Citing the now very well-established link between oral human papillomavirus (HPV) infection and cancers of the tongue, throat and tonsils, the Head and Neck Cancer Alliance (HNCA) has expanded its list of at-risk populations for oral, head and neck cancers to include sexually active adults who engage in common sexual behaviors, such as open-mouth kissing and oral sex.

The HNCA is urgings sexually active adults who may be at risk for these cancers to take advantage of free screenings during the 13th annual Oral, Head & Neck Cancer Awareness Week (OHANCAW), held nationwide April 12-18, 2010.

Incidence and occurrence
Head and neck cancer is the sixth most common cancer, with about 640,000 new cases each year worldwide. Acording to the Centers for Disease Control and Prevention (CDC) an estimated 8,000 people die from oral cancers each year in the United States alone. This is an average of about one death per hour! The American Cancer Society estimates 12,290 new cases and 3,660 deaths from laryngeal cancer in the United States alone [1] estimates that there are approximately 30,000 new oral, head and neck cancer cases combined per year.

According to a study conducted by the University of Maryland and published in the July 2009 of online edition Cancer Prevention Research, HPV is responsible for 50% of oropharyngeal squamous cell carcinomas (sometimes this is called throat cancer, oropharyngeal cancer develops in the part of the throat just behind the mouth, called the oropharynx), which account for half of all oral cancers.

The same study shows that African Americans had far less HPV infection than whites, which led to worse survival.

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“There is currently no consensus on why blacks fare worse with squamous cell carcinoma of the head and neck than whites, but this is the first clue that it may be biologic rather than related to issues of access, insurance or provider attitudes,” noted senior author Kevin Cullen, M.D., director of the University of Maryland Marlene and Stewart Greenebaum Cancer Center and professor of medicine at the University of Maryland School of Medicine.

Research showed that median overall survival was more than threefold higher for whites (70.6 months) than for African Americans (20.9 months) who were treated with chemotherapy and radiation. [2]

Oral sex and HPV-16
Research conducted by Johns Hopkins Bloomberg School of Public Health suggests that individuals who have engaged in oral sex with more than five partners are ? on average – 250% more likely to have throat cancer than those who do not practice oral sex.

After controlling for other risk factors for throat cancer, such as drinking and smoking, the analysis revealed that people who had prior infection with HPV were 32 times as likely to have this cancer as those with no evidence of ever having the virus. The risk further increased for individuals who tested positive for a particularly aggressive strain of the virus, called HPV-16.

People infected with HPV-16 were 58 times more likely to have throat cancer. Individuals with more than five oral sex partners in this group had a 750% increased risk of these HPV-16-caused cancers.

By comparison, either smoking or drinking increases the risk of such cancer by about threefold.
This study showed that there was an even stronger link between oral sex and throat cancers clearly caused by HPV-16 (those tumors that tested positive for the strain). [3]

Signs & Symptoms
Oral, head & neck cancer (OHNC) refers to a variety of cancers that develop in the head and neck region, such as the oral cavity (mouth), the pharynx (throat), paranasal sinuses and nasal cavity, the larynx (voice box), oropharynx, thyroid and salivary glands, the skin of the face and neck and the lymph nodes in the neck. Common warning signs of OHNC are:

? Red or white patch in the mouth that lasts more than two weeks

? Change in voice or hoarseness that lasts more than two weeks

? Sore throat that does not subside

? Pain or swelling in the mouth or neck that does not subside

? Lump in the neck

Other warning signs that occur during later stages of the disease include:

? Ear pain

? Difficulty speaking or swallowing

? Difficulty breathing

Major shift

“Oral, head and neck cancer is no longer a disease primarily of older patients, related to tobacco and alcohol use,” said Kevin Cullen, MD, Director, Greenebaum Cancer Center and Professor of Medicine, University of Maryland. “The bad news is that HPV-positive oral cancer has increased among adults of all ages. The silver lining here is that HPV-positive cancers of the head and neck are more responsive to chemotherapy and radiation treatment and have dramatically better prognoses than HPV-negative cancers, which underscores the importance of early detection.”

