Three health organisations are reminding Kiwis that head and neck cancer can be prevented.
With Wednesday marking World Head and Neck Cancer Day, the health agencies say it’s a timely opportunity to raise awareness about the devastating health impacts of head and neck cancers, including oropharyngeal – throat – cancer caused by Human Papillomavirus Virus – HPV.
The Head and Neck Cancer Foundation Aotearoa (HNCFA), the Head and Neck Cancer Support Network (HNCSN) and the Sexually Transmitted Infections Education Foundation (STIEF) is also reminding New Zealanders that prevention is available for free in the form of the Gardasil vaccine.
This highly effective and safe vaccine prevents infection with HPV, and significantly reduces the risk of developing many different forms of cancer, including oropharyngeal cancer, cervical cancer and penile cancer.
This year, it is even more important because a significant proportion of our children have been missing out on this health prevention opportunity, due to the disruption brought by Covid-19, which is of great concern, say the health organisations.
In 2021, 53,000 fewer vaccines were delivered than in 2019, and the total reduction in doses over two years has been approximately 78,000 – that’s more than 30,000 children who have missed out.
“It was a no-brainer to vaccinate my children against HPV – they are all fully vaccinated with Gardasil. Knowing that they are protected from HPV-related cancers is one less worry on my mind,” says HPV head and neck cancer survivor, Doug Russell.
“As a parent I do not want to be in a position later in life when our children could come to us with HPV and ask why they did not get vaccinated for this entirely preventable disease.”
HPV is one of the world’s most widespread viral infections, usually resulting from direct skin-to-skin contact during intimate sexual contact with someone who has HPV. Without immunisation, around 80 per cent of people who have ever had penetrative, or non-penetrative sexual (vaginal, oral, or anal) contact will be infected by at least one type of HPV at some point in their lives. Unfortunately, condom use during sex doesn’t reliably prevent transmission of this virus.
Although there are over 150 types of HPV, only a small number of these are ‘high-risk HPV’ strains that have the potential to lead to cancerous changes in cells.
HPV is a bit of an “unlucky dip” really: in many people, HPV is naturally cleared by the body’s immune system, some people will retain the virus but have low-risk strains that may lead to genital warts, whilst others may have the high-risk strains and develop devastating cancers – sometimes decades later – having never known about the original infection.
It isn’t possible to predict which group your child will fall into if/when exposed to HPV, but it is possible to protect them by getting them vaccinated, says the health agencies.
The virus is most commonly associated with cervical cancer, but can also cause other cancers in the genital area of people of all genders, specifically the vagina, vulva, penis, and anus.
In recent years, medical professionals have also observed a rapid rise in HPV-related oropharyngeal cancer in heterosexual people who are otherwise healthy. For this group, the main risk is oropharyngeal cancer, which affects the throat (tonsils, base of tongue and soft palate).
Although this type of cancer has traditionally been linked to smoking and heavy drinking, in recent years HPV has become the leading cause. Oropharyngeal cancers caused by HPV are rapidly rising in developed countries. In New Zealand, 95 new cases of HPV-related oropharyngeal cancer with 25 deaths were estimated for 2018. In 2020, there were 334 oropharyngeal cancer cases caused by HPV.
Doug Russell, an otherwise healthy 58-year-old, describes the lead-up to “the single toughest day” of his life in 2017.
“I had a shave one lazy Sunday morning and there was nothing wrong with me. And at lunchtime, I was sitting in the kitchen having a sandwich, and I put my hand on my throat and I said to my wife Sarah “what is that lump?”
And there was a big lump.
“So on Monday, I went to the doctor and that started this whole thing, it just appeared overnight like that.”
Doug was infected with a high-risk strain of HPV, which he had never been aware of until it led to his cancer.
“I thought I was living my life to the fullest, and I thought cancer was something that happened to other people. I really struggled, and still do struggle a little bit, to understand why this happened to me, and what the implications would be for my family.”
Doug’s experience of it happening ‘overnight’ is not uncommon. Head and neck cancers including oropharyngeal cancer are notoriously difficult to detect and, as a consequence, are often only discovered in advanced stages. Symptoms will often be very mild initially and will depend on where exactly the cancer is situated, how big it is and how far it has spread in the body.
The most common symptoms are:
• a painless lump in the neck or in front of the ear • a lump or ulcer in the mouth, such as the tongue, gum, or inside the cheek • a persistent white or red patch in the mouth • a one-sided sore throat which may be associated with earache • pain or difficulty with swallowing • a hoarse voice, especially in a smoker • difficult or noisy breathing • a lump or sore on the face • numbness or weakness on one side of the face • one-sided blocked nose with bleeding
Many less serious conditions, apart from cancer, can cause these symptoms, but it is important to consult your doctor if they persist for more than three weeks.
Background: Study of Dental Students Perception of HPV and Oral Cancer. Human papilloma virus (HPV) infection forms a major etiological factor for oropharyngeal cancer (OPC), which has exhibited increased global incidence.
Aim: To compare the knowledge regarding HPV, its association with OPC, and HPV vaccine among students from different countries, years of the undergraduate program, and gender.
Methods: The current multinational cross-sectional study was conducted in 886 undergraduate dental students from Egypt, India, Pakistan, Saudi Arabia, UAE, and Sudan through Google survey forms from July 2021 to September 2021. The survey form comprised 27 items divided into four sections. The answers to the questionnaire were compared among students from different countries, different years of the undergraduate program, and males and females. Chi-square test was used to evaluate the correlation between the demographic characteristics of students and their knowledge regarding HPV and OPC.
Results: Females exhibited a better knowledge regarding knowledge and perception on HPV vaccine, whereas males exhibited a better knowledge regarding HPV and its correlation with OPC, and these differences were statistically significant (P < 0.05). The third- and fourth-year undergraduate students displayed a higher awareness of OPC and its connection with HPV than other year students, and this variance was found to be statistically significant (P < 0.001). Third-year and internship students exhibited a more positive attitude and comfort regarding the vaccine and discussing the same with patients than the other educational-level students. Students from India exhibited better knowledge about HPV and its association with OPC than the students from other countries, and this difference was statistically significant (P < 0.001).
