Currently about 72% of all OPCs (Oropharyngeal Cancers) are the results of an oncogenic HPV infection—and very few of these cancers are found in the front of the mouth. HPV-Oral Pharyngeal Cancer (HPV-OPC) develops at the deep base of the tongue or behind of the curtains of the tonsillar pillars. Sadly, there is no effective screening method for early cancer detection.
While we fumble with the words to say and the warnings to issue, we are literally watching the HPV epidemic unfold before our very eyes. HPV related cancers have replaced smoking and alcohol related oral cancers by a long shot. The CDC states that HPV oral infection is increasing 30% a year with 50% of all new cases occurring in 15-24 year olds, effecting males more than females. Looking at oral HPV 16 alone, the prevalence is six times more in men than in women (1.7 mil men and 270,000 women). And for reasons we don’t yet understand, the HPV-OPC rates for men are twice that of women. The American Society of Clinical Oncologists warns that by 2020 the US will have more middle age, non-smoking men with HPV-OPC than all women with HPV cervical cancer.
“Why would you want to know you were infected?” That’s a question posed by one of my local ENT doctors. He said, “Even if I know someone has persistent HPV-16, what am I going to do differently? Nothing!” I responded, “Really? First, I can strongly recommend that my HPV-infected patients opt for a year of clean living—meaning good sleep, a whole foods diet, hydration, refraining from smoking (of any kind), refraining from heavy alcohol/drugs, losing weight (if overweight/obese) and avoiding undue stress.” His reply, “Okay…that’s actually a very good point.”
I continued with “Plus, as they await test results for the most common STD, they might just reconsider their high risk behaviors—like multiple sexual partners.” “Well…that’s another good point”, he confessed.
In addition, I said “And if I was the one harboring a high risk HPV infection, I’d be paying close attention to early signs and symptoms. I might even opt for an elective scope on a somewhat regular basis…just to look for the presence of small lesions. It’s kind of like the frequency with which a colonoscopy is recommended for high risk patents who regularly develop polyps.” He then agreed that in “high risk patients” (meaning one with multiple sexual partners or in this case a positive HPV test) there may be a call for prophylactic examination. The flexible fiber-optic scope (about 4mm diameter by 18 inches) can be inserted in the nose, right in the ENTs office where he/she might take a good look at the base of the tongue, tonsils, tonsillar pillars and throat.
I can envision a time—perhaps in the next few years—when the media campaigns enlighten the public about HPV cancer highlights oral and pharyngeal cancer, not just cervical cancer. I can picture dental offices administering HPV vaccination series. Furthermore, I foresee a time when salivary testing will be considered standard of care for all dental offices.
Meanwhile the clock is ticking! In the area of HPV related OPC, we need to be aggressive. I urge you to start your own awareness campaign. Talk about the cause. Push for vaccination. And by all means, encourage your patients to collect a saliva sample. This is just one more way that saliva testing saves lives! Thank you OralDNA® Labs!