scientist calls for HPV vaccination for boys

Source: www.independent.co.uk
Author: Charlie Cooper & Gloria Nakajubi

The UK should vaccinate all boys against the cancer-causing human papilloma virus (HPV), the Nobel Prize-winning scientist who discovered the link between HPV and cancer has said.

Professor Harald zur Hausen, the German virologist whose theory that HPV could be a cause of cervical cancers led to global efforts to vaccinate girls against the virus, said that boys should also be protected.

There is now a wealth of evidence that HPV also causes cancers in men, including anal, penile and throat cancer. Professor zur Hausen added that there was now a chance to “eradicate” HPV viruses altogether if the world developed global vaccination programmes for all children.

Since 2008 the UK has offered free vaccinations against HPV to girls aged 12 to 13 – a programme that had an almost 87 per cent uptake from 2013 to 2014 and has led to falls in the number of pre-cancerous abnormalities of the cervix, according to research carried out among vaccinated girls in Scotland.


Vaccine authorities in the UK, traditionally an international leader in the field of immunisation, are yet to make a judgement on a publicly funded vaccination programme for boys, which would follow in the wake of those already in place in Australia, Austria, Israel and parts of Canada.

HPV is the name for a common group of viruses that can affect the moist membranes of the cervix, anus, mouth and throat. It is usually spread through sexual contact.

Most sexually active people will contract it in their lifetime but usually it causes no ill-effects. However, in some cases it causes changes to cells, which can become cancerous. It is the cause of almost all cases of cervical cancer, a discovery made by Professor zur Hausen in the 1970s, for which he won the Nobel Prize in physiology or medicine in 2008.

Speaking to HPV Action, in an interview to be published by the campaign group this week, Professor zur Hausen said that vaccinating boys was of “the utmost importance”, not only because boys can also contract HPV-related cancers of the throat, anus and penis, but because protecting boys is key to ending transmission of the virus altogether.

“The vaccination programme for girls [in the UK] is marvellous – it reaches a very high proportion,” he said. “In my opinion, the vaccination of boys is also of the utmost importance because virus transmission is due to male partners and men are affected by oropharyngeal [cancers of the throat], anal and penile cancers as well as genital warts.”

Last year the UK’s vaccination authority, the Joint Committee on Vaccination and Immunisation (JCVI), recommended that the UK introduce a vaccination programme for gay men, to be delivered via sexual health clinics. The rationale behind the recommendation is that heterosexual men will be protected from HPV infection because most women will have been immunised, but that men who have sex with men will miss out on “herd immunity”.

However, campaigners and some experts say this reasoning is flawed, as many gay men will have been sexually active before their first visit to a sexual health clinic, and would most likely have already contracted or transmitted the virus.

The JCVI is due to consider the cost-effectiveness of vaccination for boys but campaigners do not anticipate any decision until 2017.

However, the NHS in London is currently planning what would be the first pilot of routine HPV vaccination for boys, with a likely start date of February 2016. The “field test” will work across four sites to establish whether school-age young males would “embrace the uptake of HPV vaccination as part of a community programme”, NHS England’s London office said.

Rolling out the vaccine to boys would require a public-information campaign because it has previously been presented to parents and children as a girls-only jab to prevent cervical cancer.

Scientists say changes in sexual behaviour – with more couples having oral and anal sex – may be the cause of increased cases of anal and throat cancers in both men and women in recent decades.

Margaret Stanley, emeritus professor at the University of Cambridge and a leading expert on HPV, said that cases could continue to rise. “It’s very much under-thirties [having more anal and oral sex] so you can predict there will be a rise in both those cancers. It’s a time bomb,” she said. “Wider exposure to different sexual practices – in other words porn on the internet – is also changing sexual behaviour in teenagers.”

HPV is also the cause of genital warts, the second-most common sexually transmitted infection in the UK. There are nearly 90,000 cases annually, costing the NHS around £55m. Campaigners hope that figure will be taken into account when the JCVI weighs up the cost-effectiveness of a vaccination programme.

Despite safety concerns being raised about the vaccine’s alleged side effects in some parts of the world, including Japan, no causal links have been established between the vaccine and reported long-term health problems. It is approved by the World Health Organisation, as well as European and UK vaccine-safety authorities. Professor zur Hausen added that it was “one of the safest vaccines we have”.

8-Injection-GetRolling out the vaccine to boys would require a public-information campaign because it has previously been presented to parents and children as a girls-only jab to prevent cervical cancer (Getty)


A Department of Health spokesperson said: “The HPV-prevention programme is key in helping us prevent cervical cancer. We have successfully given more than a million doses in the UK since 2008.

“Our independent vaccination experts are assessing whether it should be extended to prevent cancers in adolescent boys, men who have sex with men, or both.”

Time for an update?

Parents are currently advised and asked for consent for their daughters to have the HPV vaccination through a form and information leaflet sent out via schools.

The vaccine’s preventative effects against cervical cancer and the protection it offers against genital warts are explained. The protection against other cancers is not mentioned.

Parents and children are told that the vaccine, which is now given in just two doses instead of three, protects against 70 per cent of cervical cancers and that girls will still require cervical screening tests when they are older. Newer versions of the vaccine may protect against more cases in the future.