Conclusion: Disparities in knowledge regarding HPV-related oral cancer have been detected among the female and male participants among different nations. From the entire study population, Indian students exhibited better knowledge regarding HPV. Females from all the nations exhibited a more positive attitude and comfort regarding the vaccine and discussing the same with patients than males. The results of this necessitate intervention measures including training workshops and awareness campaigns. Improving their knowledge regarding the same may increase their awareness, resulting in better patient care.
Oral squamous cell carcinoma comprises a group of malignancies that manifest in various regions of the oral cavity and are the 11th most common cancer worldwide.1 The global incidence of these malignancies is 4 per 100,000 people, and they form a major economic burden.2 According to Globocan data, the 5-year prevalence of oropharyngeal cancer (OPC) globally is 2.2% in Africa, 37.6% in Asia, 16.9% in North America, 8.6% in Latin America and the Caribbean and 33.4% in Europe, respectively.3
The etiology for oral cancer is multifactorial, including exposure to ultraviolet radiation, betel or areca nut, tobacco, and alcohol.4,5 Additionally, human papilloma virus (HPV) infection forms a major etiological factor for oral cancer. The significance of this etiological factor can be ascertained from the fact that the prevalence of HPV among OPC increased from 16.3% in 1989 to 72.7% during 2000–2004.6 Currently, approximately 63% of all OPCs are attributable to HPV and may be preventable.7,8 Thus, an awareness about HPV-related OPC can facilitate the reduction in the incidence of these cancers.
OPC is associated with high mortality. The primary reason for this is the silent presentation and late diagnosis of most patients.9 Thus, diagnosis of OPC in the early stages could decrease the mortality and morbidity associated with the condition. The oral cavity is easily accessible for clinical examination, especially for dentists, who can form the frontline for the prevention of oral cancer. Thus, increasing awareness and knowledge among dental professionals and patients could improve survival among patients with oral cancer.
Several HPV-related malignancies caused due to HPV 16 and 18 such as oral and cervical cancer can be prevented through HPV vaccination.10 Although the HPV vaccine is licensed for both females and males between 9 and 26 years of age, it is recommended in 11- and 12-year-old adolescents.10 Although it is not yet approved for preventing HPV-related OPCs, molecular and epidemiological data support a contributory role for HPV in OPC, and research is being carried out to investigate the efficacy of HPV vaccines for preventing OPCs.11 It is therefore vital to target immunizable young adult college-going girls and boys, as both are part of the infection chain and at risk for HPV infection as they are growing adults with independent lifestyles but have a choice to undergo vaccination with the consent from parents and are within the age group of successful vaccination outcome.
HPV is a sexually transmitted infection. Thus, identifying the comfort of the healthcare professional to discuss these etiologies with their patients and the gaps in their knowledge regarding HPV assists in detecting early cases.
Although several studies have investigated the awareness of dentists regarding HPV vaccines, most of these studies have been limited to a single country. Thus, the present study attempted to compare the knowledge regarding HPV, its association with OPC, and HPV vaccine among students from different countries, years of the undergraduate program, and gender among dental undergraduate students from six countries, namely India, Pakistan, Saudi Arabia, Egypt, UAE, and Sudan.
Materials and Methods
Study Participants
The present cross-sectional study was conducted among 1500 dental students from six countries through Google survey forms from 5 July 2021 to 5 August 2021 after obtaining Dar al Uloom University ethical clearance. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of College of Dentistry, Dar Al Uloom University, Riyadh, KSA (COD/IRB/2020/22). Students from the third year onwards of undergraduate dental education from Egypt, India, Pakistan, Saudi Arabia, UAE, and Sudan were included in the study. Students from any other country or those not in dental undergraduate training were excluded from the study. Only these countries were included as we could get permission for the concerned academic institutions through our known contacts at respective nations to circulate the survey among their students. The survey form was provided to the students through faculty working in the academic institutions of these countries. The nature of the study was described to every subject before they participate in the survey. The response of the participants was maintained confidential, and their consent was obtained electronically by their willingness to participate in this survey by answering all the questions.
Among 1500 dental students approached, only 886 responded within the stipulated time. The sample size was selected as per reference article and taking into account the number of students in each university fitting our inclusion criteria from six different nations. Considering the proportion of 0.641 (64.1%) from the pilot study, with relative precision of 5% and 95% confidence level, the calculated sample size came up to 864. The formula for calculating the sample size is as follows:
where P = expected proportion, 1- α/2 = desired confidence level, and ε = relative precision.
Data Collection
A Google survey form was created using survey items adopted from the studies by Sallam et al and Daley et al12,13 Prior to the data collection, the questions were pretested among a group of 15 professionals to ensure the level of validity and degree of repeatability. The Google survey form was circulated by the faculty working in the academic institutions of each of the six countries through email and phone numbers. The survey took approximately 5–10 min to answer all the questions.
The survey form comprised 27 items divided into four sections (Figure 1). The first section comprised questions determining the demographics of the group, including age, sex, nationality, marital status, current level of education, and history of smoking. The second section attempted to determine the knowledge of oral cancer among the dental students and was termed as the knowledge-based questionnaire. The third section ascertained the awareness of HPV among participants and was termed as the awareness-based questionnaire. The fourth section comprised questions ascertaining the comfort of the practitioners to disseminate HPV information among patients and was termed as the attitude-based questionnaire.
The aim of the study is to compare the awareness, knowledge, and perception about HPV and OPC among students from different countries, years of the undergraduate program, and gender.
Statistical Analysis
The data were collected and organized in MS-Excel. Statistical analysis was conducted using SPSS v 21 (IBM, Chicago, IL, USA). The demographic and survey data were collected as per frequency and percentage. Chi-square test was used to evaluate the correlation between the demographic characteristics of students and their knowledge regarding HPV and oral cancer. P < 0.05 was considered statistically significant.
Results
The demographic characteristics of patients are presented in Table 1. Of the 886 participants, a majority were females (73.1%). Most participants were from India (29.3%), followed by Saudi Arabia (21.8%).
