Source: The Columbus Disbatch
Author: Misti Crane

Doctors are focusing increasingly on the role that human papilloma virus plays in oral cancer, and new research is prompting hope that treatments can be better tailored to patients.

People with oral cancer have a better chance of surviving if the cancer is linked to HPV, according to a new study led by an Ohio State University researcher.

Dr. Maura Gillison and her colleagues found that 82 percent of those with HPV-positive tumors in the back of their mouths survived at least three years, compared with 57percent of those with mouth tumors not tied to HPV. Their study included 323 oropharyngeal cancer patients.

HPV, which is spread by sexual contact, is the virus that also causes cervical cancer. It can cause cancer of the mouth through oral sex. The research took into account other risk factors such as tobacco use. It was published online yesterday in the New England Journal of Medicine.

This study should prompt more studies and advances in treatment, Gillison said. For example, it could be that patients with a better prognosis could have less radiation and suffer fewer side effects, she said.

Side effects of treatment include trouble swallowing, dental problems, difficulty speaking and inflexibility in the neck.

Gillison also presented new data yesterday at the American Society of Clinical Oncology meeting in Chicago. The data showed a worse outcome for smokers who have HPV-positive cancers than for patients with the same type of cancer who don’t smoke. The risk of death increased about 2.4 percent per year of smoking.

“Everything we’d been thinking for 50 years has been completely turned upside down in the last 10,” said Brian Hill, executive director of the California-based Oral Cancer Foundation, referring to the link between HPV and oral cancer, which once was chiefly associated with tobacco use.

He said individualized treatment based on HPV status is probably a ways off, but it could make a big difference.

“About 45 percent of people will die from it (any oral cancer). If you’re part of the lucky 50-some percent who make it, you don’t make it unscathed,” said Hill, who was treated for the disease 12 years ago.

Though no research has proved that vaccination against HPV lowers the incidence of oral cancer, there is hope that robust vaccination efforts in young people could slash the number of cases that are diagnosed each year, he said.

In an editorial that accompanied the research in the journal, Dr. Douglas Lowy of the National Institutes of Health and Karl Munger of Harvard Medical School agreed that the findings might lead to more individualized treatments and said that vaccination against HPV might lower the incidence of oral cancers.

Most HPV-linked oral cancers are caused by types 16 and 18, both of which are targeted by the two vaccines approved for use in the United States.

So far, vaccination efforts have been focused mostly on girls and young women because the virus causes cervical cancer, but boys also can be vaccinated.

HPV is common and is passed from one partner to another during sexual contact. Most people infected with HPV never have any problems because their immune systems adequately fight it off.

As of 2003, about 5,800 of 12,000 cases of oropharyngeal cancer in the United States were linked to HPV, said Gillison, an oncologist and head-and-neck cancer specialist at Ohio State’s Comprehensive Cancer Center.

That number has undoubtedly increased as oral-cancer diagnoses have gone up in the past seven years, she said.

In all, there are about 36,000 oral-cancer cases diagnosed in the United States each year, according to the American Cancer Society.

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