HPV Screening in Young Adults
Position Statement of the American College of Prosthodontists
In recent years, there has been a significant increase in the number of cases of oropharyngeal cancers, many of which are HPV-16-related cancers. These cancers affect a different patient demographic than traditional oral cancers do.
The majority of oropharyngeal cancers are diagnosed in younger patients (typically in the 20-to-40-yearold age range). The use of tobacco products and alcohol may be co-factors in these cancers, but they are not the causative agents.
These lesions are usually found at the base of the tongue, the oropharynx, and the tonsillar areas. All of these areas are difficult to visualize for patients and members of the dental team. As such, diagnosis often starts when symptoms arise (and the disease is at an advanced stage) rather than by physical detection during a routine dental examination. Therefore, the dentist and clinical team members must pay special attention to patient-reported symptomology which may, at first glance, appear to be benign in nature.
These symptoms include a persistent sore throat, a change in voice quality, difficulty swallowing, a persistent cough, weight loss, presence of a lump in the neck, unexplained ear pain, or pain behind the breastbone. If a patient reports any of these symptoms, a prompt referral to an ear, nose, and throat specialist (ENT) or an oral and maxillofacial surgeon (OMFS) for evaluation is indicated.
The prevalence of HPV throughout the population is significant; 4 of 5 females will have an HPV infection at some point in their lives. Ten percent of males have HPV in their mouths while 3.6% of females have HPV in their mouths. Fortunately, most sub-types of HPV are benign and self-limiting; many patients’ immune systems will clear these viruses, often without the patient even being aware they are infected.
As such, HPV is often unknowingly transmitted from one person to another during intimate and sexual contact. Education programs that emphasize the use of physical barriers such as condoms and rubber dams during sexual activity may help prevent the spread of infection. Additionally, the two FDAapproved HPV vaccines, Gardasil, and Ceravix, may be effective against HPV-16.
As a profession we need to establish protocols for frequency of examinations, determination of which oral structures should be examined as well as how they should be examined in order to detect both oral and oropharyngeal cancers. It is the position of the American College of Prosthodontists to provide routine comprehensive oral cancer screenings to all patients as well as to appropriately inquire about risk factors when treating patients.1
For more information regarding how to perform an oral cancer examination, please go to: nidcr.nih.gov/oralhealth/topics/oralcancer/detectingoralcancer.htm#TheExam
1. Hutten MC, Davis, BK: American College of Prosthodontists Position Statement: Oral Cancer Screening 2015. https://www.prosthodontics.org/assets/1/7/Oral_Cancer_Screening.pdf. Accessed May 11, 2016.
Ethan A. Pansick, DDS, MS
Ralph C. Attanasi Jr., DDS, MS
Approved ACP Board of Directors: June 3, 2016
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