HPV & cervical cancer screening

HPV test approved for cervical cancer screening


By Elizabeth Landau and Val Willingham, CNN

(CNN) -- The FDA announced approval Thursday of the human papillomavirus DNA test as a primary screening method for cervical cancer.

The U.S. Food and Drug Administration initially approved the HPV DNA test in 2011, for use alongside or as a follow-up to a Pap test, but this is the first time it has been green-lighted as a primary screening technique.

The FDA announced approval of the method on Thursday after an FDA advisory committee unanimously recommended in March that the HPV test become the first line of screening for the deadly disease.

The approval is limited to women over the age of 24.

Developed by Roche Molecular Systems Inc., the cobas HPV Testcan be used to see if a woman needs additional screening for cervical cancer and to gather information about her future risk.

The Pap test -- the standard for 60 years -- is designed to look for abnormal squamous cells that could indicate cervical cancer, while the HPV test looks for DNA from the virus. A vaginal swab is required for both the Pap test and the HPV DNA test, so you won't notice a difference at the doctor's office.

"The potential benefit of (the HPV test) is that everybody that has a precancerous change or cervical cancer will have a positive test," said Dr. Kevin Ault, professor at the University of Kansas Medical Center in Kansas City. "You're not going to miss anybody."

There are other HPV tests out there, but this one can detect the most problematic strains -- HPV 16 and 18. The test can also detect DNA from 12 other types of HPV that are associated with an increased cancer risk. HPV causes more than 99% of all cervical cancers.

The problem with any HPV test is that a lot of women -- between 2% and 10% -- will test positive for the virus, Ault said. And most women who get HPV don't develop cervical cancer.

HPV is so common that at least 70% of people who are sexually active will get a genital HPV infection at some point in their lives, according to the National Cancer Institute.

"Most people who get HPV only have it for a few months or a year and then it goes away," Ault said. "It's really the people it persists in that are going to the problem."

But how do we know who with HPV will likely develop cervical cancer? Positive results on the HPV test will necessitate further screening, he said. Patients who test positive may have to have a Pap smear as well, and potentially biopsies and other procedures.

"The disadvantage is a lot of people are going to be scared," he said.

If this new test is adopted as the primary screening method, Ault said, doctors can focus their Pap examinations on women who are already known to have HPV.

In most cases, patients who don't have HPV are less likely to need a Pap, which is why the advisory committee felt it best to recommend the Roche test be administered as the first form of detection, women's health experts say.

If both the Pap smear and the HPV test are negative, that would mean the patient essentially has almost no chance of developing cervical cancer in the next five years, Ault said.

"Every year, 12,000 women are diagnosed in the U.S. with cervical cancer. This is especially tragic because cervical cancer is a largely preventable disease, and it is well established that HPV is the cause of almost all cervical cancers worldwide. Women need better access to screening tools that include primary HPV screening in order to reduce their risk of developing cervical cancer," said Dr. Thomas Wright Jr., an expert in gynecology and pathology at Columbia University Medical Center.

Many gynecologists are used to doing routine Pap tests, so the HPV test may take a little while to replace the traditional pap smear, Ault said.

But Thursday's approval of the test does not change current practice guidelines.

Cervical cancer screening guidelines are usually proposed through organizations such as the American Cancer Society or the American College of Obstetricians and Gynecologists. The FDA's role is in approval of the test itself.

#HPV Test for Women

I love this! -- Dr. Dale.



FDA Approves HPV Test as Initial Screen for Cervical Cancer

Detects presence of high-risk strains of virus believed to cause disease

By Steven Reinberg HealthDay Reporter

THURSDAY, April 24, 2014 (HealthDay News) -- The U.S. Food and Drug Administration on Thursday approved a human papillomavirus (HPV) test as a first step in cervical cancer screening for women aged 25 and older.

"Today's approval offers women and physicians a new option for cervical cancer screening," Alberto Gutierrez, director of the Office of In Vitro Diagnostics and Radiological Health at the FDA's Center for Devices and Radiological Health, said in an agency news release.

