RISK FACTORS/CAUSES
RISK FACTORS IN NORTH AMERICA
- TOBACCO & ALCOHOL
The most recognized and acknowledged is the use of tobacco (including smokeless) and alcohol. - SEXUALLY TRANSMITTED HPV-16 and 18
Exposure to the HPV-16 + 18 virus (human papilloma virus) is the fastest growing risk factor for oral cancer. This is the same virus that is responsible for the vast majority of cervical cancers in women. The virus presents a 5 fold increase in incidence under the age of 40, which means all patients over the age of 17 should be screened annually.
Why age 17?
According to the CDC's Advisory Committee on Immunization Practices in recommendation of the new HPV vaccine "Gardasil" for cervical cancer prevention... "We chose 11 and 12 years because most girls have not had sex at that age." She adds: "By 15 years of age, about 25 % of American young people have become sexually active. And by age 17, 50% have already done so."The HPV Connection - some startling statistics:
One of the most common virus groups in the world today affecting the skin and mucosal areas of the body, is the Human Papilloma Virus. Over 100 different types of HPV have been identified. Different types of HPV are known to infect different parts of the body. The most visible forms of the virus produce warts (papilloma's) on the hands, arms, legs, and other areas of the skin. Most HPV's of this type are very common, harmless, non cancerous, and easily treatable. There are other forms of HPV which are sexually transmitted, and are a serious problem. The most common of these are; HPV-16,18,31, and 45 These cancer-associated types of HPV's cause growths that usually appear flat and are nearly invisible, as compared with genital warts caused by HPV-6 and 11.
The FDA estimates that 70% of cervical cancers are associated with HPV-16 or 18. New studies have confirmed a significant link to oral cancer as well. In the oral environment these manifest themselves primarily in the back (posterior) regions such as the base of the tongue, back of the throat (oropharynx), tonsils and tonsillar pillars.
It has now been established that the path that brings people to oral cancer contains at least two distinct etiologies; one through tobacco and alcohol and another via the HPV virus, particularly version 16, though other versions of the virus might be implicated as the research unravels further. There are further definitions that seem to be apparent between the two. In general it appears that HPV positive tumors occur most frequently in a younger group of individuals than tobacco related malignancies. They also occur more in white males, and in non smokers. The HPV group is the fastest growing segment of the oral cancer population.
- HISTORY OF ORAL CANCER Patients who survive a first encounter with the disease have a 20 times higher risk of developing a second cancer; this increased risk can last for 5 -10 years after the first occurrence
- VERRUCOUS LEUKOPLAKIA (approx. 1/3 become cancerous)
- ERYTHROPLAKIA (91% show signs of dysplasia or malignancy)
- COMPROMISED IMMUNE SYSTEM (HIV)
Is Early Detection Screening Mandatory?
- Currently there are no population based screening programs for oral cancer in the US, although early detection of oral cancer can increase survival rate to 80-90%
- The American Cancer Society (ACS) and the American Dental Association (ADA) recommend opportunistic screening for oral cancer
- The National Cancer Institute estimates that only 20% of the US population receives an annual oral examination.
- The ADA estimates that 60% of the US population visits a dentist every year, however less than 15% of those who visit the dentist regularly report having received an oral cancer screening.
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