Oral cancer more common among Americans with HPV16 viral infections

A serious change in the cause of oral cancer is taking place nationally, and its implications are impacting the American public in a manner that a decade ago no one would have predicted.

For decades, oral cancer (also known as mouth cancer, tongue cancer, tonsil cancer, and throat cancer) has been a disease which most often occurred in older individuals, who during their lifetimes had been tobacco users.  Most cases were ultimately the result of lifestyle choices. Today that paradigm has changed. A common, sexually transferred virus has replaced tobacco as the number one cause of oral cancers, Human Papilloma Virus number 16 (HPV16). This is one of the same viruses that are responsible for the majority of cervical cancers in women.

This year alone, approximately 37,000 Americans will be newly diagnosed with oral cancer, and one person will die every hour of every day from this disease. HPV16, one of about 130 versions of the virus, is now the leading cause of oral cancer, and is found in about 60% of newly diagnosed patients. Dr. Maura Gillison from the James Cancer Center, a long time researcher of the relationship between HPV and oral cancers, recently reported these new findings at the American Academy for the Advancement of Science meeting.

This change in etiology, which has accelerated its influence over the last two decades as tobacco use in the US simultaneously was declining, has also changed the demographics of who is getting the disease. It is no longer the domain of those over 50 who have smoked a decade or more of their lives. The fastest growing segment of the oral cancer population, are people in the 25-50 age range, who are never smokers, and that group predominantly comes to the disease from HPV16.  Their oral cancers occur in locations anatomically unique, mostly localized to the posterior of the mouth; in the oropharynx, tonsils, and at the base of the tongue.  This viral etiology makes identifying the "high risk" individual much more difficult.

Tobacco use in any form by itself continues to be an important risk factor for the disease. However, in the developed world, oral cancers are becoming more common because of persistent HPV16 viral infections. Evidence indicates that the virus can be sexually transmitted between partners, and accounts for the increase in young victims of oral cancer who do not fall into the historic, tobacco risk factor group. Additional risk factors include high alcohol consumption, the use of conventional smokeless (chewing/spit) tobacco, as well as prolonged exposure to the sun (for lip cancers).

In a National effort to raise awareness, The Oral Cancer Foundation has joined forces with dental offices throughout the US to screen individuals for the disease. Together, OCF and the dental community are urging the American public to take advantage of free oral cancer screenings during Oral Cancer Awareness Month in April.  Over 1250 free screening events are taking place in dental offices across America in this one month alone.  These simple visual and tactile screenings hold the hope for an early discovery, sometimes even as a pre cancer, when current treatments are the most effective and survival is the highest.  A list of the offices participating in this event can be located on the foundation's web site at:

http://www.oralcancer-screening.org/events/

Dr. Ross Kerr, an oral medicine specialist at NYU comments, "In a painless, three to five minute oral cancer screening, most of the signs and symptoms of oral cancer can be seen with the naked eye, felt with the fingers, or elucidated during the patient's oral history interview. Suspect tissues can be easily biopsied for a definitive diagnosis. Unlike most other cancer detection exams, the screening for oral cancer does not require any special equipment, is not uncomfortable or expensive, nor require invasive procedures. Any dentist or primary care physician and many nurses and dental hygienists, who have been trained to do oral cancer examinations, are in a position to find the early signs and symptoms of this disease. The dental community, through this partnership with The Oral Cancer Foundation, is positioning itself as the first line of defense against oral cancer through the process of early discovery of suspect tissues. "

Oral cancer kills almost three times as many people as cervical cancer every year, and is responsible for more deaths than from other cancers we hear about more routinely. Yet it continues to remain off the radar to most of the American public. Only recently when actor Michael Douglas was diagnosed with a base of tongue oral cancer, did the disease gain significant visibility.

It is an insidious disease, as in its early development it does not always produce physical symptoms that a person may be aware of, and this makes routine, professional screening highly important. If oral cancer is detected early (in stages 1 or 2), the survival rate can be as high as 80%-90%; but when found as a late stage disease (stages 3 or 4), the chances of survival drop to 20%-30%. Unfortunately, in more than half the cases, oral cancer is found in its later stages, and late discovery and diagnosis are major factors in the high death rate.

The good news is that it does not have to be this way. Like other cancer screenings you engage in such as cervical, skin, prostate, colon and breast examinations, opportunistic oral cancer screenings are an effective means of finding cancer at its early, highly curable stages.

Brian Hill, an HPV+ stage four oral cancer survivor and OCF Founder said, "Reducing the high death rate associated with oral cancer is a tangible opportunity today. We have seen early detection positively impact the death rates of many other cancers. The most notable is our sister disease, cervical cancer. Like oral cancer, it is predominantly squamous cell carcinoma, and is caused almost exclusively by the same HPV virus group. In the 1950's when American women began getting an opportunistic annual cervical screening, we saw the death rate associated with it drop dramatically. A reduction in oral cancer deaths is not waiting on a new scientific discovery, diagnostic device, intervention, or treatment to make it occur. We do need increased public awareness, coupled with an engaged professional dental and medical community doing opportunistic screenings, to make death reduction a reality. The American public needs to avoid known risk factors and make sure that they receive an oral cancer exam at least annually."