Oropharyngeal Cancer and HPV Relationship

Important Research Evaluating the Relationship between Oropharyngeal Cancer and HPV Is Published

Agalliu I, Gapstur S, Chen Z. et al. Associations of Oral α-, β-, and γ-Human Papillomavirus Types With Risk of Incident Head and Neck Cancer. JAMA Oncol. 2016 Jan 21.

It has been demonstrated by a research published in the previous days that detection of HPV type 16 in mouth region increases the risk of formation of oropharyngeal cancer, which is a sub-type of squamous cell cancers developing in head-neck region, for 22 times more. It is demonstrated that these cancers may develop not only by sexual contact but also other HPV types placed in head and neck region although this risk is known for a long time.

These results were published over internet at JAMA Oncology on January 11th, 2016. The results achieved from the researches conducted by Albert Einstein College of Medicine’den Doktor Ilir Agalliu, MD, ScD located in New York show that the role of HPV in terms of teh cancers in head and neck region is more important than it is supposed.

Dana E. Rollison,PhD from Moffitt Cancer Center in the state of Florida mentions that this study is a well-organized controlled research and the findings may be evaluated both as an innovation and also verification of some current information.

According to the comment of Doctor Rollison, we have already known that mucosal HPV types take a part in head-neck cancers and this information has confirmed by this mentioned study. However, it is demonstrated for the first time that viral DNA is transformed into cancer in time.

In another articles, Doctor Rollison and Maura L. Gillison, MD, PhD (from The Ohio State University Comprehensive Cancer Center) warn that we should deliberate in terms of usage of this mentioned remarkable results to constitute cause and effect relation. The same people remind that we have to consider the fact that the results achieved may have been affected from smoking and alcohol usage. As a result, smoking may topically repress immune system and directly affect cancer development making carcinogen impacts.

It is demonstrated in the same research that other HPV types (especially beta and gamma HPV) encountered more on skin increase squamous cell head and neck cancer development possibility for 3 and 6 times.

Robert Burk, MD (Albert Einstein College of Medicine) considers that this study may have importance on public health in the future. This study, which may bring a new approach to HPV scanning tests, also promises that the vaccines applied on the purpose of preventing head and neck cancer at the same time may aim at beta and gamma types in addition to HPV type 16 in the future.

This study is the first evidence-based study revealing cancer follows the existence of HPV 16.

Basically 2 results are emphasized in the research. Time-dependent relationship between HPV detection and the risk of squamous cell cancer occurrence in head and neck region is researched in the first one and the connection of other types such as beta and gamma HPV with cancer risk is investigated in the second one.

Doctor Agalliu also states that HPV types observed in skin cancers and skin are smashingly high in mouth cavity apart from HPV16 and other high risk types.

Moreover, he states that there is no data related to possible connections between HPVs within the mouth and head and neck cancers up until now.

If we check on the details of the study:

Participant number:96,650 (average age: 66.5)

Cancer has been detected in none of the participants in their first attendance to the research.

Mouth wash waters are received from each of them.

The people were followed for 4 years.

Squamous cell cancers are observed in head and neck region in 103 males and 29 females at the end of 4 years. The issue to pay attention here is that cancer has been detected only in 132 cases from 96 thousand or so participants. This point is important because it is said to increase for 22 times statistically but in fact the number of people, in whom tumor develops, is very low in terms of rate.

Each of these 132 cases is matched with 3 people from each control group.

When these cases are compared to control group, it is detected that smoking and alcohol usage is more common in these patients.

Table: The Regions, In Which Squamous Cell Cancer In Head and Neck Region Is Most Commonly Observed

HPV detection rate in mouth in control group: 1.8%

Detection rate of other high risk HPVs: 5.1%

Detection rate of viruses called alpha-HPV with no high risk: 9.6%

It is revealed that head-neck squamous cell cancer risk increases 7.1 times in case of detection of HPV DNA in mouth wash water. Data is arranged considering the usage of alcohol and smoking while these results are investigated.

But no connection is detected between detection of high risk HPV types in the mouth and cancer occurrence risk.

If we list the tumor according to its occurrence region, the oral HPV16 DNA detection case increases oropharyngeal cancer occurrence risk for 22.4 times.

However, no relationship is found with mouth cavity and larynx.

So, Is There Any Relationship With Skin Cancer?

It is revealed in the study that HPV beta and gamma types increase squamous cell cancer risk in head neck region for 2 and 4 times.

According to the statements of Doctor Agaillou, the increase of head-neck cancer risk depending on the existence of beta-1 HPV5 known to have a role in terms of occurrence of cutaneous squamous cell cancer and Epidermodysplasia Verruciformis and other HPV types (such as gamma-11 and gamma-12 types) shows that the role of HPV in these cancers are wider than it is considered.

It is revealed for the first time by this study that there is a relationship between HPV beta and gamma types and head neck cancer.

However, as Doctor Agalliu states, it is quite difficult that such a study is conducted on skin. Both HPV is observed on skin and hair follicles at high rates and choosing a specific region on the idea that cancer may develop is a complicated work.. Nevertheless, usage of HPV vaccine should be taken into consideration on the purpose of preventing skin cancer.

He adds more studies related to HPV infection should be performed in mouth and the relationship of HPV types and smoking or alcohol usage and cancer development risk should be studied.

Moreover, according to statements of Doctor Agalliu, the studies, in which more mouth wash samples are collected, should be conducted and whether the one related to head-neck cancer is from new infection or long-term infection should be researched.

What May These Findings Serve For Us In The Clinic?

Doctor Rollison states that the idea to use HPV16 DNA test for these cancers on the purpose of screening is hopeful as HPV16 DNA existence is demontsrated to be an indicator of head-neck cancer to occur in the future.

He states that the circumstance is not sufficiently clear for HPV types observed on the skin.

According to Doctor Rollison, data achieved in the mentioned study is supported by other studies and vaccine usage may be started for virus types observed on skin if HPV types related to skin is verified to have relation with head-neck cancers.

HPV vaccines , which are at use at the moment, are for HPV16 and HPV types observed in mocusa causing mouth cancer and head-neck cancers. However, these vaccines do not aim at the types observed on skin. Therefore if the connection of the types observed on skin with any cancer type is verified (it may be skin or cervix cancer), vaccines may be applied also on these regions for protection against cancer like in cervical cancer.

27 Temmuz 2016 tarihinde Prof. Dr. Süleyman Engin Akhan tarafından yayınlanmış ve 20 Kasım 2018 tarihinde de son güncelleme yapılmıştır.