Researchers Confirm Link Between HPV And Head And Neck Cancer But Europe-wide Survey Shows Woeful Public Ignorance On Role Of Oral Sex

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Main Category: Sexual Health / STDs
Also Included In: Cancer / Oncology;  Cervical Cancer / HPV Vaccine;  Ear, Nose and Throat
Article Date: 11 Jun 2009 - 9:00 PDT

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Human papillomavirus (HPV) is an important causative agent in squamous cell cancers of head and neck (HNSCC) a new meta-analysis presented at the American Society of Clinical Oncology (ASCO) confirms; but a separate European survey at the same meeting reveals the public is woefully ignorant about it and possible ways to avoid it. Lack of public awareness about the possible link between HPV-related head and neck cancer and oral sex with multiple partners presents a case for making vaccinations against HPV more widely available to boys as well as girls before they become sexually active, commented leading expert Professor Jean-Louis Lefebvre of Centre Oscar Lambret, Lille, France.

Researchers led by Farshid Dayyani at the MD Anderson Cancer Center, Houston, Texas, looked at a total of almost 7000 patients who developed head and neck cancer over the past 20 years to gauge the prevalence of HPV - a possible causative agent. They included studies which had tested for the virus in serum or in tumour tissue by PCR and found almost a quarter of patients (24.2%) had HPV positive tumours. Of these the vast majority (86.8%) were positive for HPV 16, the virus also associated with cervical cancer. Overall, the researchers concluded that being HPV positive increased the risk of developing head and neck cancer by 40 per cent. But being HPV16 positive increased the risk more than fourfold (4.47 times higher) compared to HPV16 negative patients.

However, people with HPV-associated head and neck cancer lived longer than people with other forms of the disease, the researchers point out. Their risk of dying was reduced by 60 per cent and by even more in HPV16-associated cancers of the mouth and pharynx compared to HPV negative HNSCC suggesting the virus produces a less aggressive type of cancer.

Other researchers at ASCO presented results of a pan-European survey of public awareness about head and neck cancers and their associated risk factors. Results showed only 15 per cent of people were aware of the risk of acquiring HPV-related oral cancer by oral sex with multiple partners. A finding described as "potentially worrying" by the survey authors. "Although the risk of HPV infection from oral sex is only an observational finding at this stage of our knowledge, people ought to be made aware of it," said survey leader Professor Lefebvre.

The survey conducted among more than 7500 members of the public in seven European countries - France, Germany, Italy, Netherlands, Spain, Sweden and UK - revealed an alarming lack of awareness of head and neck cancers in general and how to recognise early symptoms, he said.

Only 23 per cent of survey participants were aware of the term "Head and Neck Cancer", at all. Despite a link between those recognising the term and personally knowing someone affected, the extent of public awareness at a country by country level bore no relation to the incidence of disease nationally. Awareness was lowest in the UK (11 per cent) where almost 8000 cases are diagnosed per year and highest in Italy (39 per cent) where 12,400 cases were diagnosed. Incidence of head and neck cancer was highest in France (over 20,000 cases per year) where awareness was 20 per cent and in Germany (19,700 cases per year) where awareness was 22 per cent. The lowest incidence of disease was in The Netherlands, with just over 2300 cases per year where awareness was comparatively high at 30 per cent.

More than 60 per cent of participants underestimated the incidence of head and neck cancer by at least a factor of 10. Although the majority knew certain lifestyle factors could affect risk of developing head and neck cancer and correctly identified smoking as a risk factor, only 59 per cent knew alcohol played a major role and only 29 per cent acknowledged the part played by excessive sun exposure.

Commenting on the study Professor Lefebvre said the lack of awareness was worrying because it was likely to delay people affected coming forward for diagnosis and treatment at a stage when the disease was potentially curable. Greater efforts should be made to educate the public about avoiding harmful life-style behaviours that increase risk and about how to recognise symptoms requiring a specialist opinion. "Anyone with a sore throat persisting more than two weeks should see their GP and be referred to an ENT specialist for investigation" he advised. "Should more evidence emerge of the link between HPV infection and oral cancer there will be a case for wider vaccination against HPV with young males as well as females offered vaccination," he added.

Omnibus Internet interviews for the About Face survey were conducted in September 2008 by TNS Healthcare in conjunction with the European Head and Neck Society.

Olwen Glynn Owen
olwen(at)macline.co.uk
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