HPV-related cancer leap to have big impact on health services
 

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HPV-related cancer leap to have big impact on health services

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HPV-related cancer leap to have big impact on health services

 

HPV-related cancer leap to have big impact on health services

The rapid rise in cases of oesophageal squamous cell carcinoma  related to human papillomavirus (HPV) infection has serious implications for health services around the world, warn researchers.

They suggest that sexual transmission of HPV might be the reason for the rise.

Head and neck cancer is the sixth most common cancer, with about 640,000 new cases each year worldwide.

Despite an overall marginal decline in most head and neck cancers in recent years, the level of oropharyngeal squamous cell carcinoma (OSCC) has increased greatly, especially in the developed world.

In the US, cases increased by 22% between 1999 and 2006, after showing no change between 1975 and 1999, while the UK has seen a 51% increase in oral and oropharyngeal cancer in men between 1989 and 2006.

This increase seems to be accounted for by a rise in HPV-related tumours, say the authors, led by Hisham Mehanna at the Institute of Head and Neck Studies and Education, University Hospital, Coventry.

A recent study showed a 70% increase in the detection of HPV in biopsies taken to diagnose oropharyngeal carcinoma in Stockholm since the 1970s.

HPV-related oropharyngeal carcinoma has also been reported in 60-80% of recent biopsy samples in studies conducted in the US, compared with 40% in the previous decade.

HPV-related oropharyngeal carcinoma seems to be a new and distinct disease entity, explain the authors.

It has a better prognosis than non-HPV related oropharyngeal carcinoma, particularly in non-smokers, but the reason for this improved survival is not fully understood.

They suggest that sexual transmission of HPV might be the reason for the rise.

A recent study found that the risk of developing oropharyngeal carcinoma was associated with a history of six or more lifetime sexual partners, four or more lifetime oral sex partners, and – for men – an earlier age at first sexual intercourse.

But, whatever the reason, the rising rate of HPV related oropharyngeal carcinoma has implications for health service providers and commissioners, they warn.

For instance, patients are typically younger and employed, and – because outcomes seem to be more favourable than for patients with non-HPV related carcinoma – they will live longer.

Consequently, they need prolonged support from health, social, and other services, and may require help in returning to work.

There are also public health implications, they add. For example, including boys in HPV vaccination programmes before they become sexually active.

They write: ‘At present, we have no good evidence to support managing patients with HPV related head and neck cancer differently from those whose tumours are not HPV related, although several studies are being planned to evaluate different treatment options. Until data from such studies are available, we suggest that clinicians should not change their current treatment policies, but should aim to offer all patients with oropharyngeal cancer the opportunity to enrol in an appropriate clinical trial.'

Last month, a mouth cancer charity called for the introduction of a new HPV test in Britain which would help diagnose mouth cancer at an early stage.

The British Dental Health Foundation (BDHF) – organisers of Mouth Cancer Action Month – want the examination made available in the UK for the oral human papilloma virus (HPV) which can be tested in the dentist's chair.

The test identifies one of two exceptionally dangerous forms of HPV long before the virus develops into cancer and creates lesions.

Chief executive of the BDHF, Dr Nigel Carter, stressed the importance of early diagnosis.

Dr Carter said: ‘Currently the best chance of beating the cancer comes from early detection, improving survival rates to more than 90%.'

The warning appears in an editorial at www.bmj.com.

 Posted on : Wed 24th - Mar - 2010

 

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