June 19, 2012 — A history of periodontitis might be associated with an increased risk for head and neck tumors positive for human papillomavirus (HPV), according to data published online June 18 in the Archives of Otolaryngology — Head & Neck Surgery.
Of 124 primary cases of head and neck squamous cell carcinoma, 50 (40.3%) were positive for HPV-16 DNA. In addition, a higher percentage of oropharyngeal cancers than of oral cavity (29.0%) and larynx (20.5%) cancers were positive for HPV (65.3%).
"Periodontitis is easy to detect and may represent a clinical high-risk profile for oral HPV infection," conclude the authors, led by Mine Tezal, DDS, PhD, assistant professor in the Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York at Buffalo. "Prevention or treatment of sources of inflammation in the oral cavity may be a simple yet effective way to reduce the acquisition and persistence of oral HPV infection."
Rising Rates
The incidence of oropharyngeal cancers has been steadily rising in the United States since 1973, despite the significant decline in tobacco use since 1965, the authors note. The same trend has been reported in other parts of the world, and is attributed mainly to oral HPV infection.
As previously reported by Medscape Medical News, one review suggested that changes in sexual practices are behind the surge in the number cases of oropharyngeal squamous cell carcinoma associated with sexually transmitted HPV. The key factors appear to be multiple sex partners, starting sexual activity at a younger age, and increased oral sex.
Another study, however, found that an increasing incidence of oral tongue cancer in people 18 to 44 years of age was not associated with HPV.
Previous studies have suggested that chronic periodontitis is linked to a higher risk for oral premalignant lesions and head and neck squamous cell carcinoma, Dr. Tezal and colleagues note. A history of periodontitis also predicts poorly differentiated tumor status in the oral cavity.
The authors note that the results of a small study of patients with cancer of the base of the tongue suggested a synergy between periodontitis and tumor HPV status (Arch Otolaryngol Head Neck Surg. 2009;135:391-396). Their reserach "extends this work to assess the association of periodontitis and other dental factors with the presence of HPV-16 in oral cavity, oropharyngeal, and laryngeal cancers."
Higher Bone Loss Observed
This hospital-based case-controlled study involved 124 patients diagnosed with incident primary squamous cell carcinoma of the oral cavity, oropharynx, and larynx from 1999 to 2007. All patients had tissue samples and dental records available.
The history of periodontitis in all patients was assessed using alveolar bone loss from panoramic radiography conducted by an examiner who was blinded to cancer status.
The study's primary measure was the presence of HPV-16 DNA, which was identified in paraffin-embedded tumor samples using polymerase chain reaction.
HPV-16 DNA was present in the oral cavity in 31 cases (25.0%), in the oropharynx in 49 cases (39.5%), and in the larynx in 44 cases (35.5%).
The prevalence of HPV-positive tumors was significantly lower in patients who had moderately or well-differentiated tumors than in those with poorly differentiated tumors (34.9% vs 55.6%; P = .01). The prevalence was also lower in current smokers than in never smokers (34.9% vs 70.0%; P = .047). However, other demographic factors, such as tumor stage, age at diagnosis, sex, race/ethnicity, marital status, and alcohol use, did not significantly differ by HPV status.
Patients with HPV-positive tumors had significantly more bone loss (4.57 vs 3.78 mm; P = .001) and fewer missing teeth (7.38 vs 11.02; P = .02) than those with HPV-negative tumors.
After adjustment for age at diagnosis, sex, and smoking status, each millimeter of alveolar bone loss was associated with a 2.6-times increased odds of an HPV-positive tumor (odds ratio [OR], 2.61; 95% confidence interval, 1.58 to 4.30). The strength of this association was greater for patients with oropharyngeal lesions (OR, 11.70) than for those with oral cavity tumors (OR, 2.32) and laryngeal squamous cell carcinoma (OR, 3.89).
"Periodontitis is easy to detect and may represent a clinical high-risk profile for oral HPV infection," conclude the authors. "Prevention or treatment of sources of inflammation in the oral cavity may be a simple yet effective way to reduce the acquisition and persistence of oral HPV infection."
The study was supported by grants from the National Cancer Institute and the National Institute of Dental and Craniofacial Research. The authors have disclosed no relevant financial relationships.
Arch Otolaryngol Head Neck Surg. Published online June 18, 2012. Abstract
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Cite this: Periodontitis Linked to HPV-Positive Oral Tumors - Medscape - Jun 19, 2012.
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