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5 Countries with an Increased Cervical Cancer Risk Because of a Common Infection

Harold Mandel's picture
Getting a vaccine

The threat of oral cancer is real from HPV infection.


Many people must deal daily with denial that you too could be hit with cancer. But the threat is real. In fact recent research shows an increased incidence of oropharyngeal cancer (OPC) and a possible association with human papillomavirus infection (HPV). Here are five countries where the risk of cancer is higher with this common infection.

This is not a matter that should be taken lightly and dismissed. There has been a lot of discussions in the press in recent years about a conjectured association between human papillomavirus infection (HPV) and oropharyngeal cancer (OPC). New research shows this association is for real.

A possible role for an HPV infection association with the increasing OPC incidence has been established, according to research work published by the Journal of Clinical Oncology. Over the years HPV has been identified as a significant cause of the rising OPC incidence in many countries. Researchers opened up an investigation to determine whether or not this represents a global phenomenon.

In recent studies an increasing incidence of OPC with HPV as the potential cause, has been observed, as reported upon in a review of this research by the National Cancer Institute. Oropharyngeal cancer develops primarily in the middle part of the throat just behind the mouth, and includes the base of the tongue, along with the side and back walls of the throat, and the tonsils. In order to determine if this increase in OPC incidence is representative of a global phenomenon, Chaturvedi and his colleageus at Ohio State University and the International Agency for Research on Cancer investigated trends for oropharyngeal and oral cavity cancers.

These researchers evaluated data from more than 180,000 patients in 23 countries. They observed that OPC incidence rose overall among both women and men between 1983 and 2002. This rising incidence of OPC was seen primarily in economically developed countries. The researchers have noted that there is an association between prophylactic HPV vaccine and protection against oral HPV infection, which suggests an additional significant benefit of vaccination programs for both women and men.

There has been a growing body of evidence which shows that HPV is a common and increasing cause of oropharyngeal squamous cell carcinoma (OSCC), writes the Centers for Disease Control and Prevention. The International Agency for Research against Cancer has noted HPV is a risk factor for OSCC, along with smoking and alcohol consumption. EmaxHealth reporter Robin Wulffson, MD has written about observations that oral HPV infections are on the rise.

In recent years a rise in OSCC has been seen in several countries, including:

1: Finland

2: United Kingdom

3: Netherlands

4: United States

5: Sweden

An increase in the proportion of HPV-positive tumors was likewise noted. Researchers have conjectured that rising incidence of OSCC in the United States and countries in northern Europe is because of a new HPV epidemic which is primarily sexually transmitted. This assumption has been based on observations which indicate that patients with HPV-positive cancer often experienced their first sexual experience at a young age and have multiple partners.

Over the years vaccines against some types of HPV have been administered to girls and young women in order to protect them from HPV-induced cervical cancer. Interest in this vaccine has gained further attention because HPV is associated not just with cervical cancer, but also with genital warts and other tumors, including head neck and anogenital cancers. HPV is most commonly found in OSCC.

Head and neck cancer is generally of the squamous cell carcinoma type (HNSCC). HNSCC includes cancers of various locations, including the following:

1: Oral cavity

2: Oropharynx

3: Hypopharynx

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4: Larynx

5: Sinonasal tract

6: Nasopharynx.

HNSCC has been found to be the sixth most common type of cancer in the worldwide. There are about 600,000 new cases of HNSCC reported annually. About 10 percent of these have been found to be OSCC. Traditional risk factors for HNSCC and OSCC include:

1: Smoking

2: Alcohol consumption

3: Betel chewing

In the past decade several reports have documented an association of HPV with OSCC. The International Agency for Research against Cancer has therefore recognized HPV infection as a significant risk factor for OSCC. Furthermore, more and more reports from many countries show an increasing incidence of OSCC. It has been suggested that this increase is due to a slow epidemic of HPV infection–induced OSCC.

The most common type of OSCC has been found to be tonsillar cancer. Base of tongue cancer is the second most common type of OSCC. These 2 types of cancer together account for 90 percent of all OSCCs. Unfortunately, patients generally do not seek counseling until these tumors are large because small tumors do not cause a great deal of distress and may not even be noticed by the patient. Standard treatment plans include surgery, radiotherapy, and chemotherapy. When cures are not possible palliative therapy for pain and discomfort is given. There is an overall 5-year survival rate of just about 25 percent for patients with OSCC.

According to the Centers for Disease Control and Prevention (CDC) genital human papillomavirus, which is also called HPV, is the most common sexually transmitted infection (STI). There are greater than 40 different types of HPV which can infect the genital areas of males and females. The mouth and throat can also be infected by HPV. Very serious health problems are seen with HPV, including genital warts and certain cancers. Fortunately, in most cases HPV simply goes away by itself before it leads to any health problems. Most people infected with HPV do not even know they have it.

Anyone who has ever has sex can come down with HPV. As a matter of fact HPV is so common just about all sexually-active men and women get HPV at some point in their lives. This is even seen among people who only have sex with one person during their lifetime. Transmission of HPV occurs through genital contact, generally during vaginal and anal sex. HPV may also be transmitted during oral sex and genital-to-genital contact. On rare occassions a pregnant woman can pass the HPV on to her baby during delivery.

About 90 percent of cases of HPV infections disappear by themselves within two years.However, sometimes HPV infections persist and can cause many serious health problems, including:

1: Genital warts

2: Recurrent respiratory papillomatosis (RRP), which is a rare condition in which warts grow in the throat

3: Cervical cancer

4: Other, less common, but serious cancers, including genital cancers,
and oropharyngeal cancer

It has been my professional observation that in spite of an increased awareness about risks from HPV there is often a denial process going on regarding the fact that anyone can be hit with the consequences of this infection. Therefore, initiatives to have more tweens and teens vaccinated with the HPV vaccine do not appear to be nearly as successful as possible. This burden of convincing young people that this vaccine could save their lives should not be left solely with parents, due to the very real phenomenon of psychological backlashes wherein tweens and teens may find themselves doing the opposite of what may be good for them to prove their independence. This is a common, normal phenomenon which is often seen at this stage of development.

The burden for stressing the importance of this vaccine can not even be placed completely on pediatricians and Family Doctors, because kids are often resistant to going for standard check-ups, and forcing them to do so is likely to be met with undesirable results. It appears to me the best place to begin working to wipe out problems from HPV with the HPV vaccine is in school. Educators must take a more aggressive posture in presenting the facts about HPV to students at all ages. Robin Wulffson, MD has discussed safety issues of Gardasil HPV vaccine.

Graphic descriptions and photos of the possible consequences of HPV infection, and other venereal diseases, such as AIDs, should be presented to students in health education classes. With better education more young people may make better decisions about sexual matters in their own best interests. The scientific facts dealing with HPV, and AIDs, not reactionary political or social thinking, has derailed the sexual revolution of the 1960s baby boom generation. This should be kept in mind in dealing with this serious problem.