According to the Centers for Disease Control and Prevention (CDC), an average of 20,000 cases of oropharyngeal cancer (OPC) per year are attributed to some strain of the Human Papilloma Virus (HPV). (1) Historically, cancers of the head and neck are associated to alcohol and tobacco use as the primary etiological factor but during the mid 2000’s, diagnosed OPC increased significantly with evidence showing that 60-90% of cases were attributable to HPV strains 16 and 18. (2) This article will review statistical evidence on the rates of HPV and OPC and the literature that supports the benefit of HPV vaccination.
Extraoral and intraoral examinations have been a mainstay for dental hygienists screening patients for clinical markers of OPC. Dental hygienists are in a unique position to educate patients on risk factors and prevention. (3) With how frequent patients are treated in a dental office and with the educational skillsets that dental hygienists possess, it is sensible that these oral healthcare specialists could be providing information on HPV-associated OPC to patients eligible for vaccination. (2,3) Although a causative link between strains of HPV and OPC have not been definitively established, scientific evidence has shown that HPV infection can be prevented with vaccination. (3) Despite the proven prophylactic benefit, rates of those receiving the complete vaccine series have been historically low. (3) This could be attributed to lack of education, poor provider recommendation, and ethical or cultural concerns to name a few. (2) By empowering dental personnel to have constructive conversations with their patients and encouraging interprofessional collaboration, opportunity for patients to receive vaccination could potentially increase and rates of HPV-associated OPC across the nation could reduce.
Vaccines for Men and Women
With the HPV vaccine being a preventative means against infection and the development of cervical cancer for women, it is important to consider benefits of vaccines for men as well. (3) The development of HPV in men places them at risk for genital cancer as well as cancer of the oropharynx. (4) The average cases of cancers affecting the oropharynx attributed to HPV in men is almost five times higher than in women. (1) Although several strains of HPV exist and most often resolve independently, there are specific strains that vaccines can protect against that have been linked to these cancers. (4) Currently, the age range for vaccine administration in both men and women is from age 9 to 26. (2) For those between the ages of 9 to 11, two doses of the HPV vaccine are recommended. (4) Teenagers and adults up to age 26 who have not received the vaccine or did not complete their series should receive three doses. (5)
HPV and Oropharyngeal Cancer
Research has connected HPV to the development of cancers in the head and neck, which in the last few years, has surpassed cervical cancer, an already understood incidence from HPV risks, in being the most common HPV-associated cancer in the United States. (3,6) When discussing OPC, it is important to distinguish between HPV-negative OPC and HPV-positive OPC, as the former is closely related with alcohol and tobacco use while the latter is associated with sexual transmission. (3) As HPV-negative OPC rates have been declining, the rates of HPV-positive OPC in younger populations has been increasing, which is why dental professionals are in a pivotal spot to be educating and recommending HPV prevention immunization to their patients. (3,4)
With 70% of OPC caused by some strain of HPV and the proven statistical benefit of vaccination, oral health specialists are encouraged to take a proactive role in recommending immunization to their patients. (1) Due to over 90% of oral HPV infections being sexually acquired, dental hygienists may not feel comfortable discussing risk factors, preventative means, and vaccination with their patients and guardians. (7) With studies showing that poor patient-provider communication is one of the reasons behind low vaccine administration amongst young adults, it is imperative that oral health care professionals collaborate with healthcare disciplines such as pediatricians and primary healthcare providers. (3) This will ultimately create a referral network and help patients to understand the link between HPV and OPC. Interprofessional collaboration also has the potential within the educational setting where dental hygiene students and students from other healthcare disciplines could be given the opportunity to provide screenings and education on the correlation between HPV and OPC to high school and college students. (6) This would foster an excellent environment of professional socialization to not only get dental hygiene students comfortable discussing this topic with patients, but also give students from various disciplines the opportunity to work together as a team.
