HPV – tackling a growing problem
HPV is rapidly becoming a problem across the globe. It is implicated in the development of various types of cancer, including mouth cancer. With Sexual Health Week held on 16th-22nd September, this is the perfect time to consider how dental professionals could help tackle the issue.
HPV and cancer
Approximately 8 in every 10 people contract the HPV infection at some point during their lives. In most cases, the body can fight the virus off without any symptoms. However, in other situations the virus damages skin and mucous membrane cells, which can cause them to divide and potentially lead to genetic mutations. Persistent infection with HPV can lead to some serious health concerns, such as cancer.
Worryingly for dental professionals, around 70% of oropharyngeal cancers are the result of HPV. As are 1 in 10 oral cavity and hypopharynx cancers.[i] Most cases of cervical, vaginal, penile and anal cancer are also caused by the virus.[ii]
Research has suggested that smoking may be a risk factor for persistent infection with HPV.[iii] Alcohol consumption also increases the risk of long-term infection,[iv] with higher drinking frequency and intake having an effect.[v]
HPV – or human papillomavirus – spreads through intimate skin-to-skin contact, usually during sexual activity. Oral HPV is more commonly transmitted during oral sex. Having more sexual and oral sexual partners increases the risk of contracting the virus.[vi] That is not to say, however, that dentists should ask such a question of their patients… or should they?
This is an interesting topic that has come up in the dental and national media in recent weeks. Stephen Hancocks even broached the subject in his Editor-in-Chief’s address in the BDJ last year.[vii] In all other areas of dental health – and general health in many cases – dentists are responsible for performing detailed risk assessments. With this in mind, would it be relevant to ask a patient about their sexual history in order to determine their risk for HPV and subsequently mouth cancer? Modern society is certainly more open about these kinds of topics than it once was. Even Michael Douglas announced that HPV was – at least partly – the cause of his throat cancer. There is currently no guidance on this topic for dentists, so for now, this is simply food for thought.
In the UK, girls aged 12-18 have received the HPV vaccine since 2008. While this provided some cross-protection for males, it did not cover men in same-sex relationships. The vaccine programme was therefore made available to boys in 2018 in a move that received widespread support from health and dental organisations and individuals.
Dental professionals are well placed to spread the word about the virus and its dangers. You can also promote the vaccine by making information available to all young patients and their parents. Find further details on the NHS website.
[ii] Cancer Research UK. About Cancer. Causes of Cancer. Infections (e.g HPV) and Cancer. Does HPV Cause cancer? [Accessed August 2019]
[iii] Haukioja A, Asunta M, Soderling E, Syrjanen S. persistent oral human papillomavirus infection is associated with smoking and elevated salivary immunoglobulin G concentration. Journal of Clinical Virology. September 2014; 61(1); 101-106 doi.org/10.1016/j.jcv.2014.06.012
[iv] Oh HY, Seo SS, Kim MK, et al. Synergistic effect of viral load and alcohol consumption on the risk of persistent high-risk human papillomavirus infection [published correction appears in PLoS One. 2015;10(4):e0124991]. PLoS One. 2014;9(8):e104374. Published 2014 Aug 20. doi:10.1371/journal.pone.0104374
[vi] Hearnden V, Murdoch C, D’Aprice, K, Duthie S, Hayward NJ, Powers HJ. Oral human Papillomavirus infection in England and associated risk factors: a case-control study. BMJ Open 2018;8:e022497. doi: 10.1136/bmjopen-2018-022497