Parents are told that the vaccine may cause “soreness, swelling and redness in the arm” that will wear off in a couple of days. The leaflet states that “more serious side effects are extremely rare” and reassures parents that it meets European and UK safety standards. However, parents have the option to deny permission for their daughters to have the jab – and are told it would be “helpful” if they gave reasons for refusal.

The leaflet is directly targeted at girls and their parents and focuses on cervical cancer. If the Government were to extend the HPV-vaccination programme to boys, they would have to reconsider how the vaccine was presented to parents and children. The current programme has had impressive uptake, possibly in part because the key reason for taking the vaccine – to prevent cervical cancer – is straightforward and well understood. It may be that in a new HPV vaccination programme, the jab could be presented more broadly as protection against “a range of cancers”.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Head and neck cancer on rise in young men

Source: www.healthcanal.com
Author: staff

“The head and neck cancers we have found in younger men with no known risk factors such as smoking are very frequently associated with the same HPV virus that causes cervical cancer in women.” said Kerstin Stenson, MD, a head and neck cancer surgeon at Rush and a professor of otolaryngology at Rush University. The cancer develops from an HPV infection, likely acquired several years earlier from oral sex.

“Men are more susceptible to these cancers because they don’t seem to have the same immune response as women and do not shed the virus like women do,” Stenson said.

‘Epidemic proportions’
According to the Centers for Disease Control and Prevention, cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils) are usually caused by tobacco and alcohol, but recent studies show that about 72 percent of oropharyngeal cancers are caused by HPV.

“There has been significant change in the last decade. Overall, head and neck cancers account for approximately 3 to 5 percent of all cancers, but what’s changed in the past decade is the HPV-associated oropharyngeal cancer. It has reached epidemic proportions,” said Stenson.

The American Cancer Society estimates that 45,780 Americans will be diagnosed with cancer of the oral cavity and oropharynx in 2015. If this trend continues, the number of cases of HPV-positive oropharyngeal cancer will surpass the number of cervical cancer cases.

Early detection is key
The current vaccine has been shown to decrease the incidence of HPV-associated cervical infections and cancer. While the same result is anticipated for HPV-associated head and neck cancer, the impact of vaccines on incidence of persistent oral HPV infection and/or HPV associated oropharyngeal cancer has not yet been investigated. We will need about 10-30 more years to see the anticipated effect of the vaccine on HPV-related cancers that could affect people who are now teenagers. Still, head and neck surgeons, medical oncologists and other researchers strongly advocate vaccination of both girls and boys to help prevent all HPV-associated cancers.

“For all individuals, the key is in early detection, as with any cancer,” Stenson said.

In addition to being vaccinated, Stenson stresses the importance of regular visits to the dentist. “Dentists play a key role in detecting oral cancer. You might not see a primary care physician even once a year, but most people see their dentist twice a year. Having regular dental visits can help catch cancers early to help ensure the best outcome.”

The American Dental Association states that 60 percent of the U.S. population sees a dentist every year.

Oral cancer warning signs
The Oral Cancer Foundation presumes that cancer screenings of the existing patient population would yield tens of thousands of opportunities to catch oral cancer in its early stages.

“There is much that can be done for those who are diagnosed with head and neck cancer. Since early detection and treatment is critical, it’s important to see your dentist regularly and to promptly see a medical professional if there are any warnings signs,” Stenson advised. Strategies to improve public awareness and knowledge of signs, symptoms, and risk factors are critical topics for study and may decrease the disease burden of head and neck cancers.

Possible warning signs of oral cancer may include difficulty swallowing, pain when chewing, a white patch anywhere on the inside of your mouth, a lump or sore in the mouth or on the lip that does not heal.

If you notice any of these symptoms, ask your dentist or doctor about it.

Treatment includes surgery for early or low-volume late stage lesions and radiation or chemoradiation for more advanced cancers.

March, 2015|Oral Cancer News|

Cannabinoids may offer hope for patients with oral cancer pain

Source: www.elements4health.com

Even the strongest available pain medications are largely ineffective for many cancer patients, particularly those with oral cancers. One of the nation’s leading oral cancer treating clinicians, speaking at the American Pain Society’s annual meeting, said he believes that while prospects for major treatment advances remain bleak, a new cannabinoid-based medication may have some promise for providing meaningful pain relief.

Brian Schmidt, DDS, MD, PhD, professor, New York University College of Dentistry and School of Medicine, delivered the Global Year Against Pain Lecture and reported that today, more than 100 years since President Ulysses S. Grant died from oral cancer, there is only modest improvement in patient survival. Grant is the only American president to die from cancer.

“Oral cancer is one of the most painful and debilitating of all malignancies,” said Schmidt, “ and opioids, the strongest pain medications we have, are an imperfect solution. They become dramatically less effective as tolerance to these drugs develops.”

Now considered to be the fastest increasing cancer in the United States, oral and oropharyngeal malignancies usually begin in the tongue. Human papillomavirus transmitted through oral sex, tobacco use and excessive alcohol consumption are the leading causes of this increase in oropharyngeal cancer. In the United States, some 43,000 new cases of oral cancer are diagnosed every year and the disease is more widespread worldwide with 640,000 new cases a year.