Educational Advancement
HPV is comprised of various strains, with oncogenic strains 16 and 18 being associated with over 80% of OPCs. (8) The development of this type of cancer has historically been attributed to long term tobacco and alcohol use. However, research is showing that cancers of the oral cavity are also a result of high-risk HPV. (9) Since dental professionals are one of the most frequently visited healthcare providers, this information is crucial because they are positioned to educate, advocate, and provide a means for prevention of certain oral cancers in their patients. (2) Currently in the entry-level curriculum, dental hygienists are educated on risk factors for oral cancer, clinical signs to look for in the mouth, and how to perform intraoral and extraoral screenings. Although this secondary method of prevention is critical, providing more opportunity for hands on experience and education, will be imperative to transition oral healthcare providers to serve as primary prevention specialists. (3)
Prevention is the key component to combatting the incidence of HPV-associated OPC and numerous studies have shown the effectiveness of vaccines for patients who are eligible. (7,8) Barriers to the vaccine will be inevitable and it will be critical that dental hygienists are culturally competent, cognizant of the patient populations they are educating, and respectful of vaccine decisions. (2) Dental hygienists have a responsibility to provide their patients with the highest level of care which includes screening for clinical signs of oral cancer, educating patients on risk factors, and offering recommendations for prevention. (3) Just like dental hygienists are obligated to assess patients for clinical markers of periodontal disease and educate accordingly, they are also expected to follow the same protocol for oral cancer.
References
1. Centers for Disease Control and Prevention. (2022, February 24). HPV and oral cancer. Centers for Disease Control and Prevention. Retrieved May 4, 2022, from https://www.cdc.gov/oralhealth/fast-facts/oral-cancer-and-hpv-vaccine/
2. Arnell, T. L., York, C., Nadeau, A., Donnelly, M. L., Till, L., Zargari, P., Davis, W., Finley, C., Delaney, T., & Carney, J. (2019). The role of the dental community in oropharyngeal cancer prevention through HPV vaccine advocacy. Journal of Cancer Education, 36(2), 299–304. https://doi.org/10.1007/s13187-019-01628-w
3. Cotter, J. C., Wilson, K. J., & Mallonee, L. F. (2019). Impact of HPV immunization training on dental hygiene students’ attitudes and confidence regarding HPV preventive education. Journal of Dental Education, 84(1), 66–93. https://doi.org/10.21815/jde.019.164
4. Simon, S. (2018, August 27). More teens getting HPV vaccinations. American Cancer Society. Retrieved May 6, 2022, from https://www.cancer.org/latest-news/more-teens-getting-hpv-vaccinations.html
5. McDowell, S. (2020, July 8). ACS updates HPV vaccination recommendations to start at age 9. American Cancer Society. Retrieved May 6, 2022, from https://www.cancer.org/latest-news/acs-updates-hpv-vaccination-recommendations-to-start-at-age-9.html#:~:text=Girls%20and%20boys%20should%20get,at%20age%2015%20or%20older.
6. Guadiana, D., Kavanagh, N. M., & Squarize, C. H. (2021). Oral health care professionals recommending and administering the HPV vaccine: Understanding the strengths and assessing the barriers. PLOS ONE, 16(3), 1–15. https://doi.org/10.1371/journal.pone.0248047
7. Timbang, M. R., Sim, M. W., Bewley, A. F., Farwell, D. G., Mantravadi, A., & Moore, M. G. (2019). HPV-related oropharyngeal cancer: A review on burden of the disease and opportunities for prevention and early detection. Human Vaccines & Immunotherapeutics, 15(7-8), 1920–1928.
8. Näsman, A., Du, J., & Dalianis, T. (2019). A global epidemic increase of an hpv‐induced tonsil and tongue base cancer – potential benefit from a pan‐gender use of HPV vaccine. Journal of Internal Medicine, 287(2), 134–152. https://doi.org/10.1111/joim.13010
9. Walker, K. K., Jackson, R. D., Sommariva, S., Neelamegam, M., & Desch, J. (2019). USA dental health providers’ role in HPV vaccine communication and HPV-OPC protection: A systematic review. Human Vaccines & Immunotherapeutics, 15(7-8), 1863–1869. https://doi.org/10.1080/21645515.2018.1558690