HPV, a sexually transmitted virus, is thought to cause the majority of cervical cancers. Certain strains, such as HPV 16 and 18, are most strongly tied to these tumors. The virus also causes genital warts in both men and women and certain head and neck cancers.

Roche Molecular Systems Inc. makes the cobas HPV test. Women who test positive for the two high-risk HPV strains (16 and 18) would then be asked to undergo a colposcopy. This involves using a device that allows a doctor to get a clear view of the vulva, vagina and cervix and take a sample for further testing.

Women who don't have HPV 16 or 18 but have other high-risk types of the virus would have a Pap test to see if a colposcopy is needed, the FDA said.

One expert welcomed the test's approval.

Dr. Jill Rabin, head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y., called the FDA approval "quite exciting."

But she tempered her enthusiasm with "some caveats," noting that "in many cases an HPV infection may resolve on its own." Rabin also stressed that "most -- but not all -- cervical cancers are caused by HPV," so the test is not foolproof.

The data the FDA reviewed for its decision came from a trial that included more than 47,000 women.

The FDA first approved the cobas HPV test in 2011, to be used with or as a follow-up to a Pap test. Thursday's approval expands the use of the test as either a "co-test" or as an initial screening test for cervical cancer. But, it doesn't change current guidelines for cervical cancer screening.

According to the U.S. Department of Health and Human Services, women should have a Pap test every two years starting at age 21. Women aged 30 and older who've had three normal Pap tests in a row can now have one every three years. Women older than 65 may be able to stop having Pap tests, but should discuss the matter first with their doctor.

Typically, an HPV infection clears up on its own and doesn't lead to health problems. But, about 10 percent of women infected with high-risk HPV develop a persistent infection that may put them at risk of cancer, the FDA said in the news release.

The FDA approval followed a unanimous vote by the agency's Medical Devices Advisory Committee Microbiology Panel in March that concluded the test was safe and effective as a first-line screen for cervical cancer.

Testifying before that expert panel, Dr. David Chelmow, chair of the department of obstetrics and gynecology at Virginia Commonwealth University School of Medicine, said that "cervical cancer screening has been a huge success in decreasing cervical cancer incidence and death."

Chelmow, representing the American College of Obstetricians and Gynecologists, added that "the college strongly supports further improving cervical cancer screening through the introduction of new paradigms such as HPV testing for primary screening. HPV testing as a primary screening method for cervical cancer is very promising, and appears effective for screening for cervical cancer."

Dr. Andrew Menzin, a gynecologic oncologist at North Shore University Hospital in Manhasset, N.Y., told HealthDay that "HPV testing has been a remarkable advance in cervical cancer screening."

Its greatest value is helping to decide whether a follow-up colposcopy is needed, he said. "The idea of reversing the order of testing is an approach to try to refine and minimize who [unnecessarily] goes on to colposcopy," he said.

Whether doctors will accept using an HPV test first instead of a Pap test will depend upon the clinical trial data supporting it and on doctors and patients being educated about it, Menzin said.

He noted that current guidelines still favor using the Pap test first, "but the guidelines continue to evolve."

There are two approved vaccines, Gardasil and Cervarix, that can protect against HPV. The U.S. Centers for Disease Control and Prevention recommends that all girls and boys be vaccinated between the ages of 9 and 11.

More information

For more on cervical cancer, visit the American Cancer Society.

HPV-Linked Throat Cancer May Have Telltale Signs

Hi friends, This article from WebMd is very important - I hope you all get a chance to read it.

-- Dr. Dale




Signs of potential trouble could be different in people without the virus, study suggests

The first symptoms of throat and mouth cancer -- also known as oropharyngeal cancer -- may differ depending on whether the condition is caused by the human papillomavirus (HPV), a small study suggests.

Oropharyngeal cancer arises in the throat, soft palate, tonsils or base of the tongue. Smoking is a major risk factor, as is chronic infection with certain strains of HPV -- which causes warts in the genitals, mouth and anus, and is the most common sexually transmitted disease in the United States.