Schmidt said oral cancer patients often undergo multiple surgeries as tumors recur and also are treated with radiation and chemotherapy. The disease is difficult to diagnose at early stages and spreads quickly, leaving patients in gruesome pain and unable to speak or swallow. “Our inability to effectively treat oral cancer stems from lack of knowledge. We know that cancer pain is caused by a unique biological mechanism, but more research is needed to develop medications that are effective in treating oral cancer pain,” Schmidt said.

“The only way we can hope to reduce the devastating impact of oral cancer pain is to fund more research to help those who suffer or will suffer from this ruthless disease,” Schmidt told the APS audience. He added that half of oral cancer patients do not survive five years after diagnosis.

Schmidt noted that perhaps some good news is on the horizon, as clinical trials proceed for a drug produced directly from a marijuana plants (Sativex). It is administered as an oral spray and shows promise for treating cancer pain. The drug is available in Canada and Europe for treating spasticity from multiple sclerosis and is in Phase 3 clinical trials in the United States for treatment of cancer pain. Schmidt is a clinical investigator for Sativex trials.

“While it’s too early to conclude the cannabinoid medication will provide effective cancer pain relief, we do know that humans possess numerous cannabinoid receptors in the brain and body which regulate a significant amount of human physiology. So, there is hope that cannabinoid-based medications can become effective pain relievers for cancer patients.”

Katie Couric show on HPV vaccine sparks backlash

Source: CBS News
Published: Thursday, January 5, 2013
By: Ryan Jaslow


Katie Couric’s talk show “Katie” has drawn ire from doctors and journalists for a recent segment on the HPV vaccine that presented what it called “both sides” of the “HPV controversy.”

The segment included personal stories from two moms who claim their daughters suffered serious harm from the vaccine (one of them died). In addition, the show featured two physicians: one who researched the vaccine and thinks its long-term protection benefits are oversold, and one who recommends it to her patients, in line with recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

Ahead of the show, which aired Dec. 4, Couric tweeted:

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Dr. Arthur Caplan, director of the division of medical ethics at NYU Langone Medical Center in New York City, did not feel it was appropriate to juxtapose the anecdotal stories with the medical evidence. He had hoped more weight would be given to the scientific evidence of the vaccine’s safety profile and effectiveness at preventing cervical cancer.

“The show was kind of inexcusable in terms of damage done versus positive contribution,” he told CBS News.

Any time you’re vaccinating hundreds of thousands of people, Caplan said, you can expect that some people in that population will have health incidents occur. But their ailments may not necessarily be connected to the vaccine. What needs to be weighed is the cause and effect, versus what may be just coincidence. Mentioning such incidents in that context would have been one thing, but giving them more air-time than the bevy of evidence about safety and efficacy is another.

“The problem in TV and all media, (is) the human interest drives the story,” said Caplan. “In science and public health, it doesn’t, or it’s at risk of grave harm.”

“If you want to do a show every day that spotlights anecdotal claims about the health effects of cell phones or curative powers of megavitamins or dangers of airplane contrail vapors, you can certainly fill up lots of programming,” said added. “But I don’t think you’re doing anyone a service.”

While the show has certainly sparked debate, what’s not debatable is that HPV is a significant factor in cancer cases in the United States.

Human papillomavirus, or HPV, is an infection that is so common that it will occur in virtually all sexually-active people at one point or another. About 79 million Americans are currently infected with HPV, according to federal estimates.

There are more than 150 related viruses that make up HPV, but about 40 can be transmitted sexually, and some play a bigger role in causing genital warts while others increase risk for cancers of the cervix, anus, oropharynx (throat and back of the tongue), vulva, vagina and penis.

About 90 percent of genital warts are caused by the HPV 6 and 11 strains, while the majority of cancers related to the infection — about 70 percent — are caused by strains 16 and 18.

But most people won’t have a problem. The CDC points out 90 percent of all HPV infections, including the cancer-causing strains, will be cleared or undetectable in two years without any treatment, with many leaving the body within six months due natural immunity.

It’s the ones that don’t clear that are worrisome. Virtually all cervical cancer cases each year – there are 12,340 new ones expected in 2013 — are caused by high-risk strains of HPV, according to the National Cancer Institute.

Rates of oropharyngeal cancer have soared in recent years, studies have found, and HPV from oral sex is thought to be to blame, as Michael Douglas spotlighted in June by disclosing his throat cancer was caused by the infection.

That’s where vaccines aim to help, by preventing HPV in the first place. The two approved vaccines are Cervarix, which prevents HPV types 16 and 18, and Gardasil, which prevents HPV 16 and 18 as well as the genital-wart causing HPV 6 and 11 strains.

Both vaccines are given in three doses over a six-month period, recommended for females aged 13 through 26, and males between 13 and 21 years old.

“The vaccines that are available right now are one of our only protections against HPV,” Dr. Nieca Goldberg, director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center, told CBS News in June.

