Oral health is critical to overall good health and it also serves as a surrogate marker in critical disease. We commend Kelsall and O’Keefe1 for highlighting the need to eliminate barriers to dental care for some of our most vulnerable patients.
Oropharyngeal cancers are among the most commonly occurring malignancies in Canada. Human papillomavirus (HPV) is the causative factor in 80% oropharyngeal cancers, and it is estimated that, in the United States, these cancers will overtake uterine HPV cancers in the next 15 years;2 noncervical cancers are dramatically on the rise in Canada as well.3
The development of HPV vaccine has changed the face of gynecologic oncology, but an important emerging area is the role of immunization in HPV-related oral malignancies, and research is underway.
It is a common misconception that HPV vaccine is only effective in those who have not yet been exposed to the disease, however there is evidence that patients treated for HPV malignancy benefit from recurrence from other HPV strains with immunization.4
Understanding of HPV malignancies is growing. In one study, patients with oropharyngeal squamous-cell carcinoma had a 25-fold increased risk of cervical cancer.5 Referral and screening across the spectrum is critical.
Patients with HPV disease and malignancy provide an opportunity for interdisciplinary collaboration for those working in primary and secondary prevention, including immunization, oncology, oral health and gynecology.
Research is required to explore the role of immunization against HPV-related diseases, particularly in the senior population. We must collaborate with our dental health colleagues to promote awareness and prevention.
References
- 1.Kelsall D, O’Keefe J. Good health requires a healthy mouth: improving the oral health of Canada’s seniors. CMAJ 2014;186:893. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Mirghani H, Amen F, Moreau F, et al. Human papilloma virus testing in oropharyngeal squamous cell carcinoma: what the clinician should know. Oral Oncol 2014;50:1–9. [DOI] [PubMed] [Google Scholar]
- 3.Shack L, Lau HY, Longlong H, et al. Trends in the incidents of human papillomavirus-related noncervical and cervical cancers in Alberta, Canada: a population-based study. CMAJ Open 2014;2:E127–32. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Kang WD, Choi HS, Kim SM. Is vaccination with quadrivalent HPV vaccine after loop electrosurgical excision procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN2-3)? Gynecol Oncol 2013;130:264–8. [DOI] [PubMed] [Google Scholar]
- 5.Daley E, DeBate R, Dodd V, et al. Exploring awareness, attitudes, and perceived role among oral health providers regarding HPV-related oral cancers. J Public Health Dent 2011;71:136–42. [DOI] [PubMed] [Google Scholar]