Jessamin Cipollina, MA
April 12, 2022
April is Oral Cancer Awareness Month, an opportunity for educators, practitioners and advocates alike to promote awareness of oral and oropharyngeal cancers (OPC) and the importance of regular oral cancer screenings. In the US, human papillomavirus (HPV) is the not only the most common sexually transmitted infection, but it is one of the most difficult viruses to identify and diagnose. Studies have shown that most sexually active people experience a mild to severe HPV infection at some point in their life. The CDC estimates that over 42 million Americans are currently living with HPV and approximately another 13 million become newly infected each year. Approximately 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 women.
There are 200 types of HPV, 40 of which are sexually transmitted and at least 9 that are linked to cancer. For many people with strong immune systems, the infection clears on its own. Most oral HPV lesions are benign, and may persist or reoccur. However, even with a strong immune system, untreated HPV infection in any part of the body can lead to cancer. Findings from studies that have explored HPV-associated OPC call for improved health literacy around HPV and oral cancer screenings in dental and medical settings to reduce oral cancer rates.
OPC traditionally are thought to be caused primarily by tobacco and alcohol use, but studies show that about 70% of cancers of the oropharynx are linked to HPV. As tobacco use and alcohol abuse have reportedly declined in the US over the past 20 years, rates HPV infection and HPV-associated cancers have steadily increased. A 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 throat.
Interprofessional collaboration and management of patients with HPV-related OPC is essential for providing effective whole-person care, including strategies for health promotion, symptom management, and self-management. Medical and dental professionals are well-positioned to assess OPC risk with their patients and emphasize the importance of preventing oral cancer. The good news is that we have an effective HPV vaccine, the only confirmed cancer preventive intervention.
Health professionals – nurses, nurse practitioners, midwives, dental hygienists, physician assistants and more – are well-positioned to partner with families to improve HPV vaccine confidence. The vaccine can be administered to patients as young as 9 years of age, and up to age 45. For those adults who did not receive the vaccine as teenagers, it is not too late. Health professionals need to query adult primary care and dental patients about whether or not they have received the HPV vaccine.
A positive strategy for approaching parents of preteens and adolescents, as well as adults, about the HPV vaccine is to emphasize its value in preventing cancer. Medical and dental teams can contribute to reducing oral cancer rates and the severity of HPV-associated oral cancer by collaborating to perform oral cancer screenings and include oral health assessments as a “best practice”. Promotion of HPV vaccine administration has great potential to reduce HPV-associated cancers across the US (see Rising Rates of HPV-Associated Oropharyngeal Cancers).
A recent article in the Journal of Dental Education challenges health professionals to collaborate in preventing HPV-associated OPC and interprofessionally managing OPC when it occurs. Although vaccine administration is a common and widespread practice in primary care settings, including HPV vaccine health literacy and administration in dental offices would expand the reach of HPV vaccine administration to vulnerable populations. As of March 2022, new CDT code categories include codes for the administration of the HPV vaccine. Providing interprofessional education experiences in dentistry and other health professions at the academic level, including nursing, pharmacy and medical education, has the potential to improve all health care professionals’ knowledge of HPV and oral cancer so that they are well-prepared to provide health literacy and administer the HPV vaccine with confidence.
A critical facet of promoting HPV vaccine administration is building vaccine confidence. All health professionals have the capacity to be community leaders and build public trust in all vaccines, particularly the HPV vaccine. Providing health literacy about the HPV vaccine as a cancer prevention method is the best way to combat misinformation and educate families and communities about the importance of vaccines. Findings from numerous studies reveal that a recommendation from a trusted health care provider is key to parents’ decision to have their children vaccinated. To effectively reduce rates of HPV and HPV-associated cancers, all health care professionals need to be well-versed about HPV and OPC to provide accurate information about the vaccine and emphasize its capacity to prevent cancers with a high mortality rate (see The Need for the Needle).
We call on dental and medical professionals to provide patients of all ages with HPV vaccine and OPC information. Interprofessional communication and collaboration is vital to improving health outcomes. Faculty can play an important role by using HPV-associated OPC as a valuable interprofessional clinical exemplar in simulations or clinical experiences. Students across health professions can partner in promoting HPV vaccine confidence to decrease multiple forms of HPV-associated cancer across the US.
- 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
- Centers for Disease Control and Prevention. HPV Infection. Accessed April 12, 2022.
- Centers for Disease Control and Prevention. Chapter 5: Human Papillomavirus. Accessed April 12, 2022.
- Centers for Disease Control and Prevention. HPV and Oropharyngeal Cancer. Accessed April 12, 2022.
- FDA expands Gardasil 9 approval for head and neck cancer prevention. Healio. Accessed April 12, 2022.
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