A CDC study in June reported rates of HPV strains related to genital warts and some cancers have dropped 56 percent among American teen girls since a vaccine was introduced in 2006, from 11.5 percent of 19-year-olds infected before the vaccine was introduced, to 5 percent by 2010.

Dr. Diane Harper, chair of family medicine at the University of Louisville who researched the vaccine, told Couric that the vaccine’s protection wears off after five years, so men and women could still be at risk for HPV down the road.

The CDC, however, says studies with up to six years of follow-up data have found no evidence of waning effectiveness from the vaccine, a point Caplan also emphasized. One study found even one dose was 82 percent effective, though all three doses are recommended.

The CDC adds that if 80 percent of teens got all three doses of the vaccine, an estimated 53,000 additional cases of cervical cancer could be prevented over the lifetimes of girls aged 12 and older. For every year that increases in coverage are delayed, another 4,400 women will go on to develop the disease.

That’s not to that say the HPV vaccine, or any vaccine, can’t cause side effects.

The CDC’s Vaccine Adverse Event Reporting System (VAERS) has received at least 22,000 reports of adverse events in girls and women who got the vaccine between June 2006 through March 2013. Over this time, about 57 million doses of the vaccine were distributed in the United States.

Ninety-two percent of the reported side effects were considered nonserious. They included injection-site pain and swelling, fainting, dizziness, nausea, headache, fever and hives.

The other almost 8 percent of serious side effects included headache, nausea, vomiting, fatigue, dizziness, fainting and generalized weakness.

“Editors, producers want a face,” said Caplan. “Public health wants data, statistics, and boring compilations.”

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.






December, 2013|Oral Cancer News|

Michael Douglas: ‘Throat cancer’ was really tongue cancer

Source: cnn.com
Author: Jen Christensen, CNN

Michael Douglas never had throat cancer, as he told the press in 2010.

The actor now says he had tongue cancer. Douglas said he hid the diagnosis at the urging of his doctor to protect his career.

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“The surgeon said, ‘Let’s just say it’s throat cancer,’ ” Douglas told fellow actor Samuel L. Jackson for a segment that ran on British television as a part of Male Cancer Awareness Week.

Douglas says that the doctor told him if they had to do surgery for tongue cancer, “it’s not going to be pretty. You could lose part of your tongue and jaw.”

When Douglas first talked about his cancer diagnosis in the summer of 2010, he was on a worldwide publicity tour for the movie “Wall Street: Money Never Sleeps.”

Douglas and Jackson joked that could have been the end of his acting career. Douglas said if he had surgery he could see the director saying, “What’s your good side? I’ve got no side over here.”

“There really is no such thing as throat cancer per se,” explained Brian Hill, an oral cancer survivor and the founder of the Oral Cancer Foundation. Douglas has taped a public service announcement to raise awareness about oral cancer for Hill’s foundation.

“Throat” cancer and tongue cancer are both colloquial terms that fall under the oral cancer umbrella. Throat cancer usually refers to cancerous tumors that develop in your pharynx, voice box or tonsils. Tongue cancer refers to cancerous cells that develop on your tongue.

“The treatment up until just recently can be very brutal,” Hill said of tongue cancer. “Your career as a leading man could be over. If you have signed a contract to promote a movie, you would have a strong motivation not to say … ‘Maybe in six months I won’t have a tongue or lower jaw.’ ”

Douglas apparently did not need the potentially disfiguring surgery. He told Jackson he was instead treated with an aggressive form of radiation and chemotherapy. The treatment, he said, lasted five months.

In June, Douglas kicked off an animated conversation about the cause of oral cancer when he told The Guardian that he got throat cancer after engaging in oral sex. Oral sex can expose individuals to the human papilloma virus, which can cause cancer.

Later, Douglas’ publicist told CNN that Douglas did not blame HPV solely for his cancer; Douglas said he was also a smoker and a drinker. Smoking and drinking, particularly when combined, are considered the most significant contributing factors to oral cancer, according to the Centers for Disease Control and Prevention. So is Douglas’ gender. Men are twice as likely to develop oral cancer as women.

Oral cancers account for 2% to 4% of all cancer diagnoses in the United States. An oral cancer diagnosis is particularly serious; only half of the people diagnosed with oral cancer are still alive after five years, according to the CDC. In large part, that’s because of the late diagnoses of this disease. Most signs of this cancer are difficult to detect and are often painless.

Douglas told Jackson that initially his doctors treated him with antibiotics. Douglas had been complaining of a soreness at the back of his teeth. Three months later when it still hurt, the doctor gave him another round of antibiotics. Nine months later, after talking to a friend who was a cancer survivor, he went to the oncology department where a doctor did an initial exam and then a biopsy. He was diagnosed with stage four oral cancer in 2010.

Douglas is not the first celebrity to misidentify the kind of cancer they have.

Actress Valerie Harper, who first came to fame on the TV show “Mary Tyler Moore,” announced her cancer on the cover of People magazine in March. The story said she had little time left to live and was suffering from terminal brain cancer. It turns out the “Dancing With the Stars” celebrity actually had lung cancer that had spread to the lining of her brain.