Tables 2 and 3 present the comparison of knowledge between on HPV and its relationship with OPC in males and females. The awareness of HPV and its association with OPC was higher in males than in females, and this difference was statistically significant (P < 0.05). On the other hand, females exhibited better knowledge and perception on HPV vaccine than males, and this difference was statistically significant (P < 0.05). Females exhibited a more positive attitude and comfort regarding the vaccine and discussing the same with patients than males, and this difference was statistically significant (P < 0.001).
Tables 4 and 5 present the comparison of knowledge on HPV and its relationship with OPC among students in different undergraduate years. Third- and fourth-year students exhibited better awareness of HPV and its association with OPC than other year students, and this difference was statistically significant (P < 0.05). The third-year and internship students exhibited a more positive attitude and comfort regarding the vaccine and discussing the same with patients than the other educational-level students, and this difference was statistically significant (P < 0.001).
Table 5 Comparison of Knowledge Between Students from Different Undergraduate Years. Download Article to View
Tables 6–8 present the comparison of knowledge on HPV and its relationship with OPC among students from different countries. Majority of Indian students exhibited better knowledge and awareness of HPV and its association with OPC than other year students, and this difference was statistically significant (P < 0.05). The Indian students exhibited better knowledge about HPV than other students from other countries, and this difference was statistically significant (P < 0.001). Indian students exhibited a more positive attitude and comfort regarding the vaccine and discussing the same with patients than students from other countries, and this difference was statistically significant (P < 0.001).
Table 8 Comparison of Knowledge Between Students from Different Countries. Download Article to View
For the knowledge-based questions like Q9, Q14 where the answers could be multiple from the options, in these questions we tried to classify the students who have opted for more than 2 options to be having good knowledge (Table 8).
For Q 15 “The spread of HPV is by?”, all the respondents who opted “through sexual contact” and for Q 16 “Most HPV infections resolve within a short time”, all the respondents who opted for option “No”, and for Q 19 “Who are eligible to take HPV vaccine?”, all the respondents who opted for “ladies and gents below 30 years” are classified as having good knowledge as they opted for the correct answers (Figure 1).
Figure 2 illustrates the varying reasons for patients not getting vaccinated. Of the various reasons, lack of knowledge of vaccine is the most common reason for not getting vaccinated.
The incidence of HPV-associated OPC is increasing. Thus, awareness among healthcare professionals, especially dentists is required for the early diagnosis of this condition to reduce the associated mortality and morbidity. Thus, the present study evaluated the knowledge, attitude, and awareness of human papilloma virus and its association with oral lesions among dental undergraduate students in different nations.
The present study exhibited that males had better knowledge regarding HPV and its association with OPC, and this difference was statistically significant (P < 0.05). This finding differs from that of Reimer et al and Presto et al,14,15 who exhibited better knowledge among females. This difference may be because of the smaller sample size for males (n = 238) in the present study as compared with females (n = 648). On the other hand, females exhibited better knowledge about HPV vaccines than males, and this difference was statistically significant (P < 0.05). HPV is also responsible for cervical cancer. Cervical cancer is the third most diagnosed cancer globally and the fourth leading cause of cancer-related mortality in women.16 This cancer is preventable, and the HPV vaccine is recommended to reduce its risk. Thus, women are more aware about the vaccine. This could also explain their increased comfort level to discuss this with patients. Additionally, female students were more comfortable discussing personal health and HPV vaccines with their patients than their male counterparts, and this difference was statistically significant (p < 0.05) (Table 2). This may be because females are more emotional than males, making them more at ease with discussing personal health with their patients.
The third-year dental students exhibited better knowledge about HPV than other year students, and this difference was statistically significant (P < 0.001). Additionally, students in internship also exhibited better knowledge, awareness, and attitude than the other year students. In India, third-year students have clinical subjects such as General Medicine in their curriculum. Thus, topics on HPV and its significance may be introduced. Additionally, students in their internships would have additional practical experience with patients. This would explain their better knowledge and awareness regarding HPV. Oral microbiology is an important component in the curriculum of dentistry. Certain microorganisms including HPV dictate special focus in dentistry not only in relation to cancer but other manifestations too.
The present study exhibited that dental practitioners were able to identify the risk factors associated with oral cancer. This finding was concurrent with that of Sallam et al and Lorenzo-Pouso et al.12,17 Most dental practitioners exhibited discomfort in discussing the HPV correlation with oral cancer. This reluctance might be related to sociocultural and religious stigmas towards discussing sexually transmitted infections in these countries. It is recorded in the past that high increase in HPV-dependent OPC occurs in the United States, and other European countries and the frequency of HPV-infected OPC vary depending on geographical distribution and religious practices.18–20 HPV is regarded to be a risk factor for the development of anogenital malignancies and cervical cancers, and HPV vaccines could help in the preventing the same.20
This finding was concurrent with that of Sallam et al and Daley et al.12,13 Additionally, dentists have never been accustomed to a vaccination recommendation as the nature of their work does not include this responsibility. This may be an additional reason for the discomfort among participants.17,18 An additional reason for the discomfort may be the lack of professional guidelines for recommending the HPV vaccine as a primary prevention measure for OPC.20
In the present study, Indian students exhibited better knowledge, awareness, and attitude about HPV than other students from other countries, and this difference was statistically significant (P < 0.001). India has the highest number of oral cancers globally, with approximately 1% of the population exhibiting oral premalignant lesions.21 Thus, Indian dental students have higher clinical exposure to OPC. Moreover, the gynecologists and general hospitals usually exhibit the advertisement boards about the HPV vaccine availability and their price in India. Therefore, they are better aware of the implications of HPV in oral cancer and cervical cancer. Further, the participants were not having information about the availability of HPV vaccine in their city or surrounding hospitals in the Middle East and African countries.
