AU T H O R S:
Marcyann Bencivenga, BA
Penn State Cancer Institute Eugene J. Lengerich, VMD, MS
Associate Director, Penn State Cancer Institute
Kurt Summersgill, DDS, PhD
University of Pittsburgh School of Dental
Medicine Lynne Williams, MD Phd.
Southwest PA Area Health Education Center,
Pittsburgh
Oral health professionals can
make an important impact
upon infections with human
papillomavirus (HPV) and HPV-
related cancers in Pennsylvania.
The prevention of HPV infection
and HPV-related cancers has
been identified as a high priority
by the Centers for Disease
Control and Prevention (CDC),
the Pennsylvania Department
of Health and the Pennsylvania
Comprehensive Cancer
Control Plan.
HPV virus and
1 its What role is in the cancer?
The human papillomavirus (HPV) is a
very common family of viruses (nearly
200 different types and subtypes)
that affect epithelial tissue. While
most strains are harmless and do not
cause cancer, nine strains may lead to
cancers of the cervix and cancer in the
anogenital and oropharyngeal regions.
Oral cancers are mostly associated with
type 16, which is also a primary cause
of cervical and anogenital cancers.
Oral HPV infection can also produce
non-cancerous warts in the mouth or
throat. In addition, some head and neck
cancers can be associated with HPV
infection. Persons infected with HPV
who also use tobacco and alcohol are at
increased risk for certain types of head
and neck cancers.
Each year, HPV is responsible for
approximately 31,500 cancers in the
United States. Approximately 12,500
women are diagnosed with cervical
cancer yearly, resulting in 4,100 deaths.
In Pennsylvania, there are approximately
470 new cases of cervical cancer
and 170 deaths from cervical cancer.
Approximately 2,000 cases of cancer
of the oropharynx occur each year in
Pennsylvania, with 70 percent of these
cancers occurring among men.
What is HPV infection?
2
Every day in the United States, about
12,000 people ages 15 to 24 years are
infected with HPV. It is estimated that
by adulthood, at least 80 percent of
the population will have been exposed
to HPV. The virus is spread by intimate
skin-to-skin contact; peak transmission
is during the teen to young adult years.
Most people who are infected with
HPV never know it because the virus
produces no signs and symptoms.
The vast majority of individuals clear
the infection naturally with their own
immune response.
does HPV affect
3 How
the oral cavity?
At any given time, approximately 11
percent of people, including children,
can have HPV detected in the oral
cavity and oropharynx. Most of the time
these infections are by low-risk HPV
types which are cleared by the immune
system without causing lesions or
cancer.
The most common HPV-associated
lesions in the oral cavity include warts
and papillomas. Clinically, these typically
look like warts, with a rough, white
surface and finger-like projections.
Although they are caused by a virus,
they don’t spread very easily to other
people. Treatment is simple surgical
removal. Another very common low-
risk-HPV-caused lesion is a papilloma.
These can be found on the ventral
tongue, but more commonly in the
posterior oral cavity – the soft palate,
uvula, or tonsillar pillars. These are
usually pink (rather than white), with
round, finger-like projections, or may
look like little cauliflowers. These are a
lso unlikely to spread to other people,
and are treated by surgical removal.
On the other hand, squamous cell
carcinoma (SCC) is relatively uncommon
as compared to warts and papillomas;
however, it is the most common
malignancy of the oral cavity and
oropharynx. Very few SCCs in the oral
cavity contain HPV, and if HPV is present,
it is probably not the actual cause of
the cancer. The main concern with
HPV is cancer in the oropharynx. The
oropharynx is a very different cellular
and tissue environment, as compared
to the oral cavity, and is much more
likely to have a high-risk HPV infection.
When an SCC occurs in the oropharynx,
somewhere between 46 and 80 percent
are caused by the high-risk HPV types,
most commonly HPV-16. Early detection
is key to better treatment outcomes;
however, SCCs in this location are very
hard to detect early due to difficulty
visualizing the tonsillar pillars and
the base of the tongue. Therefore,
prevention of HPV-associated SCC is
of great importance.
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