“I see a lot of people with ‘brain cancer’ who actually have… lung cancer or breast cancer or some other cancer (that spread) to the brain,” Dr. Otis Brawley, the American Cancer Society’s chief medical and science officer, told CNN. “We treat cancer according to its origin.”

Harper’s kind of cancer, leptomeningeal carcinomatosis, can be slowed but the cells are adaptable and can develop a resistance to treatment. A complete remission is unlikely.

Douglas, on the other hand, has had regular check-ups since the diagnosis. At his two-year mark, he told Jackson, his doctors said he was clear of the cancer.

“There is a 95% chance it’s not coming back,” he told Jackson.

October, 2013|Oral Cancer News|

Celebrity confession linking sex to oral cancer raises local awareness

Source: www.vancouversun.com
Author: Pamela Fayerman

Michael Douglas is credited for raising awareness about the links between oral sex and oral cancer, but experts worry his disclosure could cause public panic and stigmatize the disease to the point of bringing shame to those afflicted. Or worse, prevent patients with symptoms from getting examined promptly.

Miriam Rosin, a BC Cancer Agency scientist, said the actor’s candid revelation that his throat cancer was caused by human papillomavirus (HPV), which he picked up from performing cunnilingus, is raising awareness of a growing problem around the world, and in B.C. “It’s created a lot of noise. I think it’s important to talk about this disease … but not in a headline-grabbing way, which may damage the cause by labelling it as a sexually transmitted disease,” said Rosin, who is also a Simon Fraser University professor.

Regardless, the public is finally getting the message that HPV, the most common sexually transmitted virus in the world – and the one that causes virtually all cases of cervical cancer – is accounting for the surge in throat cancers located at the back of the throat.

In B.C., if trends continue, HPV-caused throat cancers are expected to overtake cervical cancers in incidence. About 150 cases of cervical cancers are reported annually in this province. Of about 500 head and neck cancers, 115 are HPVcaused throat cancers, according to the BCCA.

Douglas’s interview with The Guardian newspaper last month was followed by an avalanche of sensational media reports that apparently gave the Hollywood celebrity a twinge of regret. Douglas’s publicist later claimed the 68-year-old meant only that oral sex and HPV were a potential cause of such cancers while not specifically referring to his own. The U.K. newspaper, however, stood by the story and released an audio of the interview to rebut Douglas’s backtracking. Excessive smoking and drinking alcohol are also risk factors for various forms of oral cancer, and when the actor was first diagnosed in 2010, he had previously blamed his cancer on many years of indulgence in those habits.

Up to 70 per cent of throat cancers are HPV-related. There are numerous places to get oral cancers – such as the lips, cheeks, gums, palate, tongue and tonsils – and while smokers and drinkers once fit the typical profile of an oral cancer patient, now, because of waning smoking prevalence, HPV infections have emerged as the dominant risk factor for throat tumours such as the one Douglas had.

Rosin said there was a whopping 300-per-cent increase in the age-adjusted incidence rate for throat cancers in B.C. between 1980 and 2010. It’s more commonly diagnosed in mid-life, and the ratio of males to females getting such cancers is three-to-one.

Earlier this year, the American Cancer Society issued a report showing the proportion of HPV-linked oral cancers has risen from 16 per cent of all oral cancers in the mid-1980s to 72 per cent two decades later.

Dr. John Hay, a radiation oncologist at the BC Cancer Agency and an expert in oral cancers, said HPV tumours are squamous cell clusters that surface in places where skin tissue is thin and delicate.

There are more than 100 strains of HPV. Some are benign, causing common skin warts, but high-risk strains cause cervical and oral cancers, vaginal and vulva cancers, penis and anus cancers, and genital warts. HPV infections and their links to cancer are a relatively new scientific area of study so there are many questions still to be answered, including whether the relatively new HPV vaccine will prevent future generations from getting throat cancers.

The Vancouver Sun has reviewed the latest research and developments to address expected curiosity on the subject.

How common is HPV?
Very. By age 25, a quarter of Canadian women are infected by it, and by age 50, about 85 per cent of sexually active people (males and females) have been exposed to it at one time or another. The vast majority of the time, the immune system knocks the virus out within a few years. In a minority of individuals, the virus persists, potentially leading to an HPV-linked cancer.

What is fuelling the rise in HPV over the past three or four decades?
Experts believe the advent of oral contraceptives. (The Pill) five decades ago unleashed sexual freedom and changes in sexual behaviours: more sexual partners and consequently more sexually transmitted infections, including HPV. Hay said before oral contraceptives came along, condoms were the common barrier method. “Condoms keep things in and they keep things out,” he said, referring to the fact that condoms can help prevent sexually transmitted infections while oral contraceptives do not.

Is the massive increase in throat cancers attributable to better detection methods or an increase in HPV infections?
Experts say they are seeing a true increase in the proportion of throat cancers caused by HPV. Hay said typical patients are 45 to 65 years old who may have been infected with HPV up to 20 years earlier.

Does oral sex really cause throat cancer?
The HPV virus is very common; nearly everyone who has sex will get it at one point or another. The HPV micro-organisms can reside in the cervix or other body canals (anus) and the virus can also be transmitted through skin contact and saliva. One Finnish study showed that HPV could even be detected in babies under one year, possibly through skin-to-skin contact during breastfeeding.