Most participants expressed a desire to participate in any professional training or continuous dental education program to achieve better knowledge and understanding about HPV and its association with OPC. This could be achieved through continuing dental education programs such as workshops, awareness campaigns, and training sessions. In the present study, of the various reasons, lack of knowledge of vaccine is the most common reason for not getting vaccinated, followed by lack of information about where to get the vaccine and lack of recommendation from the doctor. This underlines the necessity to imbibe knowledge regarding HPV and its association with OPV among medical and dental students.
The principal strength of the study is the multinational nature of the study allowing the generalization of the study findings. However, this study has certain constraints. The survey design always carries the risk of bias, with participants attempting to answer as per the researcher’s expectation. Additionally, the sample size was relatively small. Furthermore, most patients (73.1%) were female. This could also influence the results. Further studies with a larger sample size and evenly matched groups would strengthen the findings of this study. Several limitations in basic knowledge about HPV was noticed among participants in the clinical group, particularly related to unawareness of the vaccine availability.
Conclusion
Overall knowledge about HPV, the HPV vaccine, and HPV-related OPCs is deficient among students from this sample of undergraduate dental students. Those in their third and fourth clinical years were more knowledgeable about HPV.
More than half of them reported willingness to take the vaccine. With the increasing awareness regarding HPV-related oropharyngeal cancer, dentists must be able to advice and recommend patients regarding the risk factors and preventive measures associated with this condition. To enable this, dental colleges and organizations must provide additional information on HPV and the advances in vaccines to their students and members.
Acknowledgments
The authors extend their appreciation to the Deanship of Postgraduate and Scientific Research at Dar Al Uloom University, Riyadh, KSA for supporting this work. We would like to express our gratitude to all the students from these six nations who participated in this research and the faculty who helped us in circulating the questionnaire.
Disclosure
The authors report no conflicts of interest in this work.
Amara Swapna Lingam,1,* Pradeep Koppolu,2,* Sara Ahmad Alhussein,1 Rawa Kamal Abdelrahim,2 Ghadah Salim Abusalim,3Sally ElHaddad,1 Sadaf Asrar,4 Mohammad Zakaria Nassani,5 Sarah Salah Gaafar,5,6 Ferdous Mohammed T Bukhary,2,7AbdulRahman Saeed AlGhamdi,8 Ali Barakat,5 Mohammed Noushad,5 Hesham Almoallim1,9
1Department of Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, Saudi Arabia; 2Department of Preventive Dental Sciences Dar Al Uloom University, Riyadh, Saudi Arabia; 3Department of Medical Laboratory Science, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj, Kingdom of Saudi Arabia; 4Department Oral Biology, Liaquat college of Medicine and Dentistry, Karachi, Pakistan; 5Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia; 6Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt; 7Department of Pediatric Dentistry and Orthodontics, King Saud University, Riyadh, Saudi Arabia; 8Dental Department, Security Forces Hospital Program, Riyadh, Kingdom of Saudi Arabia; 9Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, 11545, Saudi Arabia
*These authors contributed equally to this work
Correspondence: Amara Swapna Lingam, Department of Surgical and Diagnostic Sciences, Dar Al Uloom Univeristy, Riyadh, Saudi Arabia, Email lingam@dau.edu.sa
References
1. Ghantous Y, Abu Elnaaj I. Global incidence and risk factors of oral cancer. Harefuah. 2017;156(10):645–649.
2. Salehiniya H, Raei M. Oral cavity and lip cancer in the world: an epidemiological review. Vietnamese J Biomed. 2020;7(8):3898–3905.
3. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–249. doi:10.3322/caac.21660
4. Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371(9625):1695–1709. doi:10.1016/S0140-6736(08)60728-X
5. Kumar M, Nanavati R, Modi TG, Dobariya C. Oral cancer: etiology and risk factors: a review. J Cancer Res Ther. 2016;12(2):458–463. doi:10.4103/0973-1482.186696
6. Chaturvedi AK. Human papillomavirus and rising oropharyngeal cancer incidence in the United States, J. Clin Oncol. 2011;29(32):4294–4301.
7. Wu X. Human papillomavirus-associated cancers-United States, 2004–2008. MMWR. 2012;61(15):258–261.
8. Gillison ML, Chaturvedi AK, Lowy DR. HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer. 2008;113(S10):S10:3036–3046. doi:10.1002/cncr.23764
9. Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol. 2009;45(4–5):309–316. doi:10.1016/j.oraloncology.2008.06.002
10. Markowitz LE, Dunne EF, Saraiya M. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63(RR–05):1–30.
11. Gillison M. Human papillomavirus-associated head and neck cancer is a distinct epidemiologic, clinical, and molecular entity. Semin Oncol. 2004;31(6):744–754. doi:10.1053/j.seminoncol.2004.09.011
12. Sallam M, Al-Fraihat E, Dababseh D, et al. Dental students’ awareness and attitudes toward HPV-related oral cancer: a cross-sectional study at the University of Jordan. BMC Oral Health. 2019;19(1):171. doi:10.1186/s12903-019-0864-8
13. Daley E, Dodd V, DeBate R, et al. Prevention of HPV-related oral cancer: assessing dentists’ readiness. Public Health. 2014;128(3):231–238. doi:10.1016/j.puhe.2013.12.002
14. Reimer RA, Schommer JA, Houlihan AE, Gerrard M. Ethnic and gender differences in HPV knowledge, awareness, and vaccine acceptability among White and Hispanic men and women. J Community Health. 2014;39(2):274–284. doi:10.1007/s10900-013-9773-y
15. Preston SM, Darrow WW. Are men being left behind (or catching up)? Differences in HPV awareness, knowledge, and attitudes between diverse college men and women. Am J Mens Health. 2019;13(6):1557988319883776. doi:10.1177/1557988319883776
16. Rashid S, Labani S, Das BC. Knowledge, awareness and attitude on HPV, HPV vaccine and cervical cancer among the college students in India. PLoS One. 2016;11:e166713.