Although oropharyngeal cancer is relatively uncommon, the rate of HPV-linked cases has been rising -- particularly among white adults younger than 55. The reasons aren't clear, but experts suspect that changes in oral sex practices have a lot to do with it.

The U.S. Centers for Disease Control and Prevention estimates that each year about 8,400 Americans are diagnosed with HPV-related oropharyngeal cancer.

"We're seeing this in younger, healthy people who don't smoke," said Dr. Terry Day, senior researcher on the new study and a specialist in head and neck cancers at the Medical University of South Carolina, in Charleston.

Despite the concerning rise in oropharyngeal cancers, Day said, there has been a lack of research into the initial symptoms -- including whether the signs of HPV-linked tumors are distinct.

So his team looked at records for 88 patients diagnosed with oropharyngeal cancer at their center between 2008 and 2013. Most -- 71 -- had HPV-positive cancer, and for them the most common first symptom was a lump in the neck.

Half of those patients had a "mass" in the neck, versus only 18 percent of patients with HPV-negative cancer, Day's team reported in the March 20 online issue of JAMA Otolaryngology--Head & Neck Surgery.

For the patients without HPV infection, a persistent sore throat and difficulty swallowing were the most common first signs. More than half complained of a sore throat, while 41 percent had problems with swallowing.

Some patients with HPV-linked cancer had those symptoms, too, but less commonly: 28 percent had a stubborn sore throat, and only 10 percent had trouble swallowing, the findings showed.

An expert who reviewed the study called the findings "interesting," but said they should be interpreted with caution.

Larger studies are needed to confirm the results, said Maria Worsham, research director in the department of otolaryngology/head and neck surgery at Henry Ford Hospital, in Detroit.

Plus, Worsham said, the symptoms these study patients reported are not unique to cancer. So people should not assume that a lump in the neck means they have cancer -- or oral HPV, she said.

Another expert not involved with the study said that a lump could indeed be an infection that just needs a round of antibiotics.

But if the mass persists, see your doctor again, added Dr. Dennis Kraus, director of the Center for Head and Neck Oncology at Lenox Hill Hospital, in New York City.

According to Kraus, the findings help "codify" what many doctors have noted: that people with HPV-positive oropharyngeal cancer tend to have no symptoms, but instead notice a lump.

The "good news," Kraus said, is that HPV-positive cancers generally have a better prognosis. Patients with HPV-negative cancers tend to have a more-aggressive disease -- and, therefore, obvious symptoms like an irritated throat and difficulty swallowing.

Kraus agreed with Day that the face of oropharyngeal cancer has changed from years ago. HPV-positive tumors are now more common than HPV-negative ones, he said.

According to the CDC, about 7 percent of Americans have oral HPV, though only 1 percent have the particular strain (HPV-16) that's linked to oropharyngeal cancer.

Usually, the immune system is able to clear HPV from the body, and most people never know they were infected.

But for reasons that aren't clear, some people harbor chronic HPV infections. Persistent infection with a cancer-linked strain is the big worry: Nearly all cases of cervical cancer, for instance, are caused by HPV.

There are, however, two vaccines against the most common cancer-linked HPV strains -- including HPV-16. Experts recommend all children ages 11 and 12 be vaccinated. Older girls and women up to age 26 should get "catch-up" shots if they've never been vaccinated. The same advice goes for boys and men ages 13 to 21.

The vaccines -- Gardasil and Cervarix -- are known to ward off genital and anal HPV infections. Studies on whether the vaccines prevent oral infections are just starting. But, Kraus noted, they do target the major HPV strain linked to oropharyngeal cancer.

HPV test awareness, knowledge still low

Friends, I love hearing about HPV awareness in our nation, and how great it is.  However, if only those who I see day after day with diagnosed-HPV had been as educated.

I want to stop this cycle of amazing and brilliant people getting hurt solely by not being informed.  HPV education and prevention wasn't taught in school back in the days.  So now it's up to us to share the message.  And it's up to doctor's like me to lead the pack.   Let's do this.

