Hi folks,

I've read about Michael Douglas' cancer battle and one of the articles mentioned an oral rinse test to determine any HPV infections in the mouth. I've searched this site for more information, and I'm surprised no one has mentioned it yet. Although, there is some mention on the HPV Connection page that oral rinses for HPV test seem to have limited value. So, any thoughts?

http://www.oraldna.com/Professionals/oral-hpv-testing.html

Also, lately, I'm reading that the "cure rate" of HPV tonsil cancer is now 80-90%. I am highly skeptical of that. Someone I know who is at MD Anderson has been told this as well by his oncologists there. I've seen the 5 year survival rates for orapharynx related cancers and they are not nearly as high. Do tonsilar cancers really have better prognosis?

Much thanks

First, OCF and its science advisory board are not advocates for the Oraldna HPV test. It is not of any value as a testing/screening mechanism for the public, but definitely makes money for the dentists that they are selling it to. I can explain this at a later time if someone wants to know why, but I don't have the time tonight.

There are peer reviewed published studies that clearly show a significant survival advantage for HPV+ oral cancers which occur mostly in the tonsil and the base of the tongue, and the walls of the oropharynx. The disease from this cause responds better to conventional radiation and chemo than tobacco origin cancers.

The HPV page in the OCF web site has numerous PDF's of the original scientific articles related to HPV and several related to the implication in survival of HPV+ status. One is located here, but there are more

http://www.oralcancerfoundation.org/HPV/pdf/NEJM_Gillison.pdf

And a quote from this particular published article in the NEJM, which has some of the strictest peer review processes out there.

"The extent to which the superior survival for a patient with HPV-positive oropharyngeal squamous- cell carcinoma depends on the administered therapy is unclear. Published data indicate that tumor HPV status is a strong and consistent determinant of superior survival, regardless of treatment strategy (e.g., surgery, radiation therapy, concurrent chemoradiation therapy [in this study], or induction chemotherapy plus concurrent chemo-radiation therapy, with 5-year survival rates among patients with HPV positive tumors of approximately 75 to 80%, versus 45 to 50% among patients with HPV negative tumors."

Ah, much thanks for the response, Brian. I would like to see your rebuttal to the OraRisk HPV test sometime.

By the way, I don't suppose anyone knows the false positives and negatives for this test?

The false positive and negatives are not really the issue. The test doesn't prove persistence, and since the vast majority of people in the US are going to come in contact with the virus, this is what we are really interested in. Most people's immune systems are going to clear this virus without issue.

I'm a bit confused. Does persistence imply that the virus is dormant and undetectable by this test?

MSG,
I was with my RO last week, and we were discussing some of these points. HPV can only be detected (at this point) bt testing the actual removed tissue. When my testing was done 5 years ago, the false positives on the actual tissue was up to 20%. It has since improved. He said that there are currently no other acurate ways to test.
All the best,
Rob

While it has been stated so by some in powerful positions, contrary to those opinions, there is no proven evidence that HPV goes dormant, though it may. There is no idea of how long it might remain latent after exposure, which is different than being dormant.

There are viruses that do go dormant like HSV1 and 2, but we know that because we can find it in its dormant state living on the ganglion of your nerves... you get it for life, but it is only active occasionally, usually triggered by a depressed immune system.

HPV we don't even know the complete life history of this virus, so there are tons of "we just don't knows" related to it. We do know that most people have immune systems that clear it, in different time periods, based on our experiences in the cervical cancer world. The test we're talking about is of no value because it only tells you that you have exfoliated some cells TODAY, that have via and old style PCR testing, yielded a positive finding for HPV16. If you will clear it in a week or a month, and you have a robust immune system that is going to handle all this (without you even knowing that you were infected and subsequently cleared of the virus) the test doesn't tell you.

Can we identify those that have a less than effective immune system like me? No.

So let's say you test positive with their test one day, and come back in 6-9 months for a retest. On that retest you are again positive. Is this proof of persistence? Absolutely not, and the reason that the test is only good at raising people's anxiety, and of not giving you useful information.

It is just as likely at the time of that second test that you cleared the infection on your own via your immune system, as the bulk of people will do, and via your sexual partner or partners, just got reinfected since the virus is so common in our society. Hence it is a worthless test.

You would have to abstain from all possible mechanisms of transferring the virus between tests (months of no sex, no passionate kissing etc., and we aren't even sure of all the possible means of transfer, so there is that unknown) and who in our world is actually willing to live that way, for that long, for this test to work� maybe with useful information maybe not. In the cervical cancer model, it can take 18 months or more for some women to clear the virus. They eventually do, without consequence. So how many dental visits and retests (@$140.00 apiece) are you wiling to do, and for how long?

It is really only good for dentists, who are the primary vendors of it, to make $, not provide you with information that you can put to immediate use. It tells you that on a particular day you tested positive for one of the most common viruses in America. Big whoop. OralDNA's website offers you no advice to doctors on what to tell your patients if they test positive, because..... there isn't anything you can really tell them about what it means to justify the cost or putting them through it in the first place. Here's the quote from OralDNA - "OraRisk� HPV is a non-invasive, straightforward-to-use screening tool to identify the sort(s) of oral HPV, a mucosal viral infection that could potentially lead to oral cancer, and in turn, enables the clinician to establish increased risk for oral cancer and determine suitable referral and monitoring conditions." I, and the doctors on OCF science board, see no way in which this test establishes risk, or helps anyone determine what a suitable referral or monitoring might consist of. Who exactly would you refer the patient to, and for what? Nothing to biopsy, scan, etc. The most you could say is that you want them to be on an accelerated (6 months instead of a year) visual and tactile screening, and that the dentist should teach them the early warning sings of the development of disease, which with HPV, - are very few - until it becomes something more than an early stage find.

False positive and negatives are not the measure of a test. The important measures are specificity, selectivity, and positive predictive value.

I received two emails for posters today about their dentists wishing to follow them up with this test. I am brining this topic back to the top so that I don't have to write it again for them.

bumping for my perio to read