17. Lorenzo-Pouso AI, Gándara-Vila P, Banga C, et al. Human papillomavirus-related oral cancer: knowledge and awareness among Spanish dental students. J Cancer Educ. 2019;34(4):782–788. doi:10.1007/s13187-018-1373-1
18. Kombe Kombe AJ, Li B, Zahid A, et al. Epidemiology and burden of Human Papillomavirus and related diseases, molecular pathogenesis, and vaccine evaluation. Front Public Health. 2021;8:552028. doi:10.3389/fpubh.2020.552028
19. Lechner M, Liu J, Masterson L, Fenton TR. HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nat Rev Clin Oncol. 2022;19(5):306–327. doi:10.1038/s41571-022-00603-7
20. Tota JE, Giuliano AR, Goldstone SE, et al. Anogenital Human Papillomavirus (HPV) infection, seroprevalence, and risk factors for HPV seropositivity among sexually active men enrolled in a global HPV vaccine trial. Clin Infect Dis. 2022;74(7):1247–1256. doi:10.1093/cid/ciab603
21. Singh MP, Kumar V, Agarwal A, Kumar R, Bhatt ML, Misra S. Clinico-epidemiological study of oral squamous cell carcinoma: a tertiary care centre study in North India. J Oral Bio Craniofac Res. 2016;6:31–34.
The day started out like a normal Wednesday, work in the morning and then a trip to Trader Joe’s. I almost didn’t go; my to-do list was long, and the 36-mile round trip would take time away from checking things off that list, but the little voice inside my head was telling me to go.
There’s butter lettuce, and then there’s Trader Joe’s butter lettuce, so it’s always the first thing on my list. Moving through the aisles, I filled my basket with other favorites. With a full grocery cart, I headed to the shortest checkout line. Watching the two young men who were checking and bagging the customers ahead of me was a treat; they were engaging and obviously enjoying their day at work—you could sense the smiles under their masks. As the customers ahead of me left, the checkers turned to me with bright eyes peeking over their masks and said, “How are you today? Thank you for coming in!” After exchanging pleasantries, the checker asked what I do for work. I told him I’m a dental hygienist, and I speak and educate on oral cancer. With that, he stopped scanning my groceries and said, “That’s really specific; I’ve never heard of that. I’m glad neither of us smokes; we won’t ever get that cancer. Do you have any fun or interesting facts or information to share with us about oral cancer?”
From butter lettuce to oral sex
Now I knew why that little voice was telling me to go to Trader Joe’s that day. For reasons unknown to me, I was supposed to share information with these young men. It was the perfect scenario: two young, nonsmoking, white males who believe they are not at risk for oral cancer asking me to share information with them. They didn’t know my passion for this, and sure didn’t know what was about to be shared with them! I said, “I would love to share! Thank you for asking. What we now know is that the human papillomavirus (HPV) is the main cause of oropharyngeal cancer. It’s cancer in the back of the mouth, typically in the tonsils and back part of the tongue, and those most at risk are white, nonsmoking males. We also know that HPV now causes more of this cancer than it does cervical cancer.”1
By this time, the young man bagging my groceries had stopped bagging. Both young men were intent on knowing more and very surprised to learn about this cancer and to find out they could be at risk. They said they had heard about HPV and cervical cancer but not about it causing cancer in the mouth. Both continued to ask questions, wanting more information, including how HPV gets in the mouth, and specifically what they can do to help reduce their chance of getting this cancer. I shared with them that HPV is transmitted through skin-to-skin contact, orally through oral sex, and possibly through open mouth, deep, aggressive kissing. I recommended protection during oral sex just as with conventional sex. We also discussed the HPV vaccine, which they had both had; however, they didn’t know much about it and didn’t know it could aid in protecting them from persistent HPV infections, which could possibly result in cancer. It wasn’t an awkward conversation; they were truly curious and wanted more information, and I was thrilled to get to share this information with them. They both said that they go to the dentist regularly.
Many opportunities to educate
In the last 12 years of being immersed in raising awareness about HPV and oral and oropharyngeal cancer, I wish I’d kept track of the number of conversations like this that have occurred, inside and outside of the operatory. There are simply too many to recall. Another recent conversation took place while in line for Donny Osmond’s VIP preshow in Las Vegas, again with a nonsmoking male. He was in line holding a place for his wife while she was getting ready. He, too, had many questions and asked about transmission of HPV to the mouth. He stated he was aware of HPV causing cervical cancer, but not cancer in the mouth. He was most curious about what signs and symptoms to watch for and what to do if he noticed any of those. We discussed these, and I recommended he see an ear, nose, and throat specialist (ENT) for further investigation if he ever experiences any persistent signs and symptoms.
Also, while writing this article, a phone conversation with a business colleague in his 60s about my work in oral cancer prompted him to inquire further about HPV and how it gets in the mouth. He thought he knew but wanted a little more clarification. And just last week while listening to a radio program with a respected physician as the guest, the topic of HPV was brought up. The physician mentioned HPV and its association with cervical cancer and mentioned the HPV vaccine. However, the vaccine was only referenced in relation to preventing cervical cancers, not head and neck cancers or the other cancers associated with persistent HPV infections. It was a missed opportunity for a large listening audience to learn more about other HPV cancers.
It’s purely my opinion, but I think people inquire further about oral cancer and HPV because they don’t hear much about it in the media, or even in their medical and dental offices. The messaging for cancers such as breast cancer, colon cancer, and cervical cancer is intentional in the media and respective medical offices, but not so much for oral cancer. Dentistry needs to be more intentional about educating and raising awareness about HPV and oral and oropharyngeal cancers.
What we now know is this: the number of HPV-associated head and neck cancers has surpassed the number of HPV-associated cervical cancers. Unfortunately, the messaging about HPV is still focused on cervical cancer.2
Lessons learned
I’ve learned a few things during my years of work in raising awareness about HPV and oral cancer through conversations with patients and the public.
First, if the public is going to be educated and aware of HPV and its association with head and neck/oropharyngeal cancer, it will come from dental professionals. In fact, it is our ethical responsibility to share this information about “our cancer.” If they don’t hear it from us, where else? It’s okay, even essential, to talk about the transmission of HPV via oral sex, its association with head and neck cancers, and the availability of the HPV vaccine that can aid in reducing persistent HPV infections associated not only with oropharyngeal and cervical cancer but also anal, penile, vaginal, and vulvar cancers.