I got you.

-- Dr. Dale


HPV test awareness, knowledge still low

By Shereen Jegtvig

NEW YORK (Reuters Health) - Americans are more aware that there is a test for the human papilloma virus (HPV) than counterparts in the UK and Australia, according to a new study, but few people knew much more than that.

"Awareness of HPV has tended to be low but has been rising since the introduction of testing and vaccination," said Jo Waller, the study's senior author.

People seem to be more aware of HPV vaccination than testing, however, which is not surprising given the publicity around the vaccine, added Waller, a public health researcher at University College London.

The Pap test, used to look for abnormal cell changes in the cervix, is much older and generally familiar to most people, but the newer HPV test looks for the virus that causes those changes, Waller said.

The HPV test was only introduced in the 1990s and it's used a little differently in each of the countries that were included in the new study, Waller pointed out.

In the U.S., HPV testing is used as a screening tool in women over the age of 30. In both the U.S. and the UK, HPV testing is also used along with the Pap test to determine the next steps in treatment - for instance, biopsy.

In the UK and Australia, the HPV test is also used to monitor treatment results.

Waller said that many studies have attempted to assess the public's knowledge about HPV and HPV testing, but they all used different methods and asked questions in different ways, so it's hard to compare the findings.

"We wanted to use the same questionnaire to look at knowledge across three countries where HPV testing is used in different ways," she told Reuters Health in an email.

The researchers used an online survey to find out if participants in the U.S., UK and Australia were aware of HPV testing and HPV in general.

The first question asked was 'Before today, had you ever heard of HPV?' Participants who responded 'yes' were then directed to 15 general questions about HPV.

Participants were then asked 'Have you ever heard of HPV testing?' Those who responded 'yes' were asked six more questions about the test.

Of the 2,409 men and women who answered the survey, about 61 percent had heard of HPV, Waller's team reports in the journal Sexually Transmitted Infections.

Among those who had heard of the virus, only half were aware of the HPV test. Awareness of the HPV test was higher in the U.S. than in the UK and Australia.

The participants who had heard of HPV testing, on average, answered less than half of questions about details of testing correctly. Overall, women knew more than men.

Most of the survey participants did know, for example, that the HPV test can be done at the same time as the Pap test, and that a positive HPV test doesn't mean a woman will definitely get cervical cancer.

But they didn't know a negative HPV test indicates a low risk of cervical cancer. Few also knew that the HPV test is not an indicator of whether the HPV vaccine is needed.

"It's also important for people to understand that although the HPV vaccine protects against HPV, it's still really important for women to have screening, to check for (virus) types not covered by the vaccine," Waller said.

Women who are screened and found not to have the HPV virus should be reassured that their risk of developing cervical cancer over the next five years is extremely low, Waller added.

SOURCE: bit.ly/1aLPRNE Sexually Transmitted Infections, Online January 9, 2014.

HPV & Cervical Cancer: What You Should Know

Hi friends - this is an informative article on the HPV-cervical cancer connection.  Read this please, and if you have any concerns concerning protection, please come see me in the office or email me privately.  I got you. -- Dr. Dale


When a woman's Pap smear—a test for detecting precancerous or cancerous cervical cells—is abnormal, and she is diagnosed with human papilloma virus (HPV), she may feel pretty worried. After all, each year, American women develop more than 20,000 HPV-related cancers. Cervical cancer is the most common, but HPV is also associated with other cancers such as vulva, vaginal, penile, anal and throat cancer.

While a HPV diagnosis is troubling—and certainly nothing to take lightly—in most cases, there is no need to panic. The HPV virus appears to be able to "clear" on its own in young, healthy women, so a woman who receives an abnormal Pap one year may have a normal one the following year. “At least 80 percent of young women will be HPV positive at some point,” says Mary Jane Minkin, MD, clinical professor at Yale School of Medicine’s Department of Obstetrics, Gynecology and Reproductive Sciences and author of A Woman's Guide to Sexual Health. In other words, most instances of the virus won't progress to full-blown cancer.

