HPV, which causes cervical cancer can also fuel oral cancer

WASHINGTON — A prolonged sore throat once was considered a cancer worry mainly for smokers and drinkers. Today there's another risk: A sexually transmitted virus is fueling a rise in oral cancer.
The HPV virus is best known for causing cervical cancer. But it can cause cancer in the upper throat, too, and a new study says HPV-positive tumors now account for a majority of these cases of what is called oropharyngeal cancer.

If that trend continues, that type of oral cancer will become the nation's main HPV-related cancer within the decade, surpassing cervical cancer, researchers from Ohio State University and the National Cancer Institute report Monday.

"There is an urgency to try to figure out how to prevent this," says Dr. Amy Chen of the American Cancer Society and Emory University, who wasn't part of the new research.
While women sometimes get oral cancer caused by the HPV, the risk is greatest and rising among men, researchers reported in the Journal of Clinical Oncology. No one knows why, but it begs the question of whether the vaccine given to girls and young women to protect against cervical cancer also might protect against oral HPV.

HPV vaccination is approved for boys to prevent genital warts and anal cancer, additional problems caused by human papillomavirus. But protection against oral HPV hasn't been studied in either gender, says Dr. Maura Gillison, a head-and-neck cancer specialist at Ohio State and senior author of the new research. That's important, because it's possible to have HPV in one part of the body but not the other, she says. A spokeswoman for Merck & Co., maker of the HPV vaccine Gardasil, said the company has no plans for an oral cancer study.

Monday's research was funded by the NCI and Ohio State. Gillison has been a consultant to Merck.
There are nearly 10,000 new cases of oropharyngeal cancer a year, and overall incidence has risen by 28 percent since 1988 even as other types of head-and-neck cancer have been declining.

Tobacco and alcohol have long been the main causes of these tumors, which occur in the tonsils, base of the tongue and upper throat. But over the past few years, studies have shown HPV is playing a role in that rise, probably due to an increase in oral sex even as tobacco use was dropping.

The new study took a closer look, tracking HPV over time by directly testing tumor tissue from 271 patients that had been stored in cancer registries in Hawaii, Iowa and Los Angeles. The proportion that were HPV-positive rose from just 16 percent in the late 1980s to nearly 73 percent by the early 2000s.
Translate that to the overall population, and the researchers concluded that incidence rates of the HPV-positive tumors more than tripled while HPV-negative tumors dropped by half.

Oral cancer has always been a bigger threat to men than women. Gillison says women account for only about 1 in 4 cases, and their incidence is holding steady while men's is rising. That raises questions about gender differences in sexual behavior or whether oral HPV infection is likely to linger longer in men.

While HPV is the most common sexually transmitted infection, studies show women's bodies usually clear the virus from the cervix quickly; only an infection that persists for years is a cancer risk. It's not known if oral HPV acts similarly or even is as common.

Nor is it clear if oral sex is the only way it's transmitted, cautions Dr. Gregory Masters of the American Society for Clinical Oncology, an oncologist at Delaware's Helen Graham Cancer Center.
Regardless, just over 11,000 cases of cervical cancer will be diagnosed this year, a number that has been dropping steadily thanks to better Pap smears. (It's too soon to know what difference vaccination will make.) Gillison's team calculated that annual cases of cervical cancer will drop to 7,700 by 2020 – compared with about 8,700 cases of HPV-positive oropharyngeal cancer by then, about 7,400 of them in men.

The cancer society's Chen urged caution about those numbers, saying more data is needed. But she says two things are clear: First, patients with HPV-linked oral tumors have better survival odds than those with other types of this cancer, possibly because they tend to be younger. Studies are beginning to test if they can scale back today's treatment and thus suffer fewer long-term side effects such as problems with speech and swallowing.

And "just because you're not a smoker or drinker doesn't mean you can't get throat cancer," Chen says – so get checked for symptoms like a throat that's sore for longer than two weeks.

~ Lauran Neergaard - Huffington Post

Our office offers The OraRisk^® HPV Salivary Diagnostic Test

Human papillomavirus (HPV) is one of the most common virus groups in the world. According to the Centers for Disease Control, at least 20 million people in the United States are infected with HPV and there are approximately 6 million new cases each year.

Oral HPV is a manifestation of the HPV virus in the mouth, and is primarily found in the oropharyngeal complex. Specific types of oral HPV are now considered to be separate and serious risk factor for developing oral cancers. Early detection and identification of the presence or absence of oral HPV is important, as early oral HPV infections do not typically cause any clinical signs or symptoms.
The OraRisk^® HPV test is a non-invasive, easy-to-use screening tool to identify the type(s) of oral HPV, a mucosal viral infection that could potentially lead to oral cancer. OraRisk^® HPV enables the clinician to establish increased risk for oral cancer and determine appropriate referral and monitoring conditions.

Who should be tested?

• Patients with traditional risk factors for oral cancer
• Patients who are sexually active
• Patients with signs and symptoms of oral cancer
• Patients with suspicious oral lesions

Schedule an appointment for your OraRisk^® HPV Salivary Diagnostic Test

Oral Cancer survivor urges tax increase for smokeless tobacco

Gruen von Behrens's first surgery took 13 hours when he was 17 years old. Two years later, maxillofacial surgeons transplanted bone from his back to his face to give him a mandible. The transplant lasted two days before his body rejected it.

Now 34, Behrens is cancer-free, but he has no teeth, has a hard time eating and speaking, and his face is disfigured.

