Tag Archives: HPV

Oral Cancer: To Screen or Not to Screen?

April is Oral Cancer Awareness Month, and this year, it’s involved some controversy.

It began with the release of a Consumer Reports article that included oral cancer screening among 8 “to avoid.”

“Most people,” they wrote, “don’t need the test unless they are at high risk, because the cancer is relatively uncommon.”

Not long after, a government task force said “that there is not enough published evidence to recommend for or against screening for oral cancer by primary care professionals.” Though dentists aren’t considered “primary care professionals” in this case, it’s an easy detail to miss.

So is CR right about when they say such testing isn’t necessary?

While it’s true that oral cancer used to be rather rare, with mostly smokers and heavy drinkers being at risk, that’s no longer the case. As we’ve noted before, rates have been skyrocketing, largely due to the human papillomavirus, or HPV. More than 35,000 new cases are diagnosed each year, and the 5 year survival rate is only 50%. Part of the reason for that last statistic is that many oral cancers are detected quite late – which is why dentists have been speaking up more and more about the benefits of early detection.

Unlike many other kinds of cancer screening, a screen for oral cancer is hardly invasive. At minimum, it involves a visual exam that can quickly and easily be done as part of a routine dental exam.

oral_cancer_check

Many also use technology to aid to visual screening. In our office, we have a device called VelScope, which uses a blue excitation light to make healthy areas appear fluorescent and problem areas, dark. This isn’t some extra procedure; once a year, it’s a part of every adult patient’s exam.

Brian Hill, executive director of the Oral Cancer Foundation, nicely sums up the case for screening:

It isn’t an invasive exam, there’s no radiation (no long-term exposure issue), it is painless, it’s usually free, and you’re already sitting in the dentist chair. Why would you not get it?

Indeed.

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HPV, Oral Cancer & Gum Disease

According to the CDC, more than 36,500 new cases of mouth and throat cancer are diagnosed every year. The 5 year survival rate is only about 50%.

But that rate is a whole lot better in cases where the cancer is detected early. That’s why, in my office, oral cancer screening – using VelScope – is included in every adult patient’s exam at least once a year.

A recent paper underscores why this matters.

Published last month in Head & Neck Oncology, the study confirms that

oral sex with multiple partners is one of the significant risk factors for oral cancer and oropharyngeal cancer. Young people, who increasingly practice oral sex especially with many partners, may be driving the increase in these cancers.

The culprit, as we’ve discussed before, is HPV (human papillomavirus). More known for causing cervical cancer, HPV is also a major cause of oral cancer. In fact, it’s surpassed tobacco as the leading risk factor: While smoking rates have plummetted, oral cancer rates have soared. And that risk increases along with sexual activity. According to the current research,

HPV infection is likely to be sexually acquired with increased risk of oropharyngeal cancer with either many (more than 26) lifetime vaginal-sex partners or six or more lifetime oral-sex partners.

Why is the mouth so vulnerable to HPV transmission?

It must be remembered that the oral cavity is a battlefield of healing mucosal micro abrasions which could in the right circumstances of altered local host defenses allow viral inculcation, infection and entrenchment leading to somatic genetic change. Changes in immuno-tolerance at these “special” immuno-modulating sites…combined with further environmental triggers then lead to cancerous changes. Basically, viral “genes load the gun and environment pulls the trigger.”

So maybe it’s no surprise that earlier research has suggested a connection between gum disease and oral cancer. The initial study found that precancerous lesions were twice as prevalent – and tumors, four times as prevalent – in those with periodontal disease than those with healthy gums. Inflammation appears to be the key factor, as lead author Dr. Mine Tezal recently discussed in an interview with Dr. Bicuspid about her ongoing research:

The results of our recent study suggested an association between chronic local inflammation and tumor HPV status of head and neck cancers. HPV infects only basal cells of the epithelium and gains access through breaks in the mucosa….

In this inflammatory environment, HPV is also shed in greater amounts leading to increased risk of viral transmission. If prospective studies in cancer-free populations confirm that chronic inflammation is a significant factor in the natural history of oral HPV infection, the public health implications would be important.

Thus, another cancer-preventive measure, she suggests, is to control inflammation in the mouth. And she likewise confirms what the Head & Neck Oconology paper showed: frequency of exposure to the virus matters. A lot.

HPV is a commonly transmitted virus and the majority of the infections are cleared rapidly by the immune system without causing disease. Rather than the mere presence of the virus at one time point, its persistence is critical for the development of HPV-related diseases. [emphasis added]

Learn more steps you can take to lower your risk of oral cancer from my earlier post “The Oral Cancer Pandemic & How You Can Keep Yourself Safe.”

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The Oral Cancer Pandemic & How You Can Keep Yourself Safe

Once upon a time, oral cancer was a disease limited largely to tobacco users and heavy drinkers. For all others, the risks were thought to be very low, and the rate of disease remained fairly steady.

And then it started going up. And fast.

How fast?

Between 1974 and 2007, cases of white men with oral cancer shot up by 225%.

At the same time, there was a five fold increase in young adults with oral cancer.

Incidence has especially skyrocketed for women. In 1950, for every 6 men who developed oral cancer, only one woman did. Today, that ratio has narrowed to 2 : 1.

What happened?

HPV – human papilloma virus. This sexually transmitted virus, most known for causing cervical cancer, is now a major cause of oral cancer. Over half of us are at risk for contracting HPV at some point in our lives.

Perhaps you saw the recent episode of Dr. Oz dealing with these issues. If you missed it, you can watch it here – and I highly recommend that you do. He gives an excellent, plain-language overview of the issue, including discussion of warning signs/early symptoms and demonstrations of the different exams your dentist should perform so that if you do develop cancer, it can be caught and treated as early as possible.

As a rule, I screen each of my adult patients for cancer once a year using a tool called VELscope. This technology lets us look beneath the mouth’s soft tissues for lesions and abnormal growths that may indicate beginning oral cancers. VELscope testing is completely non-invasive and painless. We just aim a blue excitation light at the tissues and see how they respond: healthy areas appear fluorescent and problem areas, dark. I’ve used this device in my practice for several years now – not as an “extra” but as an essential.

If VELscope detects a problem, the next thing we do is an oral CDX brush test, which Dr. Oz’s guest dentist describes as a “pap smear for the mouth.” This procedure, too, is non-invasive and painless. We merely use a special brush to take a sample of cells from the problem area(s), save them on a slide and send them to a lab for analysis.

You can see these early detection methods demonstrated in Part 4 and Part 5 of the Dr. Oz video – screening tools that help save lives by letting us find the cancer early enough for effective treatment.

Of course, the best course of action is to prevent the cancer from occurring in the first place. Key things you can do to lower your risk:

  • Be sure your dentist gives you an oral cancer screening at least once a year if not at every visit. If he or she doesn’t – or if you’re not sure – ask for one.
  • Limit alcohol use.
  • If you smoke or chew tobacco, quit. (And if you don’t, don’t start.)
  • Practice safer sex. Always use condoms and/or dental dams, or completely abstain from oral sex.

Also be aware of these warning signs and contact your dentist immediately if you develop one or more of them:

  • A white or red patch in your mouth, or a sore that doesn’t heal within two weeks
  • Sore throat or ear pain, typically on just one side of the head, that doesn’t go away within two weeks
  • A lump in your neck
  • Voice changes or hoarseness that last more than a week

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