Still, no one can assume her body will clear the virus—particularly women ages 30 and older. Additionally, while most types of HPV resolve spontaneously, certain strains of the virus are more likely to persist and cause precancerous cell changes that can lead to cervical lesions. So the more you know about HPV and how to avoid it, the safer you’ll be. Below are ways to guard yourself against this ubiquitous sexually transmitted infection.

Get vaccinated. The U.S. Food and Drug Administration (FDA) has approved two HPV vaccines. Gardasil protects against four strains of the virus (out of more than 100), says Minkin: “The high-risk ‘baddies’ are strains 16 and 18, which account for about 70 percent of cervical cancers.  Strains 6 and 11 are responsible for yucky warts. That’s why Gardasil protects against those four.”

The other vaccine, Cervarix, protects against HPV 16 and 18 but not HPV-related warts. Both are given in three injections over six months.

“All kids—girls and boys—need to be immunized,” says Minkin. Both vaccines are approved for ages 9-25. It’s best to get the vaccine before becoming sexually active. Some insurance plans cover the vaccines, as does Medicaid, and both manufacturers also offer help for those who can’t afford them (about $130 per dose).

The vaccines are not approved for people over age 26 because studies have not shown them to be effective in older people, but women 26+ can protect themselves by getting regular screenings for HPV, following up on abnormal results, having limited sexual partners (one, preferably), and making sure any sexual partner is infection-free.

Read more: http://www.eveningtribune.com/article/20140121/NEWS/301219922/2153/LIFESTYLE#ixzz2rTxtcmUH Read more: http://www.eveningtribune.com/article/20140121/NEWS/301219922/2153/LIFESTYLE#ixzz2rTwioMAK

5 ways to die in 2014.

The Centers for Disease Control and Prevention (CDC) has announced the top 5 threats for 2014.  Check out #4.  #HPV We're two weeks into the New Year.  Let's get you checked.  Later is today.

I got you.

-- Dr. Dale



Top 5 health threats looking ahead in 2014:

 1.  Antibiotic Resistance & Advanced Molecular Detection

Coping with untreatable infections in The End of the Antibiotic Era 

Every year, more than 2 million people in the U.S. get infections that are resistant to antibiotics and at least 23,000 people die as a result. CDC recently reported a first-ever snapshot of the burden and threats posed by the antibiotic-resistant germs that have the most impact on human health and identified four essential steps to combat antibiotic resistance. In 2014, CDC will continue to work with federal, state, and local partners towards improving antibiotic use, preventing infections and the spread of resistance, gathering data on antibiotic-resistant infections, and developing diagnostic tests to track the development of resistance. Also, with advanced molecular detection (AMD), CDC, public health partners, and healthcare facilities will be better able to track and stop the spread of drug-resistant infections in healthcare facilities, thereby protecting patients and saving lives. (Right photo: CDC microbiologist, Tatiana Travis, sets up real-time polymerase chain reaction (PCR) test to detect drug-resistant pathogens.)

2. Prescription Drug Abuse and Overdose

Reducing the number of misuse, abuse or overdose amidst a growing epidemic

Deaths from prescription painkillers have reached epidemic levels in the past decade, and more than 16,500 people died from painkiller overdoses in 2010. CDC is working to reduce the misuse, abuse and overdose of prescription painkillers while ensuring patients with pain have access to safe, effective treatment. CDC continues to track prescription drug overdosetrends to better understand the epidemic. And, in 2014, will continue to focus on comprehensive state efforts to develop, implement and evaluate promising strategies to prevent prescription drug abuse and overdose.

3. Global Health Security

Securing our global health borders knowing that disease can spread nearly anywhere within 24 hours

Infectious disease outbreaks, whether natural, intentional, or accidental, are still among the foremost dangers to human health and the global economy. With patterns of global travel and trade, disease can spread nearly anywhere within 24 hours. That’s why the ability to prevent, detect and respond to these disease threats must be developed and strengthened overseas and not just here in the U.S. Through strategic investments in critical public health systems, CDC is working with Ministries of Health to increase their ability to prepare for and respond to public health threats and reduce the risk of these threats crossing borders.

