From the Guidelines
Oral HPV infection is a significant public health concern, and the HPV vaccination (Gardasil 9) is recommended for prevention, ideally before sexual debut, to reduce the risk of oropharyngeal cancers. The infection is primarily transmitted through oral sex, deep kissing, or other direct oral contact with an infected person. According to the U.S. Preventive Services Task Force recommendation statement 1, there is no specific treatment for oral HPV itself, but regular dental check-ups can help detect any abnormal tissue changes early.
Key Points to Consider
- The prevalence of oral HPV infection is estimated to be 6.9% in adults aged 14 to 69 years in the United States, with a higher prevalence among those with more than 20 lifetime sexual partners or current tobacco use 1.
- Human papillomavirus-16 is associated with approximately 85% to 95% of cases of HPV-positive oropharyngeal cancer, and its prevalence is estimated at 1% in adults aged 14 to 69 years 1.
- The U.S. Food and Drug Administration (FDA) has not approved any screening test for oral HPV infection, and medical and dental organizations do not recommend screening for oral HPV infection 1.
- To reduce the risk of oral HPV infection and oropharyngeal cancer, it is essential to practice safer sex by using barriers like condoms and dental dams during oral sex, avoid smoking, and limit alcohol consumption.
- If you notice persistent mouth sores, pain, difficulty swallowing, or lumps in your neck, consult a healthcare provider promptly.
Prevention and Screening
- The HPV vaccination (Gardasil 9) is recommended for children at ages 11-12, but can be given as early as age 9 through age 26, and adults aged 27-45 may discuss vaccination with their healthcare provider based on individual risk factors.
- Regular dental check-ups can help detect any abnormal tissue changes early, and primary care providers should consider the potential preventable burden of oral cancer when deciding whether to screen for oral cancer 1.
From the Research
Oral HPV Prevalence and Implications
- Human papillomavirus (HPV) has a nearly ubiquitous prevalence within the adolescent and adult populations worldwide 2
- The virus has been implicated in cervical and uterine cancers, as well as an increase in cases of virally related oropharyngeal squamous cell carcinoma in both male and female cohorts 2
- Oral HPV16 infection is the cause of HPV-related oropharyngeal cancer in more than 90% of cases and is primarily linked to oral sex 3
HPV Vaccination and Prevention
- HPV vaccines can protect against oral vaccine-type HPV infection, including high-risk HPV16 infection, thus reducing the incidence of HPV-related oropharyngeal cancer 3
- Vaccinated individuals were 46% less likely to develop oral vaccine-type HPV infection and 80% less likely to develop oral HPV16 infection 3
- Vaccination against HPV, especially in males, who are predominantly affected by HPV-related oropharyngeal cancer, could result in the prevention of this disease 3
Treatment Options for HPV-Positive Oropharyngeal Cancer
- Radiotherapy (RT) and surgery are both treatment options for early-stage HPV-positive oropharyngeal cancer, with no significant difference in overall survival, progression-free survival, and locoregional control between the two 4, 5
- The choice between RT and surgery should be made on a case-by-case basis, taking into account the patient's individual characteristics and preferences 4, 5
- Concurrent cisplatin is recommended for patients receiving definitive RT with T3-4 disease and/or 1 node >3 cm, or multiple nodes 6
Radiation Therapy Guidelines
- The American Society for Radiation Oncology (ASTRO) has developed clinical practice guidelines for the use of radiation therapy in the treatment of HPV-associated oropharyngeal squamous cell carcinoma 6
- The guidelines provide recommendations on the indications for definitive and postoperative radiation therapy, dose-fractionation regimens, treatment volumes, and normal tissue considerations 6
- Intensity modulated RT is recommended over 3-dimensional techniques, with reduction in dose to critical organs at risk, including salivary and swallowing structures 6