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Published in CenterView on April 23, 2012
Dr. Kristen Otto (left), Dr. Karen Crews and Dr. Shelley Taylor perform an oral cancer examination on a patient at the Oral Oncology Clinic recently.
Dr. Kristen Otto (left), Dr. Karen Crews and Dr. Shelley Taylor perform an oral cancer examination on a patient at the Oral Oncology Clinic recently.

UMMC experts: tobacco, alcohol provide greater oropharyngeal cancer risk than HPV

By Matt Westerfield

A recent study found that the incidence of a certain type of oral cancer linked to human papillomavirus (HPV) increased by 225 percent from 1988 to 2004 nationwide, highlighting a growing public-health concern over cancer-causing oral infections.

But experts at the University of Mississippi Medical Center say the public should be far more concerned about the use of tobacco and alcohol as risks for oral cancer than with contracting oral HPV.

In fact, while there may not be enough data yet to sound an alarm about HPV-linked oral cancer, 26 percent of Mississippians are smokers, one of the highest rates in the nation. That is exactly why physicians and dentists at the Oral Oncology Clinic urge patients, friends and UMMC employees to take advantage of the free oral screening scheduled Friday, April 27, as part of a national oral, head and neck cancer awareness event.

The oral screening event will be from 8 a.m.-5 p.m. at the clinic’s location in the Jackson Medical Mall Thad Cochran Center. Those interested in signing up for a screening are asked to call (601) 815-1181.

“Most people at some point in their lives get exposed to various forms of HPV,” said Dr. Kristen Otto, assistant professor of otolaryngology. “There are dozens of subtypes of HPV. Only a few of the dozen have been linked to malignant transformation.”

The study, published last fall in the Journal of Clinical Oncology, linked oral-HPV infection with oropharyngeal squamous cell carcinoma, a cancer that affects the back of the mouth. The increase in that type of cancer was predominantly among young adults, and the study suggests that oral HPV infection might be related to oral sex.

HPV is the most common sexually transmitted disease in the U.S. However, Otto cautioned that doesn’t mean HPV is the only causative agent.

“The confounding feature is smoking because there is a very large association between oropharyngeal cancer, oral cavity cancer — or any head and neck cancer — and smoking. So while we know there is also a component of people who never smoke, never drink and get this cancer, we also know that the vast majority of the people who get this cancer are smokers.

“So there are other reasons why they’re getting it.”

Furthermore, patients who don’t smoke and have oral cancer related to HPV respond better to treatment, said Dr. Gina Jefferson, assistant professor of otolaryngology.

“By itself, if you’ve never been a smoker or a drinker, it is a prognostic improvement on the patient,” she said. “But in Mississippi, the incidence of HPV-associated oropharyngeal cancer is much lower than the national incidence.

“For whatever reason, patients in Mississippi are not having that association, and the majority of the patients in our state actually use some form of tobacco product.”

Most people who are exposed to HPV will not develop cancer, Otto said. But for that small percentage of patients who have never smoked and have HPV-related cancer, they will be treated the same as if they were smokers because currently, that’s the best standard of care.

“A lot of places in the far reaches of Mississippi don’t have otolaryngologists,” said Jefferson. “They don’t have anyone who is routinely and readily available to evaluate patients so that what they discover is an early-state disease.”

Which is why Dr. Karen Crews says dentists and dental hygienists should perform an oral cancer screening on every patient they see.

“We perform this procedure on every patient who comes into our practice, and we’ve been doing it for our entire careers,” said Crews, professor of oral oncology and behavioral medicine in the Department of Otolaryngology and Communicative Science. “What the UMMC team offers the community is a coordinated effort.

“For example, if our clinicians detect an oral problem, we can then refer the patient to the clinician who can initiate treatment. We are part of a comprehensive team made up of dentists, head and neck surgeons and radiation and medical oncologists who are ready to provide care.”

The bottom line, they say, is this: Don’t smoke and certainly don’t smoke and drink.

“Alcohol on its own is going to put you at slightly increased risk,” Otto said. “But when you smoke and drink you’re at synergistically high levels of increased risk.”

