Oral Cancer Rates Up – but is the real truth hard to swallow? …reprised

I try to avoid repeating blog posts but in view of the changes and acceptance of the opinions I felt it was time to redo this one from August 2009. Stephen Hancocks’ editorial in the BDJ as always makes the point far more eloquently than I ever can. You’ll probably need to be a member to view the article but in the article (title HPV vaccine for boys).

There have been a lot of mentions in the media over the past 10 days that the rates of Oral Cancer have risen in individuals in their 40s.

When I was a student & during my hospital career we were told that Oral & Lip Cancers were related to the “5Ss”:

• Smoking,
• Spirits,
• Sepsis,
• Sunshine
• Syphilis.

Of these without doubt the greatest cause was and remains smoking; spirits were usually blamed but heavy drinkers frequently smoked heavily and there was a synergistic effect of the two. Sepsis was implicated because frequently victims were in poor condition already and heavy smokers’ mouths were never the best with widespread gum disease. Sunshine without doubt led to an increase in tumours of lips & facial skin. Syphilis well that shows my vintage; however we seem to retain some of our puritan attitude to talking about sex.

The recent news has picked, as ever, on the easy target ‘Alcohol To Blame For Rise In Oral Cancers’ said the Sky News headline, ‘A sober look at the rise in mouth cancer’ in The Times blames binge-drinking, (article now behind a paywall) a phrase that has only been in use for a few years far too soon for the effects to be measured properly. It is impossible to properly understand an epidemic until it is over.

As ever the anti-booze bandwagon has used this information to threaten doom, but whilst most reports mention there could be involvement of the human papilloma virus it gets very little publicity. As long ago as Feb 2004 BBC News reported “Oral Sex Linked To Mouth Cancer”. This is the same virus implicated in cervical cancer and causes genital warts, a vaccine is available and should be given to both girls and boys before they become sexually active. This much we can do easily and far easier than persuading sexually active and experimental young people into changing habits. I realise that the nay-sayers will tell you that it leads to promiscuity as it removes the fear of infection but that is really an unrealistic argument.

A recent study conducted by Dr. Maura Gillison at the Johns Hopkins Oncology Center furthered the premise that HPV is linked with certain types of oral cancer. In 25% of 253 patients diagnosed with head and neck cancers, the tissue taken from tumors was HPV positive and HPV 16 was present in 90% of these positive HPV tissues. This information helps to confirm that there is a strong link between HPV 16 and oral cancer. 25% of those diagnosed with oral cancer are non-smokers while the other 75% of those diagnosed have used tobacco in some form during their lifetimes. The research into the relationship of HPV and oral malignancies may give us clues as to the origin of cancer in those 25% of diagnosed individuals who did not smoke. Further research is being conducted into the relationship of HPV with oral cancers.

The habits that dare not speak their name?

I have added the final two paragraph from Stephen’s article. Please take action for the sake of the next generation.

It is therefore very pleasing that the BDA has also now thrown its weight behind the campaign for vaccination of boys as the letter from Stokes outlines in this issue.³ This lends further credence to the case that we have made here in recent years that as dentists and dental teams we have to become far more engaged in both wider health and medical issues, as well as politically more astute and socially conscious. To this end readers are encouraged to write to and lobby their respective members of parliament and/or the public health minister Jane Ellison MP at the Department of Health as well as visiting HPV Action’s website at www.hpvaction.org.

Vaccination also has one other important advantage in that it overrides claims that young people in particular should be taught to restrain themselves sexually, reducing promiscuity and the chances of contracting sexually transmitting disease (STD). Voluntary restraint is demonstrably ineffectual as levels of teenage pregnancy (the UK has amongst the highest rates in Europe) and STDs rise. Oral sex is a fact of twenty-first century life (and it has hardly been invented recently anyway) and it is a subject that, until vaccination is more widespread, may also be appropriate to discuss with some of our patients. If talking about tobacco and alcohol habits have seemed like difficult subjects to raise then talking about oral sex may present a further challenge but it is one we need to consider. It is, I’m afraid, obvious.