4. HPV

Preventing cancer in the U.S. by vaccinating preteens and teens  

For both boys and girls, HPV vaccination rates continue to be well below the Healthy People goals for 2020, leaving an entire generation susceptible to HPV-related cancers. CDC will continue to monitor adolescent vaccination coverage levels via the National Immunization Survey (NIS) – Teen. Additionally, we will provide technical assistance to 11 immunization program awardees that received funding to improve HPV vaccination coverage levels among adolescent girls and boys. We will also continue outreach and education to clinicians through continuing medical education, partnership with professional associations, and other educational opportunities to help strengthen vaccine recommendations and eliminate missed opportunities for HPV vaccination. Finally, utilizing partnership building and media outreach, CDC will continue awareness activities aimed at parents of 11-12 year olds to help promote understanding and uptake of HPV vaccine.

5. Polio

Coming together to end polio once and for all

The world is closer than ever to ending polio everywhere, thanks to the efforts of CDC and the Global Polio Eradication Initiative. However, challenges must be addressed in 2014 to meet the goal of eradicating polio once and for all. Insecurity is the biggest challenge. Active conflict, military operations and/or local bans on immunizations prevent polio vaccinators from reaching approximately two million children in high-risk areas. Overcoming this challenge is a critical step towards ending polio and improving the lives of the world’s most vulnerable children. Working together as part of a committed global effort, we are confident that we will be able to change history and end polio forever. (Left photo: Child polio drops in Nepal. Photo Credit: Adam Bjork, 2011)

If you’re gay and you know it clap your hands. AND THEN READ THIS!

Happy Cervical Health Awareness Month! Wait. What? January is Cervical Health Awareness Month.  As an M.D. specializing in HPV, how can I not spend some time honoring such an important health topic.

HPV, the virus underlying genital warts and anal cancer in men, is one of the most commonly treated areas in my office.  Even though much of the HPV talk in the news is concerned around women and cervical cancer, there are many concerns that affect men.

Are you gay?  Or bisexual?  According to the Center for Disease Control and Prevention, you are 17 times more likely to develop HPV-related anal cancer than heterosexual men.  Why?  Well, anal cancer is one hint.  Also, “men with weakened immune systems, including those who have HIV, are more likely than other men to develop anal cancer.  Men with HIV are also more likely to get severe cases of genital warts that are harder to treat.”

In a study from 2011, it was found that more than 50% of men over the age of 15 have been infected with HPV.  The study also stated that “each year roughly 6% of men will contract a new infection of the strain that is most associated with cervical cancer in women — HPV 16.”

It’s important to know that although the overall rates of cancers are declining, the National Cancer Institute states that HPV cancers are on the rise.

PLEASE come see me if you have any questions or concerns about HPV, or if you notice anything abnormal about your body.  You can ask me anything.

I’ve saved many lives and will continue to spread the word to educate my patients, friends, family and the internet.   Don’t be afraid.

I got you!

— Dr. Dale


Study Ties Poor Oral Health to Cancer-Causing Virus

A couple weeks ago I blogged about Oral Health and its link to HPV.  Here it is again in the New York Times.  Such a great read.  -- Dr. Dale ----------


AUGUST 21, 2013, 1:09 PM

Study Ties Poor Oral Health to Cancer-Causing Virus


People with swollen gums, missing teeth and other signs of poor dental health are more likely to be infected orally with the human papillomavirus, researchers reported on Wednesday.

HPV, a sexually transmitted virus, causes cancers of the cervix, mouth and throat. The new study, published in Cancer Prevention Research, is the first to document a link between the infection and poor oral health, but other experts noted that the research found only an association and relied mostly on self-reported data about oral health. It is too early to say with confidence that brushing and flossing regularly can prevent oral HPV infection, they said.