Men are more likely to get throat cancer and one theory is that there may be more HPV in vaginal fluid than other genital areas.

“We don’t well understand how oral HPV is transmitted except to know that oral sex is the most likely way of transmitting HPV to the mouth,” said Gypsyamber D’Souza, an epidemiologist and viral cancer expert from Johns Hopkins Bloomberg School of Public Health, at the recent annual meeting of the American Society of Clinical Oncology.

What are the risk factors for contracting HPV?
Studies have shown that men are three times more likely to get HPV-related throat cancers than women, but risk for both genders goes up in those with more sexual partners. Those who’ve had six or more oral sex partners over a lifetime are 8.6 times more likely to get HPV throat cancers, compared with those who have never had oral sex. HPV is more prevalent in sexually promiscuous individuals and those already carrying other sexually transmitted infections (STI). A B.C. study done on men attending a Vancouver STI clinic found that 70 per cent were HPVpositive.

What are some of the most common symptoms of throat and other oral cancers?
Hoarseness, chronic sore throat, pain or difficulty swallowing, a painless lump in the neck area, swollen lymph nodes in the neck, ear pain and mouth sores that don’t heal.

Who should get the HPV vaccine?
There are two HPV vaccines licensed for use in Canada: Gardasil and Cervarix. Neither will wipe out infections once individuals have been exposed, so it’s best to get the vaccine before becoming sexually active. B.C. research has shown that HPV is most prevalent in women under 20, suggesting that the risky period for getting infected is when females first start having sex.

Gardasil (which protects against multiple high-risk HPV strains as well as genital warts) is approved for women aged nine to 45 and males nine to 26. Health Canada approved the vaccine for girls in 2006 and for boys a few years ago. It’s part of school-based immunization programs, but the major focus of public funding is on Grade 6 girls in B.C. The series of three shots costs up to $500 if purchased at pharmacies by parents wishing to vaccinate boys or older children who missed getting vaccinated.

The vaccine is also licensed for males up to age 25. As with girls, experts recommend boys get vaccinated before they become sexually active. Only a few provinces are considering public coverage of the vaccine for males; B.C. is not one of them at this time.

Dr. Perry Kendall, chief medical health officer for B.C., said studies have not yet proven it would be cost effective to extend public funding for vaccination of boys. “Ninety-nine per cent of cervical cancers are caused by HPV, and 70 per cent of vaginal cancers,” he said, while noting that HPV is “attributable” to about twothirds of throat cancers. B.C. spends about $3 million a year on HPV vaccines and about 60 to 70 per cent of eligible girls (Grade 6 cohorts) have been vaccinated so far, but it could take decades for the vaccine to have a significant effect in reducing both cervical and oral cancers in the younger generations.

Is the vaccine safe and effective?
A Universit y of B. C. researcher Dr. Simon Dobson has called Gardasil an “excellent vaccine.” HPV-infection suppression rates range from 70 to 90 per cent, with the highest immunity response occurring in those who get the vaccine at the youngest age.

Minor side effects such as pain at the site of injection, swelling, dizziness, nausea and headache have been reported in about six per cent of subjects, according to Dr. Monika Naus of the B.C. Centre for Disease Control in a report in the BC Medical Journal. Rare, serious adverse effects – such as deaths, stroke, embolisms and seizures – have not been directly linked to the vaccine.

How can you get tested for HPV?
Doctors scrape cells from the cervix area, similar to the way specimens are collected during a Pap smear. The test is not covered by the public medical plan so private labs charge about $90. It is not possible to swab the back-of-throat area for HPV because of gag and vomit reflexes. Saliva tests are used to detect throat HPV infections only for research purposes so far.

In women and men, swabs can be taken of the anal cavity to detect pre-cancerous changes.

Is there a treatment for HPV?
There’s no treatment for the infection but there are for the serious cancers that may result from it, such as surgery, chemotherapy and radiation.

What’s the prognosis for someone who gets HPV oral cancer?
Even those who get advanced HPV-caused throat cancers, such as actor Michael Douglas, have a fiveyear survival rate of at least 80 per cent, whereas advanced non-HPV linked oral cancers – those caused by smoking and alcohol – have a survival rate about half that. Non-HPV cancers usually affect the front of the tongue, floor of the mouth, cheeks and gums, while HPV cancers tend to affect the back regions of the mouth: the base of the tongue and tonsil area.

Is there a screening program for HPV-related oral cancers?
There’s no way to screen for HPV-related throat cancers, but a B.C.-developed device called the VELscope is used by some dentists to detect abnormalities in the front parts of the oral cavity. The device utilizes special light to detect suspicious cells, but it has not yet been shown to find HPVtype cancers in the furthest reaches of the throat. The tonsil area has folds and crevices where HPV tumours can hide out. BC Cancer Agency scientists are trying to improve the imaging system for the hardto-reach sites at the back of the throat and tonsil area.

