Are you at risk for oral cancer?  The answer is yes!

Recently, I was talking to a patient who had just been diagnosed with HPV and was in a watch and wait mode to be retested in one year. When asking her about what her ob/gyn was telling her in regards to her partner I was shocked to learn that nothing was said. So, I dove into this on the internet and there are really zero recommendations to help prevent the spread of this virus to the oral cavity. Experts just simply say that since most people have been exposed there is nothing to do except get a vaccine before getting exposed (which does not cover all the HPV strains) and get regular exams but the focus is on genital HPV.  Nothing is really being talked about oral HPV.
HPV infects roughly 80% of the sexually active population which means about 1 in 4 people are infected. The majority of people with HPV never know they have it because it becomes dormant and doesn’t cause any symptoms.   Many of the 200 HPV strains cause warts and are not pre-cancerous. However, certain strains have been shown to cause cancer in n your mouth and throat as well as the genital areas of women (vulva,cervix,anus) and men (penis, scrotum, anus). Today I want to focus on the oral problems associated with HPV.
HPV is passed by direct, skin-to-skin- contact during vaginal, anal and oral sex with someone who has the infection. There is some controversy over if it is transmissible thru kissing with some studies suggesting it is and others saying it is not likely. I did find a study that HPV 16 was found in saliva of men and women. HPV 16 is one of the worst types for progression to cancer so I have to err on the side of caution here. Transmission seems to be a little more likely with deep open kissing because of membrane contact.

Here are some quick facts about oral HPV:

  1. In the last decade there has been a 4-5 fold increase in the number of oropharynx cancers (meaning the mouth/throat) with the majority of these cases having HPV 16 which is a specific strain that is high risk for cancer.
  2. Approximately 3% of adult men and 1% of adult women have HPV 16 detectable in their mouth.
  3. Approximately 70% of oral cancers are thought to be linked to HPV while the others are from tobacco products and heavy alcohol use.
  4. There are 13,000 men diagnosed with HPV related throat cancer each year.
  5. The overall survival for oral cancer is 65% at five years and if it is HPV related and caught early survival can be as high as 83%. Unfortunately, 66% of these are diagnosed in a late stage making it very difficult to treat.
  6. HPV can infect any part of the oral cavity: the interior lining of the lips, gums, hard palate, floor of the mouth, base of the tongue or inner cheeks.
  7. You can have an exposure of HPV and it can be years before it manifests are cancerous or pre-cancerous cells.

With this rising issue there are no preventative screening protocols for oral HPV.  We screen for cervical cancer caused by HPV doesn’t it seem logical to start screening for oral HPV, too?  There is a swish and spit test that can be done to screen for oral HPV so maybe not only can we catch it early but may even be able to prevent it from turning into cancer and you never hear about this test.  We are going to start doing this testing at our office for this reason so be sure and call us and ask about the HPV test.  It is super simple, literally a swish and spit type of test.

Now that you understand how much of an issue this is becoming let’s dive into the symptoms, prevention and 5 steps that I have come up with for oral prevention/detection of HPV so READ ON for you, your spouse, your daughter and your son.  You need to know this information.

 

Symptoms:

Most people don’t have symptoms until it is a serious problem so preventative check-ups are important.

Throat cancer presents as chronic sore throat, ear pain that doesn’t go away, throat pain, trouble swallowing, lump or mass in your neck, hoarseness or constant coughing.

 

Prevention:

Condoms and dental dams (for oral sex) may help but you can still get HPV if it is located in the area surrounding what these devices cover.  If you want to know more about dental dams then click here for information from the CDC.

Screening:

Dental exams can help detect oral cancer if there is obvious lesions.  You can have the HPV virus and dentists will not be able to see it until it is causing a problem.  For significant throat symptoms an Ear Nose and Throat specialist can view farther into the oral cavity and may be able to see problems.  If there is a high degree of suspicion then radiologic scanning may be indicated.

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We can now test for the presence of Oral HPV with a simple swish and spit which may catch the presence of it so men and women can be proactive in trying to get it to go dormant and for screening purposes.

FYI,  there are no tests available for genital HPV in men so it can be transferred by men and they don’t even know they have it.

Treatment:

For oral cancer, there is no traditional treatment for a positive HPV test.  Once it becomes cancer then surgery, radiation and often chemotherapy are used and remember that 66% of the oral HPV cases are diagnosed in this stage!

 

Risk factors for progression of HPV to cancer include tobacco use and immune suppression.

 

Currently, there are no guidelines for men on how to avoid HPV except the propaganda for HPV vaccine.  If a woman has an abnormal pap with HPV and a man has oral sex with her then he is at risk for getting oral HPV.  Studies suggest once you get infected with HPV the virus stays in your body as either an active infection or lays dormant and undetectable.  It does not go away and may remain present for years.  Scientists feel like once HPV becomes dormant, it is unlikely that the virus will be passed to others.  Experts also feel that the same type of HPV virus doesn’t ping-pong back and forth between partners.  Once you both have it then you are not likely to reinfect each other with the same virus.  Now, if you go to a new partner and they have a different strain (there are over 200 strains) then you may be infected with that strain.

 

I knew of a young man in his 20’s that died from oral HPV because it was caught too late.  So, I have come up with some what I would call common sense guidelines.  These are all mine and I haven’t seen anything like these anywhere with zero studies to say they can help but with this rising issue I just can’t sit back and wait & watch for this to happen.

5 steps for oral HPV prevention if you or your partner is diagnosed with HPV anywhere (genital, cervical, anal, oral):

  1. Have a full physical exam and dental exam evaluating the mouth, neck as well as the genital area
  2. Stop smoking. Studies show if you have HPV and smoke there is a much higher risk of progression to cancer whether it is oral or genital.
  3. If you have any oral symptoms, see an Ear nose and throat doctor for an in depth exam
  4. Do the Oral HPV test to determine presence of virus. It may take as little as 1-2 months for a test to be positive or in some cases years so this is an ongoing test that I think should be screened every 3-5 years.  I think everyone should have this test done regardless of any knowledge of exposure because remember that 80% of sexually active people have been exposed to HPV.
  5. Avoid oral sex while a woman who has active HPV infection as evidenced by an abnormal pap. If you don’t want to refrain then use a dental dam. Once the pap smear is normal, then it is presumed to be ok (per what I can glean).

 

If you have a positive HPV test of any kind (cervical or oral) then I would recommend being proactive! While the majority of gential HPV cases resolve on their own without having any symptoms (approximately 70%), roughly 30% will progress to cancer.  Since oral HPV is not routinely screened I couldn’t find any statistics on the progression of a positive oral HPV test to oral cancer.

I have a protocol that I am using to do our best to discourage the progression of HPV to cancer rather than just watch and wait.  This protocol is not only for oral HPV but for genital HPV, too.  We also are now doing the oral HPV tests for men and women.  I can’t help but think if we can catch this super early we might be able to make a difference.  Call us today to find out more about this test!

 

Next week I am going to review the HPV vaccines so you are fully informed before you rush out and get one or have your sons and daughters get one so be sure and watch your inbox!

To your health,

 

Laura