The finding is a “modest association,” said Aimée R. Kreimer, an epidemiologist at the National Cancer Institute who was not involved in the study. “We don’t know if poor oral health causes HPV infection and would go on to cancer,” she said.

This finding suggests another potential downside to deficient hygiene “because of a possible association between poor to fair oral health and the presence of the human papillomavirus, which in itself is identified with several diseases,” said Dr. Sol Silverman, a professor of oral medicine at the University of California, San Francisco, and a spokesman for the American Dental Association.

Researchers at the University of Texas Health Science Center at Houston reviewed data on both high-risk and low-risk oral HPV infection and oral health in 3,439 adults, ages 30 to 69, participating in the nationally representative 2009-10 National Health and Nutrition Examination Survey, known as NHANES. The study found that being male, smoking cigarettes, and having multiple oral sex partners increased the likelihood of oral HPV infection, findings similar to those in an earlier analysis of NHANES data.

But after controlling for smoking and the number of oral sex partners, the new study found that self-rated poor oral health was an independent risk for oral HPV infection. The odds of having an oral HPV infection were 55 percent higher among those reporting poor to fair oral health.

Throat cancer caused by HPV is increasing, particularly along middle-aged white men. About 25,000 cases a year are diagnosed in the United States. Many experts believe oral infection with the virus has increased along with the frequency of oral sex.

“What we think might be happening is if you have poor oral health — ulcers, gum inflammation, sores or lesions, any openings in the mouth — that might provide entry for HPV,” said Christine Markham, the second author on the paper and an associate professor of health promotion and behavioral sciences at the University of Texas Health Science Center at Houston. “We don’t have sufficiently strong evidence to demonstrate that conclusively in the study, but that’s our thinking.”

Yet the increase in risk is modest, said Dr. Kreimer, “less than the two- to threefold elevations in risk that cause concern.” And three of the four measures used to assess the participants’ oral health, including the presence of gum disease, were self-reported, a limitation of the study. One measure — number of teeth lost — was reported by dental hygienists.

“It’s the first paper linking self-reported measures of poor oral hygiene and an oral HPV infection,” Dr. Maura L. Gillison, a professor of medicine at Ohio State University, who was not involved in the study. “It’s a strong paper because it’s a first, but does it have public health significance? Should people change their behavior? I would say no.”

Oral cancers caused by HPV are typically found near the tonsils or at the base of the tongue, she added, and it’s hard to see how those regions could be directly affected by periodontal inflammation.

Experts including Dr. Gillison nonetheless called the study an important first step. “Further study — even though it would be expensive and time-consuming — should be considered,” said Dr. Silverman.

HPV viruses linked to growth in oral cancers

Friends and Patients, It used to be that oral cancers were attributed to heavy smoking and drinking.  Now HPV has jumped up as the "number one cause of oropharyngeal cancer," according to Dr. Robert I. Haddad, the disease center leader of the Head and Neck Oncology Program at Dana-Farber Cancer Institute, in Boston, Massachusetts.



HPV viruses linked to growth in oral cancers

Howard Manly | , Karen Miller | 8/12/2013

While the annual report on the status of cancer in this country indicated a decline in the incidence and death rates of all cancers combined, some particular cancers did not fare that well. HPV-related cancer of the throat is one of them.

You don’t have to explain that to Dr. Robert I. Haddad, the disease center leader of the Head and Neck Oncology Program at Dana-Farber Cancer Institute. “I see two patients a week for HPV-related head and neck cancer,” he explained. “It’s very common and now the number one cause of oropharyngeal cancer.”

Oropharyngeal cancer affects the throat, back of the tongue and tonsils. For HPV-associated cancers, it trails only cervical cancers in number and medical experts predict that if the current trend continues, these oral cancers will move to first place. More than 50 percent of the cases are caused by HPV 16.

