HPV has officially displaced tobacco today as the number one cause of oral cancers. This data has been widely reported in the media. "Scientists say that 64 percent of cancers of the oral cavity, head, and neck in the U.S. are caused by human papillomavirus (HPV), which is commonly spread via oral sex." From CBS to NPR, OCF and our surrogates that helped us, worked hard to see this story get out. While most of the newbies here know us from this forum, this public awareness work is a large part of OCF's mission, combined with sponsoring research.

This is happening in First World developed countries, and not in third world countries. The simple explanation for this is that in the third world, tobacco use is still on the increase, (we export tons of it to them) and in developed countries its use is declining. There are likely some differences in sexual behaviors as well, but those pale in comparison to the tobacco issues. Here are two of the most important places it was picked up which we placed on the OCF news site:

http://oralcancernews.org/wp/oral-sex-now-main-cause-of-oral-cancer-who-faces-biggest-risk/

http://oralcancernews.org/wp/virus-passed-during-oral-sex-tops-tobacco-as-throat-cancer-cause/

And another interesting story about adolescents and oral sex was put on the OCF news feed today as well, as this all ties together

http://oralcancernews.org/wp/adolescents-and-oral-sex-is-it-really-something-to-worry-about-2/

For those newbies that do not monitor it, you can subscribe to the OCF news feed for free, which is updated about 5 times a week by our own oral cancer survivor and volunteer to OCF, Sheldon Sax, who has done a wonderful job of this for years now. From human interest stories to hard science, if it is related to oral cancers, we scour the world's news media and scientific journals to bring the best of it to those interested in the subject. From medical and dental students, to patients, and even reporters at medical news desks at major publications, OCF has thousands of subscribers to our feed.

http://oralcancernews.org/wp/category/oral_cancer_news/

Another great post by our leader. Brian as usual, when you speak we all listen. I thought I heard that info on one of the news shows I watch daily. Thanks for posting this.

I saw this and was very surprised by the numbers. The former study quoted smokers as making up something like 75% of oral cancer patients. This is both good and very scary as well. HPV patients have less recurrences which is so much better than going thru this over and over. But then on the other hand, the impact on society and all the other things HPV can cause is very scary. Thanks Brian for giving us such important info.

It never ceases to amaze me how many people are stunned when I inform them that OC can very likely be caused by a virus.

I am not certain what caused my tonsil cancer, since it was prior to the strong evidence about HPV (and I was never tested for it), but it responded well to treatment, the tumor melting into oblivion after only 3 weeks of radiation (if only they could have stopped there ;-). There was no recurrence.

I am also certain that not drinking and smoking helped the outcome as well.

[quote=Brian Hill]HPV has officially displaced tobacco today as the number one cause of oral cancers... "Scientists say that 64 percent of cancers of the oral cavity, head, and neck in the U.S. are caused by human papillomavirus (HPV), which is commonly spread via oral sex." ...
[/quote]

I'm a bit confused by these stats.

If the approximate number of OC cases/year in the U.S. are 37K, then are we saying HPV+ cases now comprise about 24K of those?

Another recent article link from Charm (by Dr. William Lydiatt, at the University of Nebraska Medical Center) stated the HPV+ cases are approximately 15K /yr (up from 10K a decade ago). http://www.omaha.com/article/20110226/LIVEWELL01/702269904/1161

Numbers don't seem to add up, or am I missing something?!

That would be what the data suggests and in fact the OC rate is not only increasing but younger patients are being Dx'd. When I was Dx'd in 2002 there were only 30K patients/year in the US.

IMO many people are probably still not tested for HPV.

Help us out Brian...

As I posted on another thread, I don't think the two doctors quoted in Charms article are up to speed. There was a large public health meeting held last week, and Gillison and others brought the data up to date, which was widely then reported in the other media around the country, as I posted above. The two stories that I posted above from CBS and NPR are ones that seldom get the story wrong though it hit lots of media.

The article coming out from Gillison next month in NEJM will actually detail all the data both from a retrospective point of view looking at the rapid increase over the last 30 years, and looking into the future for the next ten. This is really going to increase rapidly in incidence. There really ins't anything we can do to stop it from happening. As an advocate for the disease that reality is particularly disturbing.

