A disturbing anecdotal presence within my dental practice:

[PCIntern]

Please allow me to preface this by saying that many many years ago, I was one of the first dental practitioners who noticed that my gay male patients were coming in, almost en masse, ill with infections which were unresponsive to conventional antibiotic therapy. Questioning the Infectious Disease folks where I was a faculty member at the time resulted in responses such as "Your practice is just enlarging" or "You just notice these things because you're a dentist and don't really understand the nature of illness and epidemiology. Lots of people are sick and don't get better."

Well, a number of months after this, the (stupid) diagnosis of GRID was coined, and then of course when the geniuses in health care finally figured out that the etiological agent didn't give a damn what your lifestyle was, they called it AIDS.

To the point: within my practice during the last 18 months or so, I have noticed a dramatic increase in the incidence of throat cancer. The primary location may be in the tonsillar crypt, or at the base/behind the tongue in the throat or involving the pillars of the fauces. I am alarmed by this. I have practiced for over thirty years and have only seen a handful of these, even among smokers, in that time. All but one of my patients are non-smokers. This is of great concern.

One now-humbled infectious disease doc said to me that some of the oncologists to whom he is speaking mention the possibility of viral infection of the pharyngeal area from oral sex. Some of these viruses are thought or known to be carcinogenic. I know this will lend itself to some jokes around here (Yeah, I already thought of Lewinsky Jokes) but it's not at all funny. Now it may well be that this is a statistically insignificant finding, but there are articles within journals which are specifically dedicated to anecdotal notations of events in order that otherwise unpublishable material may get noticed "just in case" someday it proves to be important.



Keep your eyes open during the next few years; you may one day say: I once read that on a thread in DU.

[Brickbat]

1. You may have missed this story.

http://www.reuters.com/article/idUSTRE62P01Q20100326?feedType=RSS&feedName=topNews

From the story:

Despite an overall slight decline in head and neck cancers in recent years, cases of a particular form called oropharyngeal squamous cell carcinoma (OSCC) have increased sharply, particularly in the developed world.

This growth seems to be linked to cancers caused by the human papillomavirus (HPV), scientists said in a report in the British Medical Journal.

Two vaccines -- Cervarix, made by GlaxoSmithKline, and Gardasil, made by Merck & Co -- can prevent HPV, which causes virtually all cases of cervical cancer, the second most common cancer in women worldwide.

[PCIntern]

2. I did. Thank you!

[Brickbat]

3. You're welcome!

[yellerpup]

4. You do understand the nature of illness and epidemiology.

This is alarming news based on the evidence you've seen in your practice. Thanks so much for these observations. Maybe you could suggest dental dams for your patients who have this infection. It may be too late for the person who is already infected, but for their sex partners it could mean the difference between life and death. Good work!

[NuttyFluffers]

14. too deep for dental dams. pharyngeal is *ahem* deep throat.

but dental dams are a good recommendation against catching parasites during other forms of oral play. however, some favor plastic wrap when a larger surface area needs to be covered.

[yellerpup]

16. Thanks for making the distinction.

However people decide to play they, need to be safe. :pals:

[alphafemale]

5. Is there an age range? Or a gender varience that you've noticed?

That is disturbing but interesting.

[hlthe2b]

6. HPV?

Human Papilloma Virus is certainly responsible for some rise in throat cancer, which unlike other head and neck cancers is not decreasing and may well be increasing... So, yes sexually transmission of HPV may be a signficant part of what you are seeing.

Some folks at M D Anderson are doing quite a bit of work on this.

[JuniperLea]

7. STD throat cultures...

Wow.

I worked for one of the very first (founded in 1956) dental PPO capitation plans, and our head of provider relations (a dentist and former prez of the CA Dental Association) used to say that the mouth was on the front line when it comes to disease, and he was freaky about even touching his lips with a pay phone (this was in the late 80's). I used to help him with very early "universal procedures" demonstrations in dental offices (I also tested carpets and work surfaces for mercury and other metals), and he would always tell dentists that HIV/AIDS was the tip of the iceberg, and that we'd be shocked today if we knew what we'll know about disease causing virus in 20-30 years.

I used to think he was just paranoid.

:scared:

[The Doctor.]

8. Questions;

Have you noticed greater prevalence in either men or women, or are any discrepancies statistically insignificant?