According to the Centers for Disease Control and Prevention (CDC) almost 12,000 new cases are confirmed each year, and men bear the brunt of the illness at 80 percent of the diagnoses. The rate of occurrence in white and black males is similar, according to the latest CDC data.

Although the statistics are clear, the reasons for the uptick are less so. Haddad agrees. “It is difficult to pinpoint the reason for increased incidence of oral cancer,” he said.

Some clinicians blame oral sex. A 2012 CDC report on the prevalence of oral sex found that roughly two-thirds of males and females aged 15-24 had engaged in oral sex, and cited birth control as a reason. Indeed, non-coital sex prevents pregnancy, but not sexually transmitted diseases.

Even more puzzling is the description of patients diagnosed with throat cancer. The typical patient is now a non-smoker and non-drinker male in his mid- 40s or early 50s. At one time, oral cancers were more commonly attributed to heavy smoking, especially when combined with heavy drinking. Victims were generally in their 60s.

There are no FDA-approved tests to detect HPV infections in men. Nor are there screening methods similar to Pap smears to find cell changes caused by HPV infections of the throat, but that does not mean one should not be vigilant. There are tell-tale signs. A sore throat and difficulty swallowing are two of them. A lump in the neck or enlarged tonsils is another. “The lump should bring you into the doctor’s office right away,” cautioned Haddad.

Doctors often rely on dental hygienists and dentists to spot the problem. “They are in a unique position to examine the mouth,” Haddad explained. “We rely on them to be the first line of detection.”

Prevention is key. “We talk about not smoking and drinking to prevent oral and other types of cancer,” he said. “We have to emphasize vaccination as well.”

Although there has been no research on the impact of HPV vaccination on throat cancer, Haddad argues there is little reason to believe it will not affect HPV-related oral cancer as well. Yet the vaccination rate, especially among males, is very low. “Many parents think this is taboo and are uncomfortable having it done,” explained Haddad.

HPV-related throat cancer is treated by surgery, chemotherapy and radiation and depends on the stage of diagnosis. The good news is that the treatment works well. According to the American Cancer Society, oropharyngeal cancers that contain HPV DNA tend to have a better outlook than those without HPV. Still, treatment comes with long-term side effects. “The treatment is difficult and can affect speech,” Haddad explained. People have difficulty with dry mouth. Anxiety and depression are common.

“Many people will be cured, but it won’t be easy,” he warned.

HPV vaccine involving Sanford researcher moving to clinical trials

This is such great progress! -- Dr. Dale



SIOUX FALLS, S.D. - Etubics Corp. has received a $1.03 million grant from the National Institutes of Health to move a vaccine for human papilloma virus (HPV) developed by a Sanford researcher to clinical trials. The vaccine was engineered by Sanford Research’s Dr. John Lee and his team in collaboration with Etubics.


In October, a study led by Lee and published by Cancer Gene Therapy indicated a Etubics drug (Ad5 [E1-, E2b-]), when used in conjunction with chemotherapy and radiation, successfully improved long-term survival of animals expressing HPV.


The grant will support the necessary pre-clinical experiments to allow Etubics’ HPV vaccine, which targets head and neck cancers, to enter into clinical trials.


The Etubics drug delivers E6 and E7 proteins of HPV (HPV-E6/E7) as a safe vaccine, giving it the ability to deliver a long lasting "active" immune response against cancer targets and educating the immune system's T-cells to act as if the cancer is a simple virus.


“While the results of our trials in animal models were exciting, the potential of translating this vaccine to a human application could be a game changer,” said Lee, a Sanford Clinic ear, nose and throat specialist. “The incidence of head and neck cancer is on the rise, and research has indicated that HPV is playing a key role in that.”


HPV is the leading cause of more than 90 percent of cervical cancers and is linked to 60 percent of head and neck cancers, according to the Centers for Disease Control and Prevention. Currently, no HPV therapeutic vaccine is effective at treating established tumors, despite its success with preventing HPV infection.


Etubics is a clinical stage bio-pharmaceutical company with a proprietary platform vaccine technology that delivers a long lasting "active" immune response against diseases.