Answering patient questions about oropharyngeal cancer and HPV
Incidences of tongue and tonsillar cancers, which are associated with human papillomavirus (HPV), have increased steadily between 1973 and 2007, whereas rates of cancers at other oral and pharyngeal sites have decreased. As a result of coverage in the popular media related to this data, you may have experienced an increase in patient questions about the connection between HPV and oropharyngeal cancer.
Oral HPV infection is considered an important risk factor for oropharyngeal cancers for both men and women, even in the absence of smoking and alcohol consumption. Studies have shown that HPV-associated oropharyngeal cancers are higher among men, slightly younger adults (median ages 52-56 years versus 58-60 years for HPV-negative oropharyngeal cancers) and persons with a higher lifetime number of sex partners.
An article in the August 2011 Journal of the American Dental Association summarizes the available evidence of HPV-associated oropharyngeal cancers in the United States and the implications for dentistry. The article includes examples of patient questions about HPV and possible responses from dental health care personnel. Click here to read the full article, "The connection between human papillomavirus and oropharyngeal squamous cell carcinomas in the United States: Implications for dentistry."
A statement from the ADA Council on Scientific Affairs encourages dentists to be aware of the oropharyngeal cancer-HPV relationship, and provide routine intra- and extra-oral soft tissue examinations for all patients, not just those with traditional tobacco use and alcohol consumption risk factors.
ADA clinical recommendations for oral cancer screening state, ". . . recent systematic reviews suggest that human papillomavirus (HPV) is a risk factor for cancers of the base of the tongue and the tonsils. In contrast, HPV does not appear to be a significant risk factor for cancer of the anterior two-thirds of the tongue or the remaining oral cavity. The importance of this distinction is highlighted by evidence that HPV-related carcinomas have a better prognosis overall than do non-HPV-related carcinomas."
Click here to review the complete clinical recommendations regarding screening for oral squamous cell carcinomas developed by the ADA Council on Scientific Affairs. Note these recommendations exclude cancers of the oropharynx most commonly related to HPV.
Recent studies about smoking and oral health
Two reports in the recent news reinforce the link between smoking and poor oral health. A report from the National Center for Health Statistics shows that among dentate adults aged 18-64 there are differences in oral health status and oral health care utilization among current smokers, former smokers, and never smokers. Key findings include:
- Current smokers were twice as likely as former smokers and four times as likely as never smokers to have poor oral health.
- Current smokers were more than two times as likely as never smokers to have had three or more oral health problems.
- Current smokers were about twice as likely as former smokers and never smokers to have not had a dental visit in more than 5 years or have never had one.
- Cost was the reason that most adults with an oral health problem did not see a dentist in the past 6 months; 56% of current smokers said they could not afford treatment or did not have insurance.
In another study published in the American Journal of Public Health, researchers at the University of North Carolina-Chapel Hill concluded that exposure to secondhand smoke for a few hours each day can double a person's risk of severe periodontal disease. However, the results of the study may have been affected by other factors that were unaccounted for. More research is needed.
Free resources for tobacco cessation counseling
Since the Surgeon General's controversial 1964 Report on Smoking and Public Health, the ADA has had a policy to educate and inform its membership and the public about the many health hazards attributed to the use of tobacco. The ADA urges members to become fully informed about tobacco cessation intervention techniques to educate their patients to overcome their addiction to tobacco.
Studies show that tobacco users who receive help from a clinician are more likely to quit successfully. There are many free resources available on ADA.org that can assist you in counseling patients, including this link to guidelines by the U.S. Department of Health & Human Services: Treating Tobacco Use and Dependence: A Public Health Service Clinical Practice Guideline.
The patient education brochure Quit Smoking (Item# W126) can be purchased through the ADA Catalog at a discount for ADA members. To review a sample or order the brochure, visit adacatalog.org or call 1-800-947-4746.