In addition to Crews, Otto and Jefferson, Dr. George Taybos, Dr. Harold Kolodney, Dr. Shelly Taylor and the entire oral oncology dental team also will participate in the screening. Employees with the ACT Center for Tobacco Treatment, Education and Research will be on hand to provide information about quitting smoking and other tobacco products.A recent study found that the incidence of a certain type of oral cancer linked to human papillomavirus (HPV) increased by 225 percent from 1988 to 2004 nationwide, highlighting a growing public-health concern over cancer-causing oral infections.

But experts at the University of Mississippi Medical Center say the public should be far more concerned about the use of tobacco and alcohol as risks for oral cancer than with contracting oral HPV.


In fact, while there may not be enough data yet to sound an alarm about HPV-linked oral cancer, 26 percent of Mississippians are smokers, one of the highest rates in the nation. That is exactly why physicians and dentists at the Oral Oncology Clinic urge patients, friends and UMMC employees to take advantage of the free oral screening scheduled Friday, April 27, as part of a national oral, head and neck cancer awareness event.

The oral screening event will be from 8 a.m.-5 p.m. at the clinic’s location in the Jackson Medical Mall Thad Cochran Center. Those interested in signing up for a screening are asked to call (601) 815-1181.

“Most people at some point in their lives get exposed to various forms of HPV,” said Dr. Kristen Otto, assistant professor of otolaryngology. “There are dozens of subtypes of HPV. Only a few of the dozen have been linked to malignant transformation.”

The study, published last fall in the Journal of Clinical Oncology, linked oral-HPV infection with oropharyngeal squamous cell carcinoma, a cancer that affects the back of the mouth. The increase in that type of cancer was predominantly among young adults, and the study suggests that oral HPV infection might be related to oral sex.

HPV is the most common sexually transmitted disease in the U.S. However, Otto cautioned that doesn’t mean HPV is the only causative agent.

“The confounding feature is smoking because there is a very large association between oropharyngeal cancer, oral cavity cancer — or any head and neck cancer — and smoking. So while we know there is also a component of people who never smoke, never drink and get this cancer, we also know that the vast majority of the people who get this cancer are smokers.
“So there are other reasons why they’re getting it.”

Furthermore, patients who don’t smoke and have oral cancer related to HPV respond better to treatment, said Dr. Gina Jefferson, assistant professor of otolaryngology.

“By itself, if you’ve never been a smoker or a drinker, it is a prognostic improvement on the patient,” she said. “But in Mississippi, the incidence of HPV-associated oropharyngeal cancer is much lower than the national incidence.

“For whatever reason, patients in Mississippi are not having that association, and the majority of the patients in our state actually use some form of tobacco product.”

Most people who are exposed to HPV will not develop cancer, Otto said. But for that small percentage of patients who have never smoked and have HPV-related cancer, they will be treated the same as if they were smokers because currently, that’s the best standard of care.
“A lot of places in the far reaches of Mississippi don’t have otolaryngologists,” said Jefferson. “They don’t have anyone who is routinely and readily available to evaluate patients so that what they discover is an early-state disease.”

Which is why Dr. Karen Crews says dentists and dental hygienists should perform an oral cancer screening on every patient they see.

“We perform this procedure on every patient who comes into our practice, and we’ve been doing it for our entire careers,” said Crews, professor of oral oncology and behavioral medicine in the Department of Otolaryngology and Communicative Science. “What the UMMC team offers the community is a coordinated effort.

“For example, if our clinicians detect an oral problem, we can then refer the patient to the clinician who can initiate treatment. We are part of a comprehensive team made up of dentists, head and neck surgeons and radiation and medical oncologists who are ready to provide care.”
The bottom line, they say, is this: Don’t smoke and certainly don’t smoke and drink.

“Alcohol on its own is going to put you at slightly increased risk,” Otto said. “But when you smoke and drink you’re at synergistically high levels of increased risk.”

In addition to Crews, Otto and Jefferson, Dr. George Taybos, Dr. Harold Kolodney, Dr. Shelly Taylor and the entire oral oncology dental team also will participate in the screening. Employees with the ACT Center for Tobacco Treatment, Education and Research will be on hand to provide information about quitting smoking and other tobacco products.