Does it take a long time for an HPV infection to arise or should you blame the last person you had sex with?
If you do get HPV, you can’t necessarily point the finger at the last individual you had sex with. HPV infections wax and wane over lifetimes so getting an HPV-linked cancer may be more likely caused by the “sum total of your life experiences,” according to Rosin. A 2010 study in the British Medical Journal found that in those who developed throat cancers, a third had HPV antibodies (meaning they had been exposed to the virus) up to 12 years before the onset of disease.

How can one prevent or lower the chances of getting HPV-related cancers?
Talk to your doctor about getting vaccinated against the high-risk strains of HPV, reduce intake of alcohol and tobacco, limit your number of sexual partners, get tested for HPV if you have any symptoms or concerns. Women should get Pap smear tests of their cervix, which can show abnormal cellular changes that point to a possible HPV infection.

How prevalent is the oral HPV virus in the general population?
A recent snapshot-in-time U.S. study published in the Journal of the American Medical Association found that about seven per cent of Americans aged 14 to 69 are infected by HPV. But only one per cent of the 5,500 people in the study had HPV-16, the most strongly linked strain to oral and cervical cancers. If the figure is extrapolated to the whole population, it would mean that millions have HPV, but fewer than 15,000 Americans develop HPV-linked throat cancers each year. Lead author Dr. Maura Gillison, of Ohio State University, said that should be seen as reassuring; most people with oral HPV don’t get throat cancer.

The same study found that oral HPV infection was more common in men (10 per cent) than women (four per cent). HPV infection was most common in people aged 55 to 59.

How common is oral sex?
The Canadian Youth, Sexual Health and HIV/AIDS study, along with other studies and surveys in the U.S. and Canada, have shown that oral sex is enjoyed by two-thirds of adults. Results have shown it’s increasingly popular among Canadian teenagers. In 1994, nearly half of Grade 11 students (47.5 per cent) reported having oral sex at least once. When the survey was repeated in the same age group in 2002, more than half (52.5 per cent) indicated they had done so.

Should you swear off oral sex?
Since there is a long latency period for HPV infections to inflict serious damage, it’s unlikely there’s any benefit for adults to change sexual practices and preferences, especially if they are in monogamous relationships. But Rosin and Hay agree it may be prudent for individuals to be discriminating when it comes to sexual partners. They can consider asking partners about whether they’ve had HPV, if they’ve been vaccinated against HPV, or about their health and sexual histories.

July, 2013|Oral Cancer News|

HPV vaccine still fights for acceptance, despite benefits

Source: www.floydcountytimes.com
Author: Tom Collins

Last month, actor Michael Douglas caused a stir in the media when he suggested his throat cancer might have been caused by oral sex.

He could be right. Although smoking and alcohol use have long been regarded as the key risk factors, new research indicates that HPV, a sexually transmitted virus, is now the leading cause of mouth and throat cancers in the United States.

But there’s an important take-away message to this story: Some cancers caused by HPV can be prevented easily, with a simple series of three vaccinations.

Since 2000, scientists have known that certain strains of HPV are responsible for nearly all cervical cancer in women. But newer studies indicate HPV can cause other types of cancer as well. Recent findings have also linked HPV to oral, head/neck, anal, vaginal, vulvar and penile cancers, and even some cases of lung cancer.

About half of all Americans will become infected with HPV at least once during their lifetime. The most common visible symptom of an HPV infection is genital warts, although the majority of HPV infections do not display symptoms.

That’s why the Centers for Disease Control and Prevention recommends that boys and girls alike be vaccinated against HPV. Ideally, they should be vaccinated between the ages of 11 and 12. Vaccination can be initiated as early as age 9, and the U.S. Food and Drug Administration has approved the vaccine to be given up to age 26.

Yet HPV vaccination rates remain low. In Eastern Kentucky, the percentage of women who die from cervical cancer is significantly greater than in the rest of state or the nation as a whole. But the percentage of girls and young women in Eastern Kentucky who receive the full three doses of the HPV vaccine is lower than both the state and national averages.

The University of Kentucky’s Rural Cancer Prevention Center, a CDC-funded project, has conducted research over the past four years around the acceptance of the HPV vaccine. In an initial study, conducted in 2009, UK researchers found they literally could not give the vaccine away to young women in Eastern Kentucky.

A community advisory board was assembled to guide research into improving acceptance of the vaccine and completion of the three-shot series. Researchers learned that in order to increase acceptance they had to promote the vaccine in a culturally acceptable manner.

They hosted community hog-roasts, where local people helped promote the vaccine. They developed a DVD, designed to encourage completion of the three-shot series, to be shown to young women when they took the first shot. Numerous school systems sent home consent forms to parents to get permission for school nurses to provide the vaccine to their children.

Researchers at the center hope that if a community is engaged in the process and allowed to direct the delivery of the necessary change, outcomes can be achieved that will lead to a healthier population.

Note: Tom Collins is the associate director of the University of Kentucky Rural Cancer Prevention Center.

