CDA Essentials 2016 • Volume 3 • Issue 7 - page 34

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Volume3 Issue7
S
upporting
Y
our
P
ractice
oneassociatedwith tobaccoandalcohol consumption
to the secondetiological component: HPV infection.
The reality is thatwe’re seeing two setsof oral cancers:
thosecausedbyHPVand those that canbeattributed
toother risk factors. Today, this knowledge isno longer
questioned: HPV is acquiredby sexual transmission,
it’soneof themost commonly sexually transmitted
infections (STI) and it’s themost commonviral STI.
Dental professionals, bybeing keyopinion leaders
among their peers, their patients and their communities,
areable to spreadwordof theadvantagesofHPV
vaccination in termsof long-termpreventionof oral
cancers.
HPV-associatedcancers includecancersof the
cervix, penis, anus, vulva, vaginaandoropharynx.
Thecancers areallmanageddifferentlybydifferent
healthprofessionals andarediscovereddifferentlyas
well. The important thing tonote is that of the12.7
millionnewcancers in2008, about 5%werecaused
byHPV (see
Table1
). Cervical cancer isof tremendous
importance,withnearlyhalf amillioncasesworldwide.
And100%of newcasesof cervical cancer are
attributable toHPVbecause, for thisparticular cancer,
HPV is thenecessarycause. HPV is also themajor cause
of anal cancer, a significant causeof other genital
cancers, and isgradually—by theminute—becoming
amajor causeof oropharyngeal cancer. In2008, the
proportionof oropharyngeal cancer casesworldwide
related toHPVvaried from13–56%, because in some
regions smokingandalcohol are themore important risk
factors and inother regionsHPV ismore important.
According tooneestimate,HPVcauses72%of
oropharyngeal cancers in theU.S.
This estimate is from theCenters forDiseaseControl
andPrevention in2013. It’s amuchhigher estimate than
previousones, butwenowhavebetter sciencecoming
down thepipelineabout oropharyngeal cancer, and it’s
becomepart of regular practice for dental professionals
andheadandneck surgeons to test forHPV-16 inoral
cancer. Another estimate in theU.S. calculates that 89%
ofHPV-associatedoral andoropharyngeal cancer are
preventablebyvaccination. Of course,wehaven’t yet
gotten to that point becausegirls andboys aregetting
vaccinatedand theyhaven’t reached theageof beingat
risk for oral cavityandoropharyngeal cancer.
HPV-16 isby far themost commonHPV type.
Among the25alphaHPV types—theones that
infect themucosal sites—HPV-16 isby far themost
carcinogenicand themost important for oropharyngeal
cancer. Luckily thevaccines that areavailablenow target
HPV-16quiteefficiently. Hopefully themeans tocontrol
or prevent all HPV-associatedcancerswill bea single
one: HPVvaccination.
a
Table1
Global burdenofHPV-associatedcancers
Cancer
Newcases Attributable toHPV
%Attributable toHPV
Uterinecervix
530000
530000
100%
Penis
22000
11000
50%
Anus
27000
24000
88%
Vulva
27000
12000
43%
Vagina
13000
9000
70%
Oropharynx
85000
22000
25.6%
(range: 13-56%, regiondependent)
TotalHPV-associatedcancers
700000
610000*
86.30%
*4.8%of 12.7millionnewcancers in2008
Source:
FormanD,deMartelC,LaceyCJ,Soerjomataram I,Lortet-TieulentJ,BruniLetal.Globalburdenofhumanpapillomavirusandrelateddiseases.
Vaccine2012;30Suppl5:F12-23.
The epidemiology of oral cancer is gradually switching, from
one associatedwith tobaccoandalcohol consumption to the
second etiological component:HPV infection.
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