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More throat, mouth cancers linked to
Post and Courier
About once a week, Boyd Gillespie, M.D., shocks a young nonsmoker with
the diagnosis that he has cancer in the back of his mouth.
Most oral cancers are related to a lifetime of tobacco or alcohol
abuse, but that profile is changing.
Gillespie, a head and neck cancer surgeon at MUSC’s Hollings Cancer
Center, is seeing an increasing number of patients who are young, have
little if any smoking history and have cancers predominantly of the
tonsil and the back of the tongue.
The culprit is human papillomavirus, or HPV, the same sexually
transmitted virus that causes cervical cancer. The oral cancer does not
discriminate between sexes, striking men and women at equal rates,
About 25 percent of the 40,000 head and neck cancers annually in the
United States, or about 10,000 cases, might be attributable to HPV,
Gillespie said. A decade ago, the number of mouth cancers related to
the virus was nearly zero.
It’s a trend that other head and neck practitioners around the country
also have witnessed, he said. Boyd and virologist Natalie Sutkowski,
Ph.D., have studied and confirmed that factors such as age, smoking
history and tumor location and appearance are highly predictive of
which tumors are caused by HPV.
Risk factors are similar to those for cervical cancer: younger age of
first sexual intercourse and multiple sexual partners. With throat and
mouth cancers, oral sexual contact also is a factor.
“Oral sex is probably a bigger part of first sexual contact than maybe
it was in the past,” Gillespie said. A 2005 national study reported
that more than half of U.S. teenagers from 15 to 19 years of age had
engaged in oral sex. That percentage jumped to 70 percent by ages 18
But the complete story of the virus’s transmission is not known. “It’s
unclear if it’s only passed through sexual contact,” Sutkowski said.
“It would not be impossible in my mind that it could be passed through
kissing.” A recent study in Nature Clinical Practice Oncology reported
that “direct mouth-to-mouth contact or other means could not be
Another factor contributing to the rise in HPV-related oral cancers
could be that doctors 10 years ago didn’t necessarily look for the
virus, Sutkowski said, and methods of testing have improved.
Also, more people smoked 10 years ago, so it was easier to blame
But as more patients in their 20s and 30s appeared who didn’t smoke or
abuse alcohol, the medical community took note.
Symptoms of HPV-related oral cancer include a visible growth or lesion
on the tonsils or the base of the tongue that might affect speech or
The ulcer might be sore, might bleed and could cause hoarseness.
Gillespie recommends patients seek medical attention if they’ve had
symptoms for a month or longer.
Some positive news is that HPV-related oral cancers have a good
prognosis. But early intervention is key, Gillespie said, as survival
rates fall from 90 percent to 50 percent when the cancer spreads to the
To help people get medical attention early, the Hollings Cancer Center
will open the Oral Lesion Clinic this month. The clinic will be staffed
by a head and neck surgeon and an oral pathologist who will evaluate
sores, ulcers and growths in the mouth or throat. A majority of
patients will be referred by doctors or dentists.
The increased attention could lead to a push in boys receiving the HPV
vaccine marketed as Gardasil by Merck.
There are more than 100 strains of HPV, about 13 of which are
The vaccine protects against four types: HPV-16, which is responsible
for half of cervical cancers and the majority of virus-related mouth
and throat cancers, HPV-18, which is also responsible for cervical
cancers; and strains 11 and 6, which are associated with genital warts.
Whether the vaccine protects against oral cancer remains to be seen but
seems logical, Boyd said.
“Our hope is that by reducing the number of people incubating HPV-16 in
the community, we will also see a dropoff of throat cancer,” he added
From virus to tumor
How a virus interacts with tissue and becomes a tumor is complicated.
Sutkowski might have unlocked one process that contributes to human
papillomavirus’s transformation to cancer.
Sutkowski has discovered an ancient viral conversation that takes place
when HPV meets human DNA.
About 8 percent of human DNA is derived from virus particles that have
worked their way into the human genome over millions of years,
Normally, these viral particles do nothing. But when HPV is introduced,
the viral particles are activated and cause inflammation. The increased
blood flow, in turn, nourishes tumors.
“It’s known that inflammation helps tumors grow,” Sutkowski said. “And
these viral particles turn on inflammation. So maybe it’s just as
simple as that— the inflammation may be helping tumors grow.”
Sutkowski is now turning her attention to searching for drugs to
inhibit these ancient genes, stop the inflammation and interrupt the
Editor’s note: The article ran Jan. 14 in the Post and Courier and is
reprinted with permission.
Friday, Jan. 25, 2008
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