HPV and its link to Oral Cancer

1. HPV and its link to Oral Cancer Lisa Greenwell March 2, 2006 Dr. Karen Skaff

2. Question: • What cell types are found in both the vagina and the mouth? “ E ”

3. The Human Papillomavirus • Sexually Transmitted Disease • 20 million infected • Silent Virus • Usually asymptomatic • Spread via skin-to-skin contact • Causes cancer!

4. HPV and Cancer • Cervical • Skin • Vaginal • Penile • Anal • Oral

5. 8th most common cancer 30,000 new cases each year 8,000 deaths each year 5-year survival rate 52% Oral Cancer

6. Oral Cancer • According to the Mouth Cancer Foundation, “Mouth cancers have a higher proportion of deaths per number of cases than breast cancer, cervical cancer or skin melanoma.” www.rdoc.org.uk/

7. HPV in the Mouth www.lib.uiowa.edu/

8. HPV and Oral Cancer:The Seminal Work • Dr. Maria Gillison & the Johns Hopkins Oncology Center • May 2000 • 253 subjects • Squamous cell carcinomas • HPV detection 25% Gillison et al., 2000.

9. HPV and Oral Cancer:The Meta-Analysis • Dr. Craig Miller at the University of Kentucky • 1982-1997 • 94 studies analyzed • 4680 subjects included • HPV detection 46.5% Miller & Johnstone, 2001.

10. Signs of Early Oral Cancer 1.A sore or ulcer in the mouth that does not heal within three weeks2. A lump or overgrowth of tissue anywhere in the mouth3. A white or red patch on the gums, tongue, or lining of the mouth4. Difficulty in swallowing5. Difficulty in chewing or moving the jaw or tongue 6. Numbness of the tongue or other area of the mouth7. A feeling that something is caught in the throat 8. A chronic sore throat or hoarseness that persists more than six weeks, particularly smokers over 50 years old and heavy drinkers 9. Swelling of the jaw that causes dentures to fit poorly or become uncomfortable 10. Neck swelling present for more than three weeks11. Unexplained tooth mobility persisting for  more than three weeks - see a dentist urgently12. Unilateral nasal mass / ulceration / obstruction, particularly associated with purulent or bloody discharge http://www.rdoc.org.uk/

11. Examples of Early Oral Cancers White Lesions http://www.oralcdx.com/store/clinicalatlas.aspx

12. Examples of Early Oral Cancers Red Lesions Ulcerated Lesions http://www.oralcdx.com/store/clinicalatlas.aspx

13. Why is this important? • Because YOU can prevent oral cancer

14. References American Cancer Society, What Women Should Know about HPV and Cervical Health. April 2003. Available at: http://www.cancer.org/docroot/NWS/content/NWS_2_1x_What_Women_Should_Know_about_HPV_and_Cervical_Health.asp Accessed September 24, 2005. American Social Health Association, National HPV and Cervical Cancer Prevention Resource Center. Available at: http://www.ashastd.org/hpv/hpv_learn_fastfacts.cfm Accessed November 30,2005. Begum S, Cao D, Gillison M, Zahurak M, Westra W. Tissue distribution of human papillomavirus 16 DNA integration in patients with tonsillar carcinoma. Clin Cancer Res. Vol., 2005 Aug;11: 5694-5699 Bosch FX, Manos MM, Munoz N, Sherman M, Jansen AM, Peto J, et al. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst. 1995 Jun 7;87(11):796-802. Center for Disease Control and Prevention , Genital HPV Infection – CDC Fact Sheet. Available at: http://www.cdc.gov/std/HPV/STDFact-HPV.htm Accessed September 24, 2005. Center for Disease Control and Prevention, HPV and Cervical Cancer: An Update on Prevention Strategies. August 2005. Available at: http://www.phppo.cdc.gov/PHTN/HPV-05/default.asp Accessed September 24, 2005. Center for Disease Control and Prevention, National Program of Cancer Registries: United States Cancer Statistics 2002 Incidence and Mortality. Available at: http://apps.nccd.cdc.gov/uscs/Table.aspx?Group=3f&Year=2002&Display=n Accessed November 30, 2005. Gillison M, Shah K. Human papillomavirus-associated head and neck squamous cell carcinoma: mounting evidence for an etiologic role for human papillomavirus in a subset of head and neck cancers. Curr Opin Oncol. 2001;13:183–8.

15. References Ha PK, Califano JA. The role of human papillomavirus in oral carcinogenesis. Crit Rev Oral BiolMed. 2004 Jul 1;15(4):188-96 Herrero R, Castellsague X, Pawlita M, Lissowska J, Kee F, Balaram P, et al. Human papillomavirus and oral cancer: the International Agency for Research on Cancer multicenter study. J Natl Cancer Inst. 2003 Dec 3;95(23):1772-83. Kreimer AR, Clifford GM, Boyle P, Franceschi S. Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review. Cancer Epidemiol Biomarkers Prev. 2005 Feb;14(2):467-75. Miller CS, Johnstone BM. Human papillomavirus as a risk factor for oral squamous cell carcinoma: a meta-analysis, 1982-1997. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Jun;91(6):622-35. Mouth Cancer Foundation, Mouth Cancer and the Human Papillomavirus. Available at: http://www.rdoc.org.uk/hpv.html Accessed October 28, 2005. Schwartz S, Daling J, Doody D, Wipf G, Carter J, Madeleine M, et al. Oral cancer risk in relation to sexual history and evidence of human papillomavirus infection. J Natl Cancer Inst. 1998; 90 (21): 1626-36. Syrjanen K, Syrjanen S, Lamberg M, Pyrhonen S, Nuutinen J. Morphological and immunohistochemical evidence suggesting human papillomavirus (HPV) involvement in oral squamous cell carcinogenesis. Int J Oral Surg. 1983 Dec;12(6):418-24. The Oral Cancer Foundation, The Human Papillomavirus. Available at: http://www.oralcancerfoundation.org/facts/humanpapillomavirus.htm Accessed October 4, 2005. Watts SL, Brewer EE, Fry TL. Human papillomavirus DNA types in squamous cell carcinomas of the head and neck. Oral Surg Oral Med Oral Pathol. 1991 Jun;71(6):701-7.