HPV Poised to Become a Leading Cause of Oral Cancer in Men

 HPV Poised to Become a Leading Cause of Oral Cancer in Men


The sexually transmitted virus that causes cervical cancer in women is poised to become one of the leading causes of oral cancer in men, according to a new study. The HPV16 virus now causes as many cancers of the upper throat as tobacco and alcohol, probably due both to an increase in oral sex and the decline in smoking, (the historically dominant risk factor) researchers say.
The only available vaccine against HPV, made by Merck & Co. Inc., is currently given only to girls and young women. But Merck plans this year to ask government permission to offer the shot to boys. Experts say a primary reason for male vaccinations would be to prevent men from spreading the virus and help reduce the nearly 12,000 cases of cervical cancer diagnosed in U.S. women each year. I might add that by not doing gender based vaccination, we will reduce the overall reservoir of the virus in the US which is currently ubiquitous in the population. But the new study should add to the argument that there may be a direct benefit for men, too. The study was published February 1, 2008, in the Journal of Clinical Oncology.
“We need to start having a discussion about those cancers other than cervical cancer that may be affected in a positive way by the vaccine,” said study co-author Dr. Maura Gillison of Johns Hopkins University. Of course she is referring the the rapidly rising numbers or oropharyngeal, base of tongue, and tonsillar cancers we are seeing in both males and females.
Human papillomavirus, or HPV, is the leading cause of cervical cancer in women. It also can cause genital warts, penile and anal cancer, and oral cancers — risks for males that generally don’t get the same attention and press as cervical cancer. Previous research by Gillison and others established HPV as a primary cause of the estimated 5,600 cancers that occur each year in the tonsils, base of tongue and upper throat. It’s also been known that the virus’ role in such cancers has been rising. It is in fact, the primary cause of cancers in these anatomical sites.
The new study looked at more than 30 years of National Cancer Institute data on oral cancers. Researchers categorized about 46,000 cases, using a formula to divide them into those caused by HPV and those not connected to the virus. They concluded the incidence rates for HPV-related oral cancers rose steadily in men from 1973 to 2004, becoming about as common as those from tobacco and alcohol.
The good news is that survival rates for the cancer (when caused by a viral etiology) are also increasing. That’s because tumors caused by HPV respond better to chemotherapy and radiation, Gillison said. “If current trends continue, within the next 10 years there may be more oral cancers in the United States caused by HPV than tobacco or alcohol,” Gillison said.
Studies suggest oral sex is associated with HPV-related oral cancers, but a cause-effect relationship has not been proven as the only viral transfer mechanism for these cancers. Other researchers have suggested that even unwashed hands can spread it to the mouth as well. Gillison however pointed toward sex as an explanation for the increase in male upper throat cancers, and her previously published work documents this in the New England journal of Medicine. In women HPV-related upper throat cancers declined significantly from 1973 to 2004.
Merck’s vaccine, approved for girls in 2006, is a three-dose series priced at about $360. It is designed to protect against four types of HPV, including one associated with oral cancer. Merck has been testing the vaccine in an international study, but it is focused on anal and penile cancer and genital warts, not oral cancers, said Kelley Dougherty, a Merck spokeswoman. “We are continuing to consider additional areas of study that focus on both female and male HPV diseases and cancers,” Dougherty said. Merck officials praised Gillison’s research, saying it will elevate the importance of HPV-related oral cancers. As I have posted here before, I believe that Gillison’s work should be mandatory reading for all those that have the opportunistic ability to discover early these very deadly posterior mouth cancers (Dentists, oral hygienists, and members of the ENT profession.)
In a typically guarded observation, Government officials and the American Cancer Society say they don’t know yet whether Merck’s vaccine will be successful at preventing disease in men. No data from the company’s study are available yet. Indeed, it’s not clear yet that the vaccine even prevents the HPV infection in males, let alone cancer or any other illness, said Debbie Saslow of the American Cancer Society. However in speaking with experts in the virus research community, I believe that if Merck’s current trials show that it can prevent persistent HPV 16 infections, that the logical extension of that fact would indicate that without the persistent infection, there would also be no mechanism for the disease process to take place. Keep in mind that tobacco will still be a major player in the incidence of oral cancers, and we are looking at a subset population of people with oral cancer when speaking of HPV16.
Merck plans to seek U.S. Food and Drug Administration approval for the vaccine in men later this year, meaning a government decision would be likely in 2009.

Oral Cancer & Early Detection

Oral Cancer

The Oral Cancer Foundation estimates that close to 42,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour, 24 hours per day.

Factors That May Cause Cancer

Research has identified a number of factors that may contribute to the development of oral cancer. In the past, those at an especially high risk of developing oral cancer were over 40 years of age, heavy drinkers and smokers.

While smoking and heavy drinking are still major risk factors, the fastest growing segment of oral cancer patients is young, healthy, nonsmoking individuals under the age of 40. Recent research has identified the human papilloma virus version 16 as being sexually transmitted between partners and related to the increasing incidence of oral cancer in young non-smoking patients. There are also links to young men and women who use conventional "smokeless" chewing or spit tobacco. Promoted by some as a safer alternative to smoking, this form of tobacco use is actually no safer when it comes to oral cancers.

Other factors that may promote oral cancer include physical trauma, infectious disease, poor oral hygiene and poor nutrition; however, the research regarding their involvement is uncertain. It is likely that there is a complex interaction of many external and internal factors that play a role in the development of oral cancer.

Perform a Self-Exam Monthly

Historically the death rate associated with this cancer is particularly high, not because it is hard to detect or diagnose, but because the cancer is often discovered late in its development.

The National Cancer Institute's SEER data indicate that when oral cancer is detected early, survival outcomes are improved and treatment-related health problems are reduced. Among healthcare professionals, your family dentist or oral and maxillofacial surgeon is in the best position to detect oral cancer during your routine dental examinations. If you are at high risk for oral cancer, you should see your general dentist or oral and maxillofacial surgeon for an annual exam.

In addition, dentists and oral and maxillofacial surgeons recommend that everyone perform an oral cancer self-exam each month. An oral examination is performed using a bright light and a mirror:

•remove any dentures

•look and feel inside the lips and the front of gums

•tilt head back to inspect and feel the roof of your mouth

•pull the cheek out to see its inside surface as well as the back of the gums

•pull out your tongue and look at all of its surfaces

•feel for lumps or enlarged lymph nodes (glands) in both sides of the neck including under the lower jaw

Early Detection and Treatment Provide a Better Chance for Cure

When performing an oral cancer self-examination, look for the following:

•white patches of the oral tissues — leukoplakia

•red patches — erythroplakia

•red and white patches — erythroleukoplakia

•a sore that fails to heal and bleeds easily

•an abnormal lump or thickening of the tissues of the mouth

•chronic sore throat or hoarseness

•difficulty in chewing or swallowing

•a mass or lump in the neck

See your dentist or oral and maxillofacial surgeon if you have any of these signs. If your doctor agrees that something looks suspicious, a biopsy may be recommended. A biopsy involves the removal of a piece of the suspicious tissue, which is then sent to a pathology laboratory for a microscopic examination that will accurately diagnose the problem. The biopsy report not only helps establish a diagnosis, but also enables the doctor to develop a specific plan of treatment.

A Word about Oral Care

Keep in mind that your mouth is one of your body's most important early warning systems. Don't ignore any suspicious lumps or sores. Should you discover something, make an appointment for a prompt examination. Early treatment may well be the key to complete recovery.

© 2005-2013 American Association of Oral and Maxillofacial Surgeons 

(AAOMS).   http://www.aaoms.org