Society is open to hearing this information. The public wants to know how to help prevent cancers and recognize the signs and symptoms for the earliest detection. Most are still of the belief that tobacco is the only risk factor for oral and head and neck cancers. Patients and the public deserve to know this information so they can make informed decisions for themselves about their oral health. This does not need to be a knee-to-knee conversation; the optimal time to share information is during the extraoral and intraoral evaluation (EOIO). Information can also be shared in newsletters the dental office sends to patients, in social media posts, and in brochures and flyers in the office.
The public and some medical and dental professionals are misinformed about HPV. It is still the common belief that HPV is most associated with causing cervical cancer and the purpose of the HPV vaccine is to help prevent cervical cancers in females. Statistics released by the US Cancer Statistics Data Briefs, No. 26 in December 2021 based on data from 2014–2018 reveals that there are approximately 10,600 cases of oropharyngeal cancer in males and 1,800 cases of oropharyngeal cancer in females each year that are attributable to HPV types 16 and 18.2 The US FDA added prevention of oropharyngeal cancer to the HPV vaccine’s indication: “The human papillomavirus (HPV) recombinant 9-valent vaccine (Gardasil 9) received FDA approval for an expanded indication to include the prevention of oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58.”3
People are listening! The public and our patients are listening, and they are looking for health-care professionals to share our expertise and have courageous conversations about critical health information. When I first started sharing information about HPV with my patients 12 years ago, I would bring it up when I was palpating the occipital nodes behind them so I wouldn’t have to look at them. I was very uncomfortable with this conversation at first; however, I knew it was vital information to my patients’ oral and systemic health and it needed to be shared. During your clinical appointments, find the time and place that is most comfortable for you.
Our job doesn’t end when we take off our scrubs. Be open to spontaneous conversations regarding essential information about HPV and oral cancer. In a recent conversation with Katrina Sanders, MEd, she eloquently said, “Irene Newman, the first dental hygienist—her job was not to improve production and close more cases. Her job was to be a patient advocate and educate the community.” I’m encouraging you to be like Irene Newman: be an advocate and educate the community, share the tremendous amount of knowledge, expertise, and lifesaving information you possess about “our cancer,” not only with patients, but the general public as well.
Call to action
If you are uncomfortable or lack confidence in sharing information about HPV or feel you need more knowledge, find a mentor, do some research, and be your own advocate to gain the knowledge you need. Recruit your entire dental team or dental service organization (DSO) to establish a positive, informative culture around HPV and oral cancer. Make it your mission to save lives through sharing critical information with patients and the public. Perform a thorough EOIO evaluation on every patient, tell them what you’re doing, and use that time to efficiently share information and raise awareness about what we now know concerning HPV and oral cancer.
HPV/oral cancer facts. The Oral Cancer Foundation. https://oralcancerfoundation.org/ understanding/hpv/hpv-oral-cancer-facts/
Cancers associated with human papillomavirus, United States—2014–2018. U.S. Cancer Statistics Data Briefs, No. 26. Centers for Disease Control and Prevention. December 2021. https://www.cdc.gov/cancer/uscs/about/data-briefs/no26-hpv-assoccancers- UnitedStates-2014-2018.htm
FDA adds prevention of oropharyngeal cancer to HPV vaccine’s indication. AAP News. May 2021. https://www.fda.gov/media/150779/download
The day started out like a normal Wednesday, work in the morning and then a trip to Trader Joe’s. I almost didn’t go; my to-do list was long, and the 36-mile round trip would take time away from checking things off that list, but the little voice inside my head was telling me to go.
There’s butter lettuce, and then there’s Trader Joe’s butter lettuce, so it’s always the first thing on my list. Moving through the aisles, I filled my basket with other favorites. With a full grocery cart, I headed to the shortest checkout line. Watching the two young men who were checking and bagging the customers ahead of me was a treat; they were engaging and obviously enjoying their day at work—you could sense the smiles under their masks. As the customers ahead of me left, the checkers turned to me with bright eyes peeking over their masks and said, “How are you today? Thank you for coming in!” After exchanging pleasantries, the checker asked what I do for work. I told him I’m a dental hygienist, and I speak and educate on oral cancer. With that, he stopped scanning my groceries and said, “That’s really specific; I’ve never heard of that. I’m glad neither of us smokes; we won’t ever get that cancer. Do you have any fun or interesting facts or information to share with us about oral cancer?”
From butter lettuce to oral sex
Now I knew why that little voice was telling me to go to Trader Joe’s that day. For reasons unknown to me, I was supposed to share information with these young men. It was the perfect scenario: two young, nonsmoking, white males who believe they are not at risk for oral cancer asking me to share information with them. They didn’t know my passion for this, and sure didn’t know what was about to be shared with them! I said, “I would love to share! Thank you for asking. What we now know is that the human papillomavirus (HPV) is the main cause of oropharyngeal cancer. It’s cancer in the back of the mouth, typically in the tonsils and back part of the tongue, and those most at risk are white, nonsmoking males. We also know that HPV now causes more of this cancer than it does cervical cancer.”1
By this time, the young man bagging my groceries had stopped bagging. Both young men were intent on knowing more and very surprised to learn about this cancer and to find out they could be at risk. They said they had heard about HPV and cervical cancer but not about it causing cancer in the mouth. Both continued to ask questions, wanting more information, including how HPV gets in the mouth, and specifically what they can do to help reduce their chance of getting this cancer. I shared with them that HPV is transmitted through skin-to-skin contact, orally through oral sex, and possibly through open mouth, deep, aggressive kissing. I recommended protection during oral sex just as with conventional sex. We also discussed the HPV vaccine, which they had both had; however, they didn’t know much about it and didn’t know it could aid in protecting them from persistent HPV infections, which could possibly result in cancer. It wasn’t an awkward conversation; they were truly curious and wanted more information, and I was thrilled to get to share this information with them. They both said that they go to the dentist regularly.
