Rising Rates of HPV-Associated Oropharyngeal Cancers: A Challenge For Interprofessional Education and Practice

Jessamin E. Cipollina, M.A.

It is predicted that over the next twenty years, oropharyngeal cancers will make up the majority of head and neck cancers, and HPV-associated oropharyngeal cancers are believed to become the most prevalent HPV-associated cancer in the U.S. by 20201,2. A recent report from the CDC declared that the most common HPV-associated cancer in the United States is oropharyngeal squamous cell carcinoma (SCC), including those cancers on the tongue, tonsils, mouth and throat3. As rates in HPV-associated cervical cancer have decreased, oropharyngeal SCC rates have increased among both men and women3. According to the CDC, HPV is believed to cause 70% of oropharyngeal cancers4. Although it can take years for cancer to develop due to HPV infection, recent studies have begun to examine if HPV alone causes oropharyngeal cancers or if the interaction with other harmful behaviors, such as smoking and alcohol, are to blame1,4,5.

The high prevalence of HPV among sexually active adults has become common knowledge in recent years; an estimated 10% of men and 3.6% of women have oral HPV, and other types of HPV transmission are known to be equally widespread in both men and women4. Despite the popularity of HPV, both as a sexually transmitted disease and highlight of family dinner conversations, education and awareness of the long-term impacts of HPV remain mostly unknown to the general public. Studies have examined the perceptions, knowledge and awareness of HPV and oropharyngeal cancers among practitioners from various backgrounds1,5,6; dentists, nurses, practitioners physicians, midwives and physicians assistants are among those most likely to be responsible for identifying signs and symptoms of oral HPV and cancers5. It thus becomes the responsibility of healthcare professionals from all backgrounds to disseminate the importance of HPV causes and prevention, and further improve interprofessional practice and competencies within the realm of public health7,8.

HPV is the most common sexually transmitted virus in the U.S. yet it is one of the most difficult viruses to identify and diagnose despite mass interest in preventing the disease and related cancers4,9. There are approximately 200 different strains of HPV, and at least 9 are responsible for causing cancers worldwide5. In the U.S., 90% of HPV-related oropharyngeal cancers are caused by the HPV-16 strain2. Recent studies that have explored the association between HPV and oropharyngeal cancers call for increased awareness about proper oral health care and about signs of oral HPV1,5.

Sun and colleagues describe “cultural and social hurdles” related to general attitudes about HPV that impair practitioners’ ability to identify signs of HPV infection and oral cancer1. Another study by Kechner and colleagues surveyed general practitioners about their awareness and knowledge of HPV and associated oropharyngeal cancers, and found that while their awareness was high they were less likely to recognized signs of HPV and related cancers6. A similar study was conducted with oral health professionals and they found that while many were aware of HPV and oral health, few educated their patients about HPV, vaccinations and oral health links5.

The results and conclusions drawn from these studies collectively provide further implications for the need to build interprofessional practice and oral health competencies in treatment and prevention of HPV and oropharyngeal cancers. They also represent a severe disconnect between oral health and HPV awareness that puts their patients at great risk for HPV-associated cancers and complications.

Interprofessional education and practice has great potential in improving patient-centered care and broader population health7,8. Recent studies and reports around the impact of HPV and its connection with widespread oropharyngeal cancers demand greater attention on just how invasive this disease can be for those infected, as well as demands that healthcare practitioners collaborate with one another on bringing awareness to HPV signs and symptoms. Providing interprofessional education at the academic level can bring together physicians, nurses, dentists and midwives to learn to communicate with one another about their knowledge and concerns related to oral HPV and cancers, as well as connect on proper examination of the head, neck and oral cavity7. These providers and many others have the resources to screen and educate patients about HPV and provide more information about prevention, including safe-sex practices and advocating for administering the Gardasil vaccine before becoming sexually active until age 264.

Not only is it the responsibility of patients, namely sexually active adults, to be informed about HPV transmission, but it is the responsibility of clinicians to address the risk factors related to HPV and direct patients through the proper channels in treating and identifying any oropharyngeal complications. Interprofessional care has the unique ability to connect doctors in a way that support patients from all backgrounds and with varying access to healthcare. Education and awareness about HPV has the potential to be as pervasive and insidious as the virus itself, and the ever-growing instances of oral HPV infections and oropharyngeal cancers can be greatly diminished with the inclusion of interprofessional communication in everyday healthcare practice.

 

  1. Sun CX, Bennett N, Tran P, et al. A Pilot Study into the Association between Oral Health Status and Human Papillomavirus-16 Infection. Diagnostics (Basel, Switzerland). 2017;7(1). doi:10.3390/diagnostics7010011
  2. Chaturvedi AK, Graubard BI, Broutian T, et al. Effect of Prophylactic Human Papillomavirus (HPV) Vaccination on Oral HPV Infections Among Young Adults in the United States. J Clin Oncol. 2018;36(3):262-267. doi:10.1200/JCO.2017.75.0141
  3. Mulcahy N. CDC: Top HPV-Associated Cancer Is Now Oropharyngeal. MedScape. http://www.medscape.com/viewarticle/901122. Published 2018.
  4. CDC. HPV and Oropharyngeal Cancer. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm. Published 2018. Accessed August 20, 2009.
  5. Arora S, Ramachandra SS, Squier C. Knowledge about human papillomavirus (HPV) related oral cancers among oral health professionals in university setting–A cross sectional study. J Oral Biol Craniofacial Res. 2018;8(1):35-39. doi:10.1016/J.JOBCR.2017.12.002
  6. Lechner M, Vassie C, Kavasogullari C, et al. A cross-sectional survey of awareness of human papillomavirus-associated oropharyngeal cancers among general practitioners in the UK. BMJ Open. 2018;8(7):e023339. doi:10.1136/bmjopen-2018-023339
  7. Haber J. Building a culture of collaboration: Interprofessional education and practice. J Acad Disting Educ. 2014;2(1):12-14. http://ohnep.org/sites/ohnep/files/Building a Culture of Collaboration.pdf.
  8. Haber J, Hartnett E, Allen K, et al. The Impact of Oral-Systemic Health on Advancing Interprofessional Education Outcomes. J Dent Educ. 2017;81(2).
  9. The Oral Cancer Foundation. HPV / Oral Cancer Facts. 2018:1. https://oralcancerfoundation.org/understanding/hpv/hpv-oral-cancer-facts/.

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