He began chewing tobacco at the age of 13, a common practice in the rural farming community in Illinois where Behrens grew up. As a teenager, he thought about "baseball, food, and women, in that order," he recalled in a DrBicuspid.com interview. "Everybody used tobacco; they really didn't think it would hurt us if your grandfather or uncle was using it."

But after developing squamous cell carcinoma in his lymph nodes, surgeons removed half his tongue and neck muscles. Still, von Behrens feels lucky to be alive.

"Eighty percent of the people with that diagnosis die within five years of surgery," he notes.

Last month von Behrens testified at a Maryland legislative hearing, urging lawmakers to increase the tobacco tax on cigars and smokeless tobacco to 70%, the same level as the tax rate on cigarettes.

"Tobacco is tobacco is tobacco, and I believe having a lower tax on some tobaccos and a higher tax on the smoking tobaccos -- that's basically saying this is a safe alternative when it is not," von Behrens said.

In 2010, he testified before a U.S. Senate hearing about the dangers of tobacco in professional sports.

White spot lesion

Three years after von Behrens began chewing tobacco, he noticed a white spot on the side of his tongue where he kept it.

"After passing the tobacco with my tongue, it became raw and it hurt at first but then it became kind of tough, and I started to see white spots," he recalled. "I was terrified."

von Behrens kept it secret from his mother because she had warned him about the dangers of chewing tobacco.

“Spit tobacco seemed harmless, but it has ruined my life.”— Gruen von Behrens

"I kept telling her it was my wisdom teeth that was making my speech slurred and making me drool on myself," he recalled.

When von Behrens went in to get his primary molars removed, he knew what the maxillofacial surgeon's diagnosis would be.

"I told him I had cancer before he put the gas mask on me," he said. "I was scared to death of what they were going to do to me. I was afraid of needles, let alone having surgery done."

von Behrens said his mother's anguish was the worst part. "I've never seen my mother cry like that before, and the pain that it inflicted on her hurt me more than the surgeries," he said.

34 surgeries

To date, von Behrens has had 34 surgeries and was a college sophomore when radiation treatments burned his face and forced him to have all his teeth removed.

He now serves as a spokesman for Oral Health America's National Spit Tobacco program and travels to schools around the U.S. to warn young people about the dangers of smokeless tobacco.

"I want kids to have a fair shot with their lives and know what the effect of tobacco use is," von Behrens explained. "If I had known then what I know now, I never would have put a dip in my mouth."

He says he has traveled to 46 states and spoken to 3 million children.

"I know how to talk to kids and relate to them, and I think that has even more of an impact than my face," von Behrens observed. "My face is an attention-getter for the first five rows, but for the rest it's my story that captivates them."

He also addresses health organizations and health departments, often at the request of dentists.

Cosmetic surgery costly

He would like to have plastic surgery and was heartened by the recent story of a man who had a total face transplant.

"Oh man, that would be my dream, but I just can't afford to do that," von Behrens said.

Maxillofacial surgeons would have to replace his mandible before a face transplant could be done, he noted. von Behrens cannot wear dentures because after surgeons reconstructed his face in the last surgery, they removed his mandible and replaced it with fibula bone from his leg. They also used pectoral muscles from his chest to recreate the floor of his mouth.

Implants would require drilling into the fibula bone that now serves as a replacement for his mandible.

Today von Behrens lives in central Illinois with his wife and two young daughters. "I met an angel," he said of his wife. "It's amazing she picked me in spite of the way I look."

He also works with the National Spit Tobacco Education Program to correct the false belief that smokeless tobacco is a safe alternative to smoking.

"Spit tobacco seemed harmless, but it has ruined my life," von Behrens said.

 In honor of Oral Cancer Awareness Month     

In honor of Oral Cancer Awareness Month, Brian S. Nylaan, D.D.S. will be offering complimentary oral cancer screenings on Thursday, April 26th from 2 – 5 pm. Oral cancer is not a rare disease. Approximately 37,000 people will be diagnosed with oral cancer every year in the US. It kills one person every hour of every day, and over 100 new individuals will be diagnosed with it each day. The good news is that it can often be found early in its development, through a simple, painless, and quick screening.

Who should get screened?
Every adult. Oral cancer can often be caught early, even as a pre-cancer. With early
detection, survival rates are high and the side effects are from treatment are at their lowest. Like other screenings you engage in such as cervical, skin, prostate, colon and breast examinations, oral cancer screenings are an effective means of finding cancer at its early, highly curable stages. Make them part of your annual health check‐ups.

What are the risk factors?
There are two distinct pathways by which most people come to oral cancer. One is through the use of tobacco and alcohol, a long term historic problem and cause, and the other is through exposure to the HPV16 virus (human papilloma virus version 16), which is now the leading cause of oral cancers in the US, and the same one, which is responsible for the vast majority of cervical cancers in women. The quickest growing segment of the oral cancer population are young, healthy, non-smokers due to the connection to this virus.

Early Indicators:
Red and/or white discolorations of the soft tissues of the mouth.
Any sore which does not heal within 14 days.
Hoarseness which lasts or a prolonged period of time.

Advanced Indicators:
A sensation that something is stuck in your throat.
Numbness in the oral region.
Difficulty in moving the jaw or tongue.
Difficulty in swallowing.
Ear pain which occurs on one side only.
A sore under a denture, which even after adjustment of the denture, still does not heal.
A lump or thickening which develops in the mouth or on the neck.

An oral cancer screening should be conducted every year, so take advantage of this offer and get screened today.

 Call our office at (616) 361-7317, or click here to make an appointment for your complimentary screening.

For more information about oral cancer screenings click here; VELScope oral cancer screenings click here or general dental information visit our website.
 references:

Dr. Bicuspid

Oral Cancer Foundation

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