HPV Oral Cancer Lecture 2024 PDF

Oral Human Papilloma Virus Infection (HPV)  What is HPV?  HPV is a sexually transmitted virus. There are more than 150 subtypes of HPV that can infect the genital area and the throat (tonsillar HPV). An infection that causes warts in various parts of the bo...

Oral Human Papilloma Virus Infection (HPV)  What is HPV?  HPV is a sexually transmitted virus. There are more than 150 subtypes of HPV that can infect the genital area and the throat (tonsillar HPV). An infection that causes warts in various parts of the body, depending on the strain. According to the CDC, about 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that almost every person who is sexually-active will get HPV at some time in their life if they don’t get the HPV vaccine. 85% of people will get human papillomavirus (HPV) in their lifetime. The World Health Organization (WHO) estimates that one in three men worldwide are infected with HPV More than 90 percent of sexually active men and 80 percent of sexually active women will be infected with HPV in their lifetime. Around 50 percent of HPV infections involve certain high-risk types of HPV, which can cause cancer. American Dental Association (ADA) has identified how oral health professionals can help educate patients about using the HPV vaccine to help prevent oropharyngeal cancers. The ADA’s new policy, which urges dentists to support use and administration of the HPV vaccine, was adopted shorty after the U.S. Food and Drug Administration approved expanded use of Gardasil 9 (introduced in 2006) to include men and women ages 27 to 45 in October. HPV is now associated with 9,000 cases of head and neck cancers each year in the United States, according to the CDC. It is four times more common in men than women.  HPV Facts  HPV is the most common sexually transmitted infection  There are nearly 200 different strains of HPV, most of which are harmless and not cancer causing  About 79 million Americans are currently infected with HPV  14 million people become newly infected each year  HPV is so common that most sexually-active men and women will get at least one type of HPV at  Facts Continued  You can have HPV without ever knowing it because the virus often produces no signs or symptoms that you will notice  There is no cure for the virus  Twovaccines known as Gardasil and Cervarix protect against the strains of HPV that cause cervical cancers (HPV16 and 18)  Vaccines are most effective if given to children before they become sexually active Oral health professionals are in a unique position to begin conversations about the HPV vaccine. Unlike primary care physicians who will focus on the vaccine’s prevention of cervical cancer and cancers directly related to sexual activity, clinicians can focus on oral health, as many patients are unaware of the association between HPV and oral cancer.  Which cancers are caused by HPV?  Cervical cancer: Virtually all cases of cervical cancer are caused by HPV, and just two HPV types, 16 and 18, are responsible for about 70% of all cases  Anal cancer: About 95% of anal cancers are caused by HPV. Most of these are caused by HPV type 16  Oropharyngeal cancers (cancers of the middle part of the throat, including the soft palate, the base of the tongue, and the tonsils): About 70% of oropharyngeal cancers are caused by HPV. In the United States, more than half of cancers diagnosed in the oropharynx are linked to HPV type 16  Rarer cancers: HPV causes about 65% of vaginal cancers, 50% of vulvar cancers, and 35% of penile cancers Most of these are caused by HPV type 16  Oral cancer caused by HPV  Each year, in the U.S., about 9,000 people are diagnosed with cancers of the oropharynx that may be caused by HPV  Cancers of the oropharynx are about four times more common in men than women  HPV number 16 is the one that is responsible for oral cancer  HPV is the leading cause of oropharyngeal cancers in the back of the throat  HPV16 manifests itself primarily in the posterior regions (the oropharynx) such as the base of the tongue, the back of the throat, the tonsils, the tonsillar crypts, and tonsillar pillars  Best way to screen for HPV related oral and oropharyngeal cancer today is through a visual and tactile exam given by a medical or dental professional and a thorough medical history Is there a test for me to find out if I have oral HPV?  