Sir, by 2030 half of all head and neck cancers will be related to HPV. This major new risk factor has the potential to influence all aspects of diagnosis and management of oral cancer; not restricted to secondary care.
General dental practitioners must ensure they are providing accurate information in regards to a rapidly advancing field of research which can be gained via continuing professional development that is specific to the challenges and advances of this disease. Accurate patient information leaflets specific to the topic may further be of benefit to practices.
Reassuringly, thorough clinical examinations may vastly remain unchanged as the presentation of these cancers are clinically indistinguishable. However, a change in demographic and patients' needs will be evident. Previously, patients with head and neck cancer have, for the most part, been male, over 60 years old and have a history of high alcohol intake and smoking. Instead, those affected by HPV positive oro-pharyngeal squamous cell carcinomas (OPSCC) are often younger middle-aged men who may lack the previously significant risk factors.1
At the time of diagnosis or after the completion of treatment, patients may have questions and concerns regarding how and why they have become infected with HPV2 as well as needing advice relating to vaccination. In addition, these patients will possibly have partners and young families under care of the same practitioner. These relatives may have anxieties and questions of their own relating to HPV transmission. The treating team will often be the first point of contact for the provision of information. As the number of those treated increases it is likely that the dental practitioner or members of their team will be asked questions that were previously considered taboo and potentially cause embarrassment. The possible psychosocial impact of diagnosis of HPV positive OPSCC should not be overlooked either. Receiving a diagnosis can initiate new feelings of anguish in addition to those coupled with a cancer diagnosis. In cervical cancer, research has shown emotional distress is common amongst women diagnosed with HPV. These feelings include decreased self-esteem, guilt and depression and can generate transmission concerns and intimacy issues.3 Investment in advanced communication skills courses for dental teams may aid the practitioner in addressing these topics. Early signposting to medical practitioners and support systems could also be of benefit.
References
Rates of mouth cancer increase to all time high. BDJ Team January 2016. Available at: http://www.nature.com/articles/bdjteam20162 (accessed May 2016).
Hancocks S . HPV vaccine for boys. Br Dent J 2014; 216: 1.
McCaffery K, Waller J, Nazroo J, Wardle J . Social and psychological impact of HPV testing in cervical screening: a qualitative study. Sex Transm Infect 2006; 82: 169–174.
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Dillon, M., Smith, D. & Kanatas, A. Oral cancer: Another challenge for the dental team?. Br Dent J 220, 499–500 (2016). https://doi.org/10.1038/sj.bdj.2016.357
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DOI: https://doi.org/10.1038/sj.bdj.2016.357
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