Oral Cancers Associated with HPV Increasing in the Americas

Posted on July 28, 2015

Washington, D.C., 4 June 2015 (PAHO/WHO) - Although oral and pharyngeal cancers are usually associated with tobacco and alcohol use, the incidence of HPV-associated oropharyngeal cancers has increased by 225% in the past two decades in the United States, according to data published in the Journal of the American Dental Association. The evidence suggests that in particular, cancers located on the base of the tongue and the tonsils are associated with HPV infection.

Cancers of the oral cavity and oropharynx are among the most common cancers worldwide, with an estimated 443,000 cases and 241,000 deaths occurring globally in 2012. While individuals with HPV-associated oral cancers tend to have better prognoses than individuals with non-HPV-associated oral cancers, HPV-associated cancers are more likely to develop in people without traditional risk factors, like tobacco and alcohol use.

“Cancer is a major threat to public health worldwide, and oropharyngeal cancer is an important component of the global cancer burden with significant costs to the healthcare system,” said Dr. Saskia Estupinan-Day, head of the oral health program at the Pan American Health Organization/World Health Organization (PAHO/WHO). “Cancer in the oropharynx is especially threatening because in its early stages it might be overlooked, as it usually develops without producing any pain or symptoms the individual could recognize.”

More than 190 types of HPV have been identified and classified according to their potential to induce cancer, with more than 15 of these having been linked to human cancers. One specific type – known as high-risk HPV-16 – is associated with 85-95% of the oral cancers linked to HPV. As HPV-16 and other strains associated with oropharyngeal cancers become more prevalent, the frequency of these cancers grows. In addition to the surge of HPV-associated oropharyngeal cancers over the past 20 years, the risk for tonsillar and oropharyngeal cancers have increased at least by two-fold among individuals with HIV/AIDS due to impairment of the immune system.

Despite this, scientific gaps exist regarding HPV infections, its persistency and its associated oropharyngeal cancers in the general population and in HIV-infected individuals. Additionally, evidence on the efficacy of HPV vaccines to prevent HPV-associated oropharyngeal cancer – which could prove to be an important tool for prevention - is lacking.

To address these gaps, PAHO/WHO, through the Regional Oral Health, Cancer, and Non Communicable Diseases programs with the support of the National Institutes of Health (NIH)/National Institute of Dental and Craniofacial Research (NIDCR), the International Association for Dental Research (IADR), the American Dental Association (ADA), and the American Dental Association Foundation (ADAF), has issued a call to action and organized an international consultation meeting that will be held from July 27-28, 2015 at PAHO Headquarters in Washington, D.C. to assess the state-of-science on HPV-associated oropharyngeal cancer research, address the existent technical gaps, and outline future directions for research, practice, and policies in the Americas and other regions of the world.

“The increase in HPV oral infections, persisting infections, and the development of HPV-associated oropharyngeal cancer globally is an emerging public health problem in the general population that is exacerbated in individuals infected with HIV,” said Dr. Isaac Rodriguez-Chavez, Director of the AIDS and Immunosuppression Program at the National Institute of Dental and Craniofacial Research. “The international consultation meeting at PAHO/WHO will help us understand current state-of-the science, gaps, needs, and trends to inform the development of public health policy on HPV for the Americas. This is also a unique opportunity to harmonize global health efforts to address HPV-associated infections, persisting infections and oropharyngeal cancer.”

“Having a regional plan will be crucial in moving forward to prevent and treat oropharyngeal cancers associated with HPV,” said Dr. Estupinan-Day.

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