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HPV and Oral Cancer: Is there a link?

20220114_133841Human Papillomavirus (HPV) and Oral Cancer: Is there a link?

Dr. Kapil Bandil Ph.D

Background: Globally, oral cancer is placed on position sixth in common cancer. In which India contributes to almost 30% of the total burden and scores second position in the highest number of oral cancer cases (Borse V et al., 2020). Oral lesions are associated with different types of viruses like Human Papillomavirus (HPV), Epstein-Barr virus (EBV), Cytomegalovirus (CMV), and Human Herpesvirus (HHV). Currently, the most common virus found in oral lesions is the human papillomavirus (HPV). Transmission of the virus can occur with direct contact, genital contact, anal and/or oral sex.

Sexually active people with oral sex habits will contract Human papillomavirus (HPV) at some point in their lifetime. HPV is the most common in sexually transmitted infection (STI) not only in western countries but in India also. Oral HPV infection will persist if there is  a cut inside the mouth, it enters in basal cells of the epithelium of tonsils and oropharynx. Approximately more than 60% of oropharyngeal cancers cases have found HPV DNA in molecular diagnosis. More than 110 types of HPV exist, and more than 40 subtypes of HPV can affect the genital area and throat. Frequently found HPV types 2, 4, 6, 11, 13, and 32 have been associated with benign oral lesions while HPV types 16 and 18 have been associated with malignant lesions. The most frequent oral HPV subtype is HPV-16 (Alexandra L.et al., 2021).

HPV has emerged as one of the causes of oral cancer in the western population in recent years. Hollywood actor Michael Douglas has spoken about the need for HPV awareness after he was treated for oral cancer. According to a recent review done by Tata Memorial Hospital in Parel, Mumbai, the human papillomavirus (HPV), which was spread due to oral sex and was found in every fifth case of oropharyngeal cancer in India. Oropharyngeal cancer constitutes about 10% of all head and neck cancers in India. Of these, 20% in India and 75% in the western population are attributable to HPV.

In other parts of the body, such as the genital tract, HPV infects exclusively the basal cells of the epithelium, where the virus persists in the latent stage. There is evidence that HPV also infects gingival tissue (Hormia M. et al., 2005). The periodontal pocket is the only location of the gingival mucosa where basal cells are exposed to the environment. The periodontal pocket enlarges during the progression of periodontitis as a result of chronic inflammatory processes (Tezal M. et al., 2012). In the presence of chronic inflammation, increased basal cell proliferation leads to a higher viral load in saliva as well as a higher risk of HPV transmission (Christian U Hübbers and Baki Akgül 2015).

This led to the hypothesis that chronic inflammation and continuous epithelial proliferation in the junctional gingiva could favor the replication of HPV and might be an important reservoir for HPV in the oral mucosa.

HPV infection and Oral Cancer Risk:  Oral Sex and Multiple Partners – Facts suggest that oral sexual habits may increase the chances of the oral lesion in the mouth due to HPV infection. Men have a greater risk of receiving an oral HPV diagnosis than women. Sexual activity with multiple partners may increase risk of HPV and other STIs (Sexually Transmitted Infections).

Smoking, Drinking Alcohol and Tobacco Habit: Smoking habit has been shown to promote HPV infection and increases chances of developing oral cancers. Research has indicated that a high intake of alcohol increases the risk for HPV infections in men. If you smoke and drink, you’re at an even higher risk.

Symptoms:

Generally, oral HPV infection is asymptomatic in most of the cases. It’s possible to develop warts in the mouth or throat in certain cases, but this is less common. HPV persistence in the mouth can turn into oropharyngeal cancer if you have oropharyngeal lesions, cancer cells form in the middle part of the throat, including the tongue, tonsils, and pharynx walls and it lead to oral cancer if not screened or left untreated.

Few symptoms of oropharyngeal cancer are as follows: Trouble in swallowing, constant earaches, coughing up blood, unexplained weight loss, lymph nodes size enhance, constant sore throats, lumps appear on the cheeks, in some cases growths or lumps on the neck were also found and hoarseness. If a person observes any of these symptoms consult the concerned doctor as soon as possible.

Diagnosis:

Generally, a dentist may discover lesions through a routine oral screening. As there is no specific blood test is available to determine HPV infection in mouth. In case of lesions found in the mouth, a dentist can perform a biopsy and send it to pathology lab to check the cells are cancerous or not and if reported cancerous then HPV test is strongly recommended. As per scientific evidence, early diagnosis is always the most effective way of reducing the overall oral cancer burden of the disease, decreasing mortality and improving the individual quality of life.

Treatment:

In most cases, oral HPV infection does not cause any severe health issues and clear from the oral part of the body by itself. If a person feels the development of any warts in the mouth then immediately contact the concerned clinician, get yourself screened and start treatment if required. In some cases, treatments of warts can be difficult because warts may be hard to reach then it is surgically removed followed by radiotherapy or chemotherapy. Usually, surgical treatment option is the mainstay of all possible therapy options for patients with advanced stages of oral cancer.

Prevention:

Most medical and dental organizations are recommending oral HPV screening. HPV infection can be prevented by following some preventive measures: Prevent HPV infection by adopting safe sexual practice and you should be tested regularly for sexually transmitted infections (STIs). It is advisable to limit your number of sexual partners and use of condoms is highly recommended to prevent infections. Six-month health checkups at the dentist is recommended especially if you have oral sex practice and there is a dental cavity or cut in your mouth. Make it a habit to self examine your mouth once in a month and if possible get vaccinated against HPV.

Author:

Dr. Kapil Bandil Ph.D (Department of Biotechnology, Dr. A.P.J. Abdul Kalam Technical University, Lucknow, Uttar Pradesh).

January 15, 2022

Edited By

Dr. Arif Ahmad, Ph.D

Scientific Editor at ABSF (Aabir Bio-Services Foundation).

Reference:

1. Alexandra L. Hernandez, Rajiv Karthik, Murugesan Sivasubramanian, Show all 9 authors, Joel M. Palefsky (2021) Prevalence of oral human papillomavirus infection among Indian HIV-positive men who have sex with men: a cross-sectional study BMC Infectious Diseases (2021) 21:675

2. Christian U Hübbers & Baki Akgül (2015) HPV and cancer of the oral cavity, Virulence, 6:3, 244-248,

3. Hormia M, Willberg J, Ruokonen H, Syrjanen S. Marginalperiodontium as a potential reservoir of human papillomavirus in oral mucosa. J Periodontol 2005; 76:358-63;

4. Tezal M. Interaction between Chronic Inflammation and Oral HPV Infection in the Etiology of Head and Neck Cancers. Int J Otolaryngol 2012; 2012:575242;

5. Vivek Borse, Aditya Narayan Konwar, Pronamika Buragohain (2020). Oral cancer diagnosis and perspectives in India. Sensors International.  1: 100046.

 

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