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Human Papilloma Virus (HPV) and Rising Oral Cancers

February 12, 2018

Science is increasingly finding more connections between our systemic health, or our entire bodies, and the health of our mouths. One of these connections being seen is with Human Papilloma Virus, or HPV, and a stark increase in head and neck cancers that stem from this virus.

 

HPV, What is It?

 

HPV is a group of 150-200 related viruses, some of which cause Papillomas, or warts. Some of the strains also cause cancer, which can include the head and neck cancers (which will be discussed later), Penile cancer in men and Cervical, Vaginal, and Vulvar cancers in women.

 

One of the factors that makes HPV so alarming is that it is the most common Sexually Transmitted Infection (STI). HPV affects 79 million Americans, mostly in people in their late teens and early twenties.  Everyday in the United States, about 12,000 people aged 15-24 are infected with HPV, and on any given day about 26 million Americans have an oral HPV infection, with about 2,600 of those being HPV16 (the main cancer-causing strain).

 

The virus is spread by vaginal, anal, or oral sex with someone who has the virus, even if that person shows no signs or symptoms. Essentially anyone who is sexually active can get HPV, even if only active with one partner. What makes it even more difficult is that symptoms can appear years after having sexual activity with someone who was infected.

 

Now the good news is that HPV usually goes away on its own, with no long-term health effects. Problems arise when the infection does not get cleared and lingers, then various strands can cause various issues. Some strands cause warts in the affected areas, others cause cancer.

 

HPV and Cancer

 

There are more than 40 types of HPV that can infect the genital areas, with strands number 16 and 18 being the main two cancer causing types. These strands of HPV account for 70% of all cervical cancers in women.

 

These same strands can also cause cancer in the mouth and throat.  HPV is the leading cause of Oropharyngeal cancer. The risk factors for these oral cancers are like other cancers caused by HPV. The main risk factor being the number of sexual partners an individual has, and the number that partner has had. In other words, even if a person only has one partner, but that partner has had many other partners, then the risk increases. Men are at a 4 to 1 risk over females. Another risk factor is a weakened immune system. People with HIV/AIDS or people on immune suppressing drugs are at higher risk as well.

 

Oral HPV cancers are hard to discover because the symptoms are not always obvious to the infected person or to professionals who are looking for it. Other oral cancers, such as the ones caused by tobacco, often manifest clinical signs, a white patch for example, whereas HPV often does not. Oral cancer screening devices on the market cannot find HPV related cancers.

 

Signs and Symptoms

 

As mentioned before, HPV related cancers can be tough to discover due to the lack of symptoms, and even when symptoms are present, they can be confused for many other ailments. Some symptoms may include:

  • An ulcer or sore that does not heal within 2-3 weeks

  • A red, white, or black discoloration on the soft tissues of the mouth

  • Difficult or painful swallowing

  • A swollen but painless tonsil (they should be the same size)

  • Pain when chewing

  • A persistent sore throat

  • A swelling or lump in the mouth

  • A painless lump felt on the outside of the neck

  • A numb feeling in the mouth or lips

  • Constant coughing

  • An earache on one side which persists

 

Do I Have HPV? How to Know?

 

Finding out if a person has HPV can be very difficult, especially when talking about oral HPV. There are usually no visible oral signs and there are no viricides to kill HPV. For women, HPV can be tested for during a regular Pap test, and the Center for Disease Control (CDC) recommends routine Pap tests with HPV screening. For men, there are currently no genital tests available.

 

How to Avoid HPV

 

 

The best way to avoid HPV is by practicing smart and safe sexual practices. Limiting sexual partners will reduce risk of exposure.

 

There are also two current vaccines (Gardasil and Cervarix) available to prevent HPV infections. The CDC recommends both boys and girls get the vaccine around the age of 11 or 12 before they become sexually active. Catch up vaccines are also recommended for boys through the age of 21 and girls through the age of 26 if they have never been vaccinated.

 

The good news when examining HPV is that for most people, the virus will go away all on its own with two years and cause no problems. Overall it is a small number that will have an HPV infection that will cascade all the way into oral cancer, but that number is increasing every year by about 10%! The graph shows the number of cases diagnosed each year as reported by the CDC. Oral HPV cancers are on the rise at rate that is catching the eye of many oral pathologists across America, which is why it is so important to be informed.

 

 

 

 

 

 

 

 

 

 

For more info visit the CDC’s website

https://www.cdc.gov/std/hpv/stdfact-hpv.htm https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm

Special thanks to Dr. Stephen Williams, an Oral Pathologist in Spokane, WA whose informative lecture on HPV also contributed to this post.

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