People have suspected this had already happened for some time as individual treatment centers looking at their local patient populations were already reporting incidence rates of 60% HPV and more. But the problem was there was no national consensus up till just recently. Hopkins and James say more than 60% of new patients, MDACC says more than 70% and so on. So for it to be 51% is very believable. Not every cancer center in the US is collecting data, and worse they do not all use the same test to determine if the cancers is HPV+, which has caused other problems in the data, mostly artifacts of HPV 18, 33, 35, which are certainly not players in this, but actually assay type errors in very small numbers. If someone is interested, I can talk about this more, but it really doesn't change this thread, and that is the virus is king in OC now.

Brian,

I'm curious, as a non-smoker, very light drinker with a primary that was never tested for HPV due to the location, are your researchers still only seeing HPV+ tumors at the back of the oral cavity?

- Margaret

It is not impossible to have an HPV positive lesion in the anterior mouth. Having said that it is exceptionally rare. I am going from memory on a conversation with Gillison 6 months ago, but I think she said she had only seen two EVER.

Thanks.

- Margaret

Now all we have to do is figure how many tumours that test positive for HPV actually caused the cancer rather than the smoking and drinking which just confound everything.

Alex and I are blaming his positive HPV status even though he had a 2 pack a day and heavy drinking history for the last 30 odd years (better hope for the future if it was the HPV that did it)

According to Dr Trotti (Moffitt), my RO and someone that has taken an interest in HPV since I was treated, he points to the more favorable prognosis of an HPV+ diagnosis but also says that when tobacco use is added to that patient's profile the chances of a recurrence increase over a HPV+ patient without tobacco use.

@David / Klo

RTOG study of Tobacco Use and HPV+OC was released at the ASTRO conference last June by Dr's Ang (MD Anderson) and Gillison (Ohio State):

PER THE STUDY: the risk of death and cancer progression increased by 1% for each pack-year of tobacco smoking.

**************

ASCO Abstract # 5510: Analysis of the effect of p16 and tobacco pack-years (p-y) on overall (OS) and progression-freesurvival (PFS) for patients with oropharynx cancer (OPC) in Radiation Therapy Oncology Group (RTOG) protocol 9003

...RTOG researchers led by K. Kian Ang, M.D., Ph.D. of the University of Texas M.D. Anderson Cancer Center, who is the lead
author of the study being published in the NEJM, and Maura L. Gillison, M.D., Ph.D. of The Ohio State University, who directed
the HPV analysis, found that oropharyngeal cancer patients with HPV-positive tumors had a survival rate 25 percentage points
higher at three years (82.4% vs. 57.1%) than patients on the study with HPV-negative tumors. This survival benefit was seen
irrespective of the assigned cancer treatment and traditional prognostic factors such as tumor stage and age. The researchers
also found that tobacco smoking was independently associated with survival for both groups of patients and the risk of death and cancer progression increased by 1% for each pack-year of tobacco smoking.

nice post.... am I finally relieved from being the person that watches the hard data and posts it here?

I have questions around such a high rate of oral cancer being attributable to HPV.

I can see that 64% of all patients could test positive for HPV (and have read figures much higher), but how can one say that the HPV caused the oral cancer? And surely if this is what is being suggested, the patient group would have to be non-smoking otherwise, how could one relate the cancer to HPV and not smoking? I would also suggest this figure might be possible in young patients under 50 (or even 60)?

Waiting for the publication with bated breath.

Also, DonB, I needed your skills a few months ago when I took 3 (very long) emails to convince our RO to test my Alex for HPV (RO was convinced HPV status was irrelevant because Alex had a smoking/drinking history). My attempt to summarise the abstract was long winded and convoluted in making the point you make so eloquently. Will call on you the next time I have to go into battle for something.

The HPV virus invades the squamous cells found in the BOT and tonsils and basically overrides 2 "built in" cellular safe guards that prevents a normal cell from reproducing too soon and too often, i.e., the now defective cell reproduces at a fast rate and can not be stopped (without radiation) and that is a very basic definition of the oral cancer caused by HPV.