Procedures
Oral Cancer Screening/HPV Testing
There are approximately 30,000 new oral cancer cases diagnosed each year. Unfortunately, many of these are not diagnosed until the cancer is in an advanced stage where it may have spread to distant sites. One of the reasons for this is that in the early stages, oral cancerous lesions are usually not painful, and therefore may go unnoticed or be ignored. Periodic oral cancer examinations are important to determine if there are any abnormal lesions present which may have the potential to develop into malignancies.
Recently, greater attention has been focused on the rapidly increasing incidence of cancer of the tonsils or base of the tongue which is related to the Human Papilloma Virus (HPV).
There are well over 100 different strains of the HPV virus, and the overwhelming majority of them are relatively harmless, occasionally producing annoying but innocuous conditions such as warts. Some of the strains of HPV however, have been proven to produce cancer. Cervical cancer, is one type of malignancy that has been shown to most commonly be produced by a certain strains of the HPV virus, the most common of which is HPV 16. Although abuse of tobacco and alcohol have been the traditional risk factors, HPV 16 has been implicated in at least 50% of cancers of the base of the tongue and tonsils, and that number is expected to increase. The virus finds the posterior aspect of the oral cavity (especially the tonsils, and the small accumulations of similar tissue seen at the base and sides of the tongue) to be a particularly hospitable environment, and can thrive and replicate easily.
Although HPV 16 is considered to primarily be a sexually transmitted infection, there may be other modes of transmission, and if this virus is present in the mouth chronically, the individual may be at risk for eventual Oropharyngeal Cancer. We now have a non-invasive test which can allow us to determine if HPV 16 is present in the mouth. This involves a simple rinse with a saline solution, which is then sent off to a lab for testing. The lab can perform specialized DNA testing. Almost 80 - 90 % of the population has been exposed to some form of the HPV virus. As of now, it is only HPV 16 that has been shown to be oncogenic, or cancer causing.
Simply testing positive for HPV 16 does not necessarily mean that the patient is destined to develop Oropharyngeal Cancer. It simply means that at the time that the test was taken, the virus had colonized the mouth and throat. A repeat test six months later may be negative, and may indicate that the body’s immune defenses have removed the virus from the system. It may be prudent to consider yet another test in six months to be sure that the virus is indeed no longer colonizing the mouth. If the repeat test is still positive, the patient is normally referred to an ENT physician for regular follow-up.
With regard to whom may be at risk for HPV 16, it is of most concern in the spouses or partners of women diagnosed with Cervical Cancer or who are HPV 16 positive. We strongly encourage anyone who is sexually active, or has had multiple sexual partners to be tested at some point.
Please see the attached link to an article written by Dr. Digney regarding HPV and Oropharyngeal Cancer for more information on this subject.