Many opportunities to educate
In the last 12 years of being immersed in raising awareness about HPV and oral and oropharyngeal cancer, I wish I’d kept track of the number of conversations like this that have occurred, inside and outside of the operatory. There are simply too many to recall. Another recent conversation took place while in line for Donny Osmond’s VIP preshow in Las Vegas, again with a nonsmoking male. He was in line holding a place for his wife while she was getting ready. He, too, had many questions and asked about transmission of HPV to the mouth. He stated he was aware of HPV causing cervical cancer, but not cancer in the mouth. He was most curious about what signs and symptoms to watch for and what to do if he noticed any of those. We discussed these, and I recommended he see an ear, nose, and throat specialist (ENT) for further investigation if he ever experiences any persistent signs and symptoms.
Also, while writing this article, a phone conversation with a business colleague in his 60s about my work in oral cancer prompted him to inquire further about HPV and how it gets in the mouth. He thought he knew but wanted a little more clarification. And just last week while listening to a radio program with a respected physician as the guest, the topic of HPV was brought up. The physician mentioned HPV and its association with cervical cancer and mentioned the HPV vaccine. However, the vaccine was only referenced in relation to preventing cervical cancers, not head and neck cancers or the other cancers associated with persistent HPV infections. It was a missed opportunity for a large listening audience to learn more about other HPV cancers.
It’s purely my opinion, but I think people inquire further about oral cancer and HPV because they don’t hear much about it in the media, or even in their medical and dental offices. The messaging for cancers such as breast cancer, colon cancer, and cervical cancer is intentional in the media and respective medical offices, but not so much for oral cancer. Dentistry needs to be more intentional about educating and raising awareness about HPV and oral and oropharyngeal cancers.
What we now know is this: the number of HPV-associated head and neck cancers has surpassed the number of HPV-associated cervical cancers. Unfortunately, the messaging about HPV is still focused on cervical cancer.2
Lessons learned
I’ve learned a few things during my years of work in raising awareness about HPV and oral cancer through conversations with patients and the public.
First, if the public is going to be educated and aware of HPV and its association with head and neck/oropharyngeal cancer, it will come from dental professionals. In fact, it is our ethical responsibility to share this information about “our cancer.” If they don’t hear it from us, where else? It’s okay, even essential, to talk about the transmission of HPV via oral sex, its association with head and neck cancers, and the availability of the HPV vaccine that can aid in reducing persistent HPV infections associated not only with oropharyngeal and cervical cancer but also anal, penile, vaginal, and vulvar cancers.
Society is open to hearing this information. The public wants to know how to help prevent cancers and recognize the signs and symptoms for the earliest detection. Most are still of the belief that tobacco is the only risk factor for oral and head and neck cancers. Patients and the public deserve to know this information so they can make informed decisions for themselves about their oral health. This does not need to be a knee-to-knee conversation; the optimal time to share information is during the extraoral and intraoral evaluation (EOIO). Information can also be shared in newsletters the dental office sends to patients, in social media posts, and in brochures and flyers in the office.
The public and some medical and dental professionals are misinformed about HPV. It is still the common belief that HPV is most associated with causing cervical cancer and the purpose of the HPV vaccine is to help prevent cervical cancers in females. Statistics released by the US Cancer Statistics Data Briefs, No. 26 in December 2021 based on data from 2014–2018 reveals that there are approximately 10,600 cases of oropharyngeal cancer in males and 1,800 cases of oropharyngeal cancer in females each year that are attributable to HPV types 16 and 18.2 The US FDA added prevention of oropharyngeal cancer to the HPV vaccine’s indication: “The human papillomavirus (HPV) recombinant 9-valent vaccine (Gardasil 9) received FDA approval for an expanded indication to include the prevention of oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58.”3
People are listening! The public and our patients are listening, and they are looking for health-care professionals to share our expertise and have courageous conversations about critical health information. When I first started sharing information about HPV with my patients 12 years ago, I would bring it up when I was palpating the occipital nodes behind them so I wouldn’t have to look at them. I was very uncomfortable with this conversation at first; however, I knew it was vital information to my patients’ oral and systemic health and it needed to be shared. During your clinical appointments, find the time and place that is most comfortable for you.
Our job doesn’t end when we take off our scrubs. Be open to spontaneous conversations regarding essential information about HPV and oral cancer. In a recent conversation with Katrina Sanders, MEd, she eloquently said, “Irene Newman, the first dental hygienist—her job was not to improve production and close more cases. Her job was to be a patient advocate and educate the community.” I’m encouraging you to be like Irene Newman: be an advocate and educate the community, share the tremendous amount of knowledge, expertise, and lifesaving information you possess about “our cancer,” not only with patients, but the general public as well.
Call to action
If you are uncomfortable or lack confidence in sharing information about HPV or feel you need more knowledge, find a mentor, do some research, and be your own advocate to gain the knowledge you need. Recruit your entire dental team or dental service organization (DSO) to establish a positive, informative culture around HPV and oral cancer. Make it your mission to save lives through sharing critical information with patients and the public. Perform a thorough EOIO evaluation on every patient, tell them what you’re doing, and use that time to efficiently share information and raise awareness about what we now know concerning HPV and oral cancer.
HPV/oral cancer facts. The Oral Cancer Foundation. https://oralcancerfoundation.org/ understanding/hpv/hpv-oral-cancer-facts/
Cancers associated with human papillomavirus, United States—2014–2018. U.S. Cancer Statistics Data Briefs, No. 26. Centers for Disease Control and Prevention. December 2021. https://www.cdc.gov/cancer/uscs/about/data-briefs/no26-hpv-assoccancers- UnitedStates-2014-2018.htm
FDA adds prevention of oropharyngeal cancer to HPV vaccine’s indication. AAP News. May 2021. https://www.fda.gov/media/150779/download
Newswise — Chulalongkorn University’s researchers have developed a cervical cancer test kit that uses urine samples. A simple, accurate, and fast method of early detection is guaranteed for its quality by the 2021 Outstanding Inventions Award from the National Research Council of Thailand. Early detection is the key to saving lives.