Oral cancer sneaks up

Source: well.blogs.nytimes.com
Author: Donald G. McNeail Jr. and Anahad O’Connor

The actor Michael Douglas has done for throat cancer what Rock Hudson did for AIDS and Angelina Jolie did for prophylactic mastectomy. By asserting last week that his cancer was caused by a virus transmitted during oral sex, Mr. Douglas pushed the disease onto the front pages and made millions of Americans worry about it for the first time.

In this case, it was a subset of Americans who normally worry more about being killed by cholesterol than by an S.T.D. The typical victim is a middle-aged, middle-class, married heterosexual white man who has had about six oral sex partners in his lifetime.

The virus, human papillomavirus Type 16, also causes cervical cancer. So is there any early oral screening that a man can have — an equivalent to the Pap smear, which has nearly eliminated cervical cancer as a death threat in this country?

The answer, according to cancer experts and a recent opinion from the United States Preventive Services Task Force, is no. And for surprising reasons.

The Pap test — invented in 1928 by Dr. George N. Papanicolaou — involves scraping a few cells from the cervix and checking them under a microscope for precancerous changes. Precancerous cells have a “halo” around the nucleus, while cancerous ones have larger, more colorful nuclei, said Dr. Paul D. Blumenthal, a professor of gynecology at Stanford University Medical School.

In theory, it should be similarly easy to scrape and examine throat cells. But in fact, cancer specialists said, doing so would be useless.

Virtually all cancers on the mouth, tongue, gums, hard palate or anywhere in front of the uvula (the “punching bag” dangling from the soft palate) are caused by tobacco and alcohol.

The kind of chronic HPV 16 infection that leads to oral cancer occurs much farther down, near the base of the tongue. Adding to the difficulty, the infection is often “deep down in the crypts of the tonsils,” said Dr. Eric J. Moore, a Mayo Clinic surgeon specializing in such cancers.

The tonsils, an expanse of lymphoid tissue that includes much more than the two back-of-the-throat bumps removed in tonsillectomies, have deep folds and crevices.

“If you spread them out, they’re 2 feet by 2 feet, said Dr. Marshall R. Posner, medical director for head and neck cancer at Mount Sinai Medical Center. “You can’t swab them. It’s just not possible.” By contrast, the end of the cervix swabbed during a Pap test is only about two square inches and easily reached with a speculum. It is impossible even to see deep tonsillar tissue without a scope that goes through the nose. Probing this area would set off gag and vomit reflexes so strong that patients might have to be anesthetized.

A saliva test can detect an oral HPV infection. But that’s not useful, since 85 percent of the population catches at least one of the 100 different human papillomaviruses that circulate. Most infections are beaten by the immune system in a year or two. Even among those who get an oral HPV 16 infection, less than 1 percent will go on to develop throat cancer.

“If I tell you that you have HPV in your mouth, it’s not going to help you if I don’t have anything to offer you, and you’re going to live with the anxiety and fear that you might get cancer,” said Dr. Robert I. Haddad, chief of head and neck cancer at the Dana-Farber Cancer Institute in Boston. “But if I tell a woman that she has an abnormal Pap smear, there’s something she can do about it.”

Someone with chronic HPV 16 year after year would be at the highest risk for throat cancer — but even then it is not clear what to do. Probing through all the tonsillar tissue under anesthesia looking for something worrisome to biopsy would be difficult and expensive and could set off bleeding near the entrance to the lungs.

Even when surgeons find large, cancerous lymph nodes, the primary tumor that seeded them sometimes turns out to be a speck only a sixteenth of an inch wide buried by healthy tissue, Dr. Moore said.

Although throat cancer caused by HPV is increasing, it is relatively rare. About 25,000 cases a year are diagnosed in the United States, compared with 226,000 lung cancers. But it is growing in importance as smoking-related oral cancers decline.

Oral sex has become more common since the sexual revolution of the 1960s, but not astonishingly so. According to Debby Herbenick, a director of Indiana University’s Center for Sexual Health Promotion, the mean number of lifetime oral sex partners reported by American men 35 to 54 is six. Men 55 to 64 report five, and men 25 to 34 report four. Men over 65 and under 25 report three.

However, such “fairly modest changes” in sexual habits do not explain why the cancer risk has doubled or tripled over the years, said Gypsyamber D’Souza, a viral cancer specialist at Johns Hopkins Bloomberg School of Public Health. It has risen the most in white men 45 and up. The older age is explained by the fact that, like cervical cancer, it can take decades to develop.

Men are twice as likely as women to get it, according to Dr. D’Souza, and it is more common among whites than blacks, perhaps because whites are more likely, by 90 percent to 69 percent, to have ever performed oral sex.

And straight men are more likely to get the cancer than gay men. One theory is that there may be more HPV in vaginal fluid than on the penis, said Dr. Lori J. Wirth, a head and neck cancer specialist at Massachusetts General Hospital.

The lack of a screening test means that a doctor should be seen as soon as symptoms appear: a lump in the neck, a sore throat or ear pain that persists for two weeks, or what Dr. Posner called “the hot potato voice: the way you talk when something is burning the back of your throat.”

Though no studies proving it have been done, Gardasil and Cervarix, the vaccines to prevent cervical cancer from HPV Types 16 and 18, should also prevent this oral cancer and should be offered to boys and young men, several doctors said.