There is no FDA-approved test to diagnose HPV in the mouth or throat  Medical and dental organizations do not recommend screening for oral HPV  Talk to your dentist about any symptoms that could suggest early signs of oropharyngeal cancer  HPV vaccines that are now on the market were developed to prevent cervical and other less common genital cancers  Studies have not yet been done to determine if HPV vaccines will prevent oropharyngeal cancers  It is possible that HPV vaccines might also prevent oropharyngeal cancers, since the vaccines prevent an initial infection with HPV  Oral Cancer Signs and Symptoms  An ulcer or sore that does not heal within 2-3 weeks  A red, white, or black discoloration on the soft tissues in the mouth  Difficult or painful swallowing. A sensation that things are sticking in the throat when swallowing  A swollen but painless tonsil. When looking in the mouth, tonsils on both sides should be symmetrical in size  Pain when chewing  A persistent sore throat or hoarse voice  A swelling or lump in the mouth  A painless lump felt on the outside of the neck, which has been there for at least two weeks  A numb feeling in the mouth or lips  Constant coughing  An ear ache on one side (unilateral) which persists for more than a few days  What are some oral cancer screening tools available on the market?  TISSUE REFLECTANCE Prior to evaluation of the oral mucosa, the dental patient rinses with a 1% acetic acid solution to remove superficial debris. Depending upon the manufacturer, a chemiluminescent or battery-powered light source is used to examine the oral cavity for distinctly white (acetowhite) lesions.  TISSUE AUTOFLUORESCENCE based upon the observation that living tissues contain molecules (fluorophores) that can be stimulated by specific wavelengths of light to emit a weak light of their own.  SALIVARY TESTING These tests analyze patient saliva for elevations in protein markers associated with oral cancer, HPV DNA, or both  CYTOLOGIC TESTING cytology is only to be used when a mucosal abnormality has been identified.  VELscope  VELscope helps identify oral disease in its early stage  Blue light stimulates natural fluorescence in the soft tissue which allows dental professionals to see disease not visible with the naked eye  This system is an adjunctive device which means it must be used together with and as a supplement to the traditional intra and extraoral head and neck exam  Healthy tissue should fluoresce upon examination with VELscope  Should be used on all patients on hygiene appointments How Does the VELscope Work? Oral cancer Healthy patient Prevention  Vaccines The three HPV vaccines approved for use in the U.S. can protect against some but not all of the high-risk strains, The HPV Vaccine Does Not Protect Against All Strains  Gardasil protects against four of the most common types and the two that cause 9 percent of all genital warts.  Gardasil 9 protects against an additional five strains  Cervarix protects against the two most common high-risk strains but provides no protection against genital warts.  Vaccine Recommendations  CDC recommends HPV vaccination for 11- to 12-year-olds. CDC also recommends HPV vaccination for everyone through age 26 years, if not vaccinated already.  Vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit, as more people have already been exposed to HPV.  HPV vaccination prevents new HPV infections but does not treat existing infections or diseases. This is why the HPV vaccine works best when given before any exposure to HPV. Vaccine Recommendations  In2016, the U.S. Centers for Disease Control and Prevention (CDC) updated HPV vaccine dosing recommendations to two doses, starting the series before the individual’s 15th birthday, and three doses for those receiving the vaccine at ages 15 to 26. The CDC, American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Obstetricians and Gynecologists recommends boys and girls receive the HPV vaccine during adolescence.  Treatment  There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause: Genital warts can be treated by your healthcare provider or with prescription medication. If left untreated, genital warts may go away, stay the same, or grow in size or number.  Since HPV is a viral infection, it is resistant to antibiotics.  Most cases of HPV clear up on their own after one to two years, and you'll no longer be contagious once it leaves your system. However, the virus can remain dormant for years, and some people experience infections that stick around for much longer.  According to the ADA Council on Scientific Affairs, an excellent predictor of whether a young person or adolescent will receive the vaccine is a recommendation from a health care provider. “Dental professionals have the ability to have the conversation with patients when they come for a cleaning, as well as with their parents, who make the decision on whether the teenager will be vaccinated or not  Conclusion  HPV oral and oropharyngeal cancers are harder to discover than tobacco related cancers  Symptoms are not always obvious to the individual who is developing the disease, or to professionals that are looking for it  Anything that has persisted for two or more weeks should be evaluated  All boys and girls ages 11 or 12 years should get vaccinated  At present, there is no generally available test to show whether an individual has been exposed to HPV  The currently approved HPV tests show only whether a person has a current infection with a high-risk HPV type at the cervix Thank You!