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 ----------

http://well.blogs.nytimes.com/2013/08/21/study-ties-poor-oral-hygiene-to-cancer-causing-virus/?ref=health&_r=0

AUGUST 21, 2013, 1:09 PM

Study Ties Poor Oral Health to Cancer-Causing Virus

By CATHERINE SAINT LOUIS

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.

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http://baystatebanner.com/news/2013/aug/12/hpv-viruses-linked-growth-oral-cancers/

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.