Oropharyngeal carcinoma
Despite an overall marginal decline in the incidence of most head and neck cancers in recent years, the incidence of oropharyngeal squamous cell carcinoma has increased greatly, especially in the developed world. A pooled analysis of eight multinational observational studies that compared 5,642 cases of head and neck cancer with 6,069 controls, published in the March 2010 issue of the BMJ, found that the risk of developing oropharyngeal carcinoma was associated with a history of six or more lifetime sexual partners (odds ratio 1.25, 95% confidence interval 1.01 to 1.54), four or more lifetime oral sex partners (3.36, 1.32 to 8.53), and?for men?an earlier age at first sexual intercourse (2.36, 1.37 to 5.05).

The researchers suggest that the increase of sexual transmission of HPV?primarily through orogenital intercourse might be the primary reason for the increase in incidence of HPV related oropharyngeal carcinoma. [4]

Researchers report that cancer of the throat that stems from a human papillomavirus infection generally responds to treatment better than throat cancer that?s triggered by other causes.

“When diagnosed early, oral and other head and neck cancers can be more easily treated without significant complications and the chances of survival greatly increase, especially for patients with HPV-related oral cancers,” said Terry Day, M.D., President of the HNCA, Professor and Clinical Vice Chairman Director, Division of Head and Neck Oncologic Surgery, Medical University of South Carolina. “However, many Americans do not recognize the symptoms of these cancers, which makes screening very important. For this reason, we are encouraging everyone to take advantage of the free, quick and painless screenings that could save their life.”

Psychosocial effects Complications of Oral, Head & Neck Cancer, including oral mucositis,[5] are among the most devastating of both short- and long-term problems encountered by people. Because these cancers they affect eating and communication, the most basic of human activities, patients can become withdrawn, socially avoidant, and even clinically depressed as a result of the difficulties and frustrations they encounter living with oral cancer complications. Physicians treating these patients with psychotropic drug interventions should choose these drugs with an eye toward improving or at least not worsening their oral complications. For example, in the treatment of depression in such patients, highly anticholinergic drugs should be avoided in patients with xerostomia and salivary problems.

In addition to oral HPV infection, tobacco and alcohol use can increase the risk for cancers of the oral cavity, head and neck. Limiting consumption of these products is the most effective prevention strategy and can decrease the likelihood of getting these cancers.

Oral, Head & Neck Cancer Awareness Week (OHANCAW), coordinated by the Head and Neck Cancer Alliance, is a week in April annually dedicated to educating the public about these potentially life-threatening but highly treatable cancers, and to promoting prevention, screening and early detection. During this year’s Oral, Head & Neck Cancer Awareness Week, nearly 200 sites nationally and internationally will offer free oral, head and neck cancer screenings to the public

  1. American Cancer Society. Cancer Facts and Figures 2009. Atlanta, Ga: American Cancer Society, 2009. Also available online Last accessed March 30, 2010.
  2. Settle K, Posner MR, Schumaker LM, Tan M, Suntharalingam M, et al. Racial survival disparity in head and neck cancer results from low prevalence of human papillomavirus infection in black oropharyngeal cancer patients.Cancer Prev Res (Phila Pa) . 2009 Sep;2(9):776-81. Epub 2009 Jul 29 PubMed abstract
  3. D’Souza G, Kreimer AR, Viscidi R, Pawlita M. et al. Case?Control Study of Human Papillomavirus and Oropharyngeal Cancer N Engl J Med. 2007 May 10;356(19):1944-56.
  4. Hisham Mehanna H, Jones TM, Gregoire V, Ang KK. Oropharyngeal carcinoma related to human papillomavirus. BMJ 2010 Mar 25;340:c1439 Pubmed Abstract
  5. Heck JE, Berthiller J, Vaccarella S, Winn DM, Smith EM, et al. Sexual behaviours and the risk of head and neck cancers: a pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. Int J Epidemiol 2009; Publi
    shed online 18 December.
  6. Dodd MJ, Dibble S, Miaskowski C, et al.: A comparison of the affective state and quality of life of chemotherapy patients who do and do not develop chemotherapy-induced oral mucositis. J Pain Symptom Manage 21 (6): 498-505, 2001.

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