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Saturday, December 21, 2013

Human papillomavirus (HPV) and oropharyngeal cancer. An update on prevention from the CDC.

Human papillomavirus (HPV) can cause serious health problems, including genital warts and certain cancers. However, in most cases HPV goes away on its own before causing any health problems. The same types of HPV that infect the genital areas can also infect the mouth and throat. Some types of oral HPV can cause cancers of the head and neck. Other types of oral HPV can cause warts in the mouth or throat.

HPV can cause cancers in the back of the throat (oropharynx), most commonly in the base of the tongue and tonsils. These cancers are called “oropharyngeal cancers.” Cancer caused by HPV often takes years to develop after initially getting an HPV infection.  It is unclear if having HPV alone is sufficient to cause oropharyngeal cancers, or if other factors interact with HPV to cause these cancers. 

Signs and symptoms oropharyngeal cancers may include persistent sore throat, earaches, hoarseness, enlarged lymph nodes, pain when swallowing, and unexplained weight loss. Some individuals have no signs or symptoms or may only have a lump in the neck as the initial presentation.

Knowing whether ones cancer was caused by HPV may help physicians determine the prognosis for survival.  Head and neck cancers caused by HPV infection respond better to current treatments as compared to head and neck cancers caused by tobacco or alcohol use.  There are also new treatment options such as vaccine clinical trials and de-intensification radiation protocols available to patients whose cancers are caused by HPV.

About 7% of people in the USA have oral HPV. But only 1% of them have the type of oral HPV that is found in oropharyngeal cancers (HPV type 16). Oral HPV and cancers of the oropharynx are about 3 times more common in men than in women. About 8,400 people are diagnosed in the USA with cancers of the oropharynx caused by HPV. This means that the annual risk of acquing head and neck cancer in those who are HPV positive is about 1 in 20 000.

Oncogenic oral HPV infection is detectable in most patients with HPV associated oropharyngeal cancer, but the incidence of such HPV infection in long-term sexual partners is not increased beyond the one seen in the general population.

It is uncertain how people get oral HPV. Some studies suggest that oral HPV may be passed on during oral sex (from mouth-to-genital or mouth-to-anus contact) or open-mouthed (“French”) kissing, others have not. The likelihood of getting HPV from kissing or having oral sex with someone who has HPV is not known. One can reduce the risk of getting HPV by using condoms and dental dams during oral sex, since they serve as barriers, and can stop its transmission from person to person.

There is no FDA-approved test to diagnose HPV in the mouth or throat, and medical and dental organizations do not recommend screening for oral HPV.

HPV vaccines that are now on the market were developed to prevent cervical and other genital cancers. It is possible that HPV vaccines might also prevent oropharyngeal cancers, since the vaccines prevent an initial infection with HPV types that can cause oropharyngeal cancers, but studies have not yet determined if HPV vaccines will prevent oropharyngeal cancers.