What age range, if any, exhibits greater incidence?

A question I'd love to ask each of your patients; "Have you or your partner taken any HPV vaccines at all, and when?"

I know you are constrained by ethics from delving, but if they are willing to (anonymously) volunteer the information it could well be very valuable even if only from an informal study.

[hedgehog]

9. I lost a cousin to throat cancer a few years back - he wasn't

even 60. My mother has been watching the news for several years and asking why males don't get the vaccine as well as females for the reasons you suggest.

[hlthe2b]

10. 2007 NEJM case control study of HPV and throat cancer

FIrst to really implicate but the role of HPV and oral cancers; epidemiological studies since have really underscored the role of HPV in these cancers. Here's the abstract of that study:

***


Case–Control Study of Human Papillomavirus and Oropharyngeal Cancer
Gypsyamber D'Souza, Ph.D., Aimee R. Kreimer, Ph.D., Raphael Viscidi, M.D., Michael Pawlita, M.D., Carole Fakhry, M.D., M.P.H., Wayne M. Koch, M.D., William H. Westra, M.D., and Maura L. Gillison, M.D., Ph.D.

http://content.nejm.org/cgi/content/full/356/19/1944

Background Substantial molecular evidence suggests a role for human papillomavirus (HPV) in the pathogenesis of oropharyngeal squamous-cell carcinoma, but epidemiologic data have been inconsistent.

Methods We performed a hospital-based, case–control study of 100 patients with newly diagnosed oropharyngeal cancer and 200 control patients without cancer to evaluate associations between HPV infection and oropharyngeal cancer. Multivariate logistic-regression models were used for case–control comparisons.

Results A high lifetime number of vaginal-sex partners (26 or more) was associated with oropharyngeal cancer (odds ratio, 3.1; 95% confidence interval , 1.5 to 6.5), as was a high lifetime number of oral-sex partners (6 or more) (odds ratio, 3.4; 95% CI, 1.3 to 8.8). The degree of association increased with the number of vaginal-sex and oral-sex partners (P values for trend, 0.002 and 0.009, respectively). Oropharyngeal cancer was significantly associated with oral HPV type 16 (HPV-16) infection (odds ratio, 14.6; 95% CI, 6.3 to 36.6), oral infection with any of 37 types of HPV (odds ratio, 12.3; 95% CI, 5.4 to 26.4), and seropositivity for the HPV-16 L1 capsid protein (odds ratio, 32.2; 95% CI, 14.6 to 71.3). HPV-16 DNA was detected in 72% (95% CI, 62 to 81) of 100 paraffin-embedded tumor specimens, and 64% of patients with cancer were seropositive for the HPV-16 oncoprotein E6, E7, or both. HPV-16 L1 seropositivity was highly associated with oropharyngeal cancer among subjects with a history of heavy tobacco and alcohol use (odds ratio, 19.4; 95% CI, 3.3 to 113.9) and among those without such a history (odds ratio, 33.6; 95% CI, 13.3 to 84.8). The association was similarly increased among subjects with oral HPV-16 infection, regardless of their tobacco and alcohol use. By contrast, tobacco and alcohol use increased the association with oropharyngeal cancer primarily among subjects without exposure to HPV-16.

Conclusions Oral HPV infection is strongly associated with oropharyngeal cancer among subjects with or without the established risk factors of tobacco and alcohol use.

[Hassin Bin Sober]

11. Are these cases you are the first to diagnose or set off the alarm for your patients?

I had a scare a few months ago. My dentist noticed a spot on my tongue and sent me to a surgeon for a consult. It checked out fine. The only thing that bothers me is the spot still shows up once in a while.

[PCIntern]

12. Tongue 'conditions' are quite prevalent...

most are quite benign but somewhat frightening..."black, hairy tongue" comes to mind:



+++++++++++++++++++

To answer some of the above questions:

Almost all male
Interestingly, almost all heterosexual to my knowledge...but hoo really nose?
I only bring up sex-stuff if the patient asks a question...some really intersting conversations over the years.

[progressoid]

13. Oh, dear lord.

:yoiks:

[DiverDave]

15. My friends son died from throat

cancer,
22 and a non smoker.
90 days from discovery to his death.
My friend joined his son 4 months after.

God I miss them...