While many spouses of patients diagnosed with human papilloma virus (HPV)-positive oropharyngeal cancer (OPC) have anxiety over their own HPV-related cancer risk, a new study, supported by the Johns Hopkins Innovation Fund and the Richard Gelb Cancer Prevention Award, finds that spouses were no more likely to test positive for oral HPV infection than people in the general population.

The Human Oral Papillomavirus Transmission in Partners over Time (HOTSPOT) study is the first large, multi center, study to examine oral HPV infection among patients with HPV-caused oropharyngeal cancer and their spouses.

This HOTSPOT study was designed to evaluates oral HPV infection and risk factors in people with head and neck cancer and their partners or spouses. It focused on oropharyngeal cancer patients and includes patients with HPV-associated and HPV-unassociated disease. A comparison group of people without cancer, so-caled controls, were also being enrolled. Couples were followed longitudinally. In designing the study, researchers hoped that this study would help them to understand risk factors for oral HPV infection, persistence and transmission as well as researching biomarkers for HPV-associated oral cancer and survival.

“While we can’t guarantee that the partners of patients will not develop oral HPV infections or cancers, we can reassure them that our study found they had no increased prevalence of oral infections, which suggests their risk of HPV-related oral cancer remains low,”said lead study author Gypsyamber D?Souza, PhD, MPH, MS, an associate professor of epidemiology at Johns Hopkins Universityin Baltimore, Md.

Sexual behavior
This study results, presented at the Annual Meeting of the American Society of Clinical Oncology(ASCO), being held in Chicago, Ill, May 31, – June 4, 2013, confirms that couples who have been together for several years do not need to change their intimacy or sexual behavior because of the cancer diagnosis.

HPV infection is very common among men and women in the U.S., but the overwhelming majority of individuals with the infection will not get cancer. The incidence of HPV positive head and neck cancers, however, has increased significantly over the past 20 years, particularly among non-Hispanic, white U.S. men.


A study of patients with HPV positive oropharyngeal cancer and theirpartners indicate that partners do not have increased HPV infection compared to the general population and that their risk of developing HPV-related oropharyngeal cancer remains low.


?Patients with HPV-positive oropharyngeal cancers and their spouses often worry about oral HPV transmission and wonder about the spouses? cancer risk,? D?Souza said. ?[But] couples who have been together for several years have likely already shared whatever infections they have and no changes in their physical intimacy are needed.?

HPV-related oral cancers are on the rise among white men in the United States, and fear of transmitting the virus can lead to anxiety, divorce, and curtailing of sex and intimacy among couples, D’Souza explained. Persistent oral HPV infections can lead to the development of oropharyngeal cancers, located at the base of the tongue, tonsils, pharynx, and soft palate.

Study designThe study included 166 individuals with HPV-OPC and 94 spouses/partners. The OPC patients were predominantly male and partners predominantly female. The median age of OPC patients in this study was 56 years. Oral HPV DNA was collected through a 30-second mouth rinse and gargle at diagnosis and again one year later. The oral rinse samples were tested for 36 different subtypes of HPV, including HPV16, the type responsible for most HPV-OPC cases as well as a variety of other cancers.

Prevalence
HPV DNA was detected in 65% of HPV-OPC patients at diagnosis but only 6% of those patients still had oral HPV infection one year later, after having gone through cancer treatment. The overall prevalence of oral HPV among partners was 6.5%. The prevalence among the 88 female partners was 5%, which is comparable to the prevalence among women in the general population (4%, based on previously published data). The prevalence among the small number of male partners assessed in this study was also similar to that among men in the general population, though higher than in the female population.

Taken together, the findings provide reassurance for both female and male partners that their risk of developing HPV-OPC is low. HPV16, the subtype responsible for most cases of HPVOPC, was detected in 54% of HPV-OPC patients but in only 2,3% of female partners and innone of the male partners. No pre-cancers or cancers were detected in the 64% of partners that underwent a visual oral exam.

Researchers emphasized, however, that to better understand oral HPV transmission more couples research is needed among young adults.

Oropharyngeal cancers
Histologically, almost all oropharyngeal cancers are squamous cell carcinomas (SCCs).Other cancers in this area include minor salivary gland carcinomas, lymphomas, and lymphoepitheliomas, also known as tonsillar fossa.[1]

References
[1] Mendenhall WM, Werning JW, Pfister DG: Treatment of head and neck cancer. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 729-80.

For more information:
Abstract #CRA6031: Oral HPV infection in HPV-positive oropharyngeal cancer cases and their spouses.
Poster Discussion Session: Head and Neck Cancer
Study Author: Gypsyamber D?Souza, PhD, MPH, MS, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Date: Saturday, June 1, 2013, 5:15 ? 5:30 PM CDT
Location: Room: E354a

Oropharyngeal Cancer and HPV Research News [Watch the Video]

Clinical trials
NCT01342978Human Papillomavirus (HPV) Oral Transmission Study in Partners Over Time (HOTSPOT)