Cervical cancer can be cured if detected in its early stages. Many women are, however, deterred by the rather high cost of the screening procedure, and the pap smear testing method. This leads to late detection that can cause cancer to spread making it harder to treat.
Today, there is a new invention that makes cervical cancer treatment a simpler and pain-free procedure that can be done frequently. The HPV paper-based DNA sensor testing kits for cervical cancer developed by the Department of Chemistry, Faculty of Science, Chulalongkorn University’s research team comprising Prof. Dr. Orawan Chailapakul, Dr. Prinjaporn Tee-ngam, Sarida Naorungroj, Dr. Somrak Petchcomchai along with Prof. Dr. Tirayut Vilaivan.
Dr. Prinjaporn, one of the main researchers on the team discussed how this innovation was conceived, “The government has consistently urged women to get tested for cervical cancer. One of the limitations of the original form of testing which requires taking a sample of cells from the cervix on stirrups invokes fear in many women who would rather avoid the test altogether. For this reason, we have tried to find an easier way that most women would feel more comfortable with. This could help to increase the number of those being tested as well as the frequency of their tests so that if any anomalies are found, then treatment can be immediately provided.”
Getting to know cervical cancer and early detection methods
Cervical cancer is the second most common cancer of women in Thailand after breast cancer with an incidence rate of 10,000 new cases per year affecting women between the ages of 30-60 and claiming as many as 5,000 deaths each year. The Ministry of Public Health recommends that from the age of 25 women should receive regular screening for cervical cancer every five years.
Prof. Dr. Orawan explains that cervical cancer is a sexually transmitted disease, mainly caused by the human papillomavirus (HPV). The use of condoms as protection cannot prevent such transmission, and the HPV vaccine is not yet prevalent or provides 100% protection against cervical cancer.
She also stressed that “Most of those who have been affected are asymptomatic which makes it necessary for us to still be tested regularly since that is a crucial way to prevent us from the disease and death.”
The HPV paper-based DNA sensor testing kits
The cervical cancer testing kits are easier and much faster than the Pap Smear or Pap Tests currently in use. It eliminates the need to insert a tool and hold the vaginal walls open as well as swabbing over the cervix to take cell samples that are sent to the lab for testing.
“HPV paper-based sensor testing is a way to test the DNA of the HPV virus by using PNA (Peptide Nucleic Acid) which is a synthetic substance that imitates our DNA designed to be specific according to the cells being tested which can be specified since HPV comes in many different strains and not all strains cause cervical cancer. When designing the substance, we needed to determine which strains there were when it comes to HPV infection,” said Prof. Dr. Orawan.
The HPV paper-based sensor testing kit is something that a lot of us are already familiar with from the ATK tests we have undergone for COVID-19.
“The urine is mixed in a solution then dropped onto the paper after which we notice the change in color of the solution. Normally the color of the solution is bright red but if the urine is contaminated by the virus the color appears lighter. The brightness of the color varies according to the amount of the virus. We have an additional tool, used with the colorimeter application on smartphones that helps make the color more visible.”
Prof. Dr. Orawan assured us that the HPV paper-based sensor testing kit has been tested and shows a high level of accuracy with a sensitivity of 85%, specificity of 78%, and reproducibility rate of 100%.”
The HPV Testing Kits have not been produced for home use. They are, however, being used in health centers and community hospitals.
“In the urine, there are fewer DNA materials than in tissues, which means we need to have a device that increases the DNA level so that the change of color is more visible and the device is already in use in the clinics and community hospitals.”
How to watch over our health to stay away from cervical cancer
Prof. Dr. Orawan left us with some tips on how to help women stay safe from cervical cancer. “First, women should make sure they always keep their vaginal areas clean. Vaccinations are good but the prevention they offer isn’t a hundred percent. The best way is to have regular cervical cancer checkups for early detection and treatment.”
The research team hopes that this innovation will motivate women to get themselves tested regularly, with a simple and painless process, at an affordable price. Each test kit should not exceed 500 baht.
Prof. Dr. Orawan left us with these words. “We’d like to see women getting cervical cancer tests regularly as advised by the Ministry of Public Health. Therefore, we have tried to make the cost of these kits as low as possible to make them easily accessible. It would be ideal if women can be tested regularly, for example once a month at a health center nearby.”
Nursing facilities or agencies interested in these HPV paper-based DNA sensor testing kits may contact Prof. Dr. Orawan Chailapakul at the Department of Chemistry, Faculty of Science, Chulalongkorn University, email address orawon.c@chula.ac.th for more information.
Newswise — Chulalongkorn University’s researchers have developed a cervical cancer test kit that uses urine samples. A simple, accurate, and fast method of early detection is guaranteed for its quality by the 2021 Outstanding Inventions Award from the National Research Council of Thailand. Early detection is the key to saving lives.
Cervical cancer can be cured if detected in its early stages. Many women are, however, deterred by the rather high cost of the screening procedure, and the pap smear testing method. This leads to late detection that can cause cancer to spread making it harder to treat.
Today, there is a new invention that makes cervical cancer treatment a simpler and pain-free procedure that can be done frequently. The HPV paper-based DNA sensor testing kits for cervical cancer developed by the Department of Chemistry, Faculty of Science, Chulalongkorn University’s research team comprising Prof. Dr. Orawan Chailapakul, Dr. Prinjaporn Tee-ngam, Sarida Naorungroj, Dr. Somrak Petchcomchai along with Prof. Dr. Tirayut Vilaivan.
Dr. Prinjaporn, one of the main researchers on the team discussed how this innovation was conceived, “The government has consistently urged women to get tested for cervical cancer. One of the limitations of the original form of testing which requires taking a sample of cells from the cervix on stirrups invokes fear in many women who would rather avoid the test altogether. For this reason, we have tried to find an easier way that most women would feel more comfortable with. This could help to increase the number of those being tested as well as the frequency of their tests so that if any anomalies are found, then treatment can be immediately provided.”
Getting to know cervical cancer and early detection methods
Cervical cancer is the second most common cancer of women in Thailand after breast cancer with an incidence rate of 10,000 new cases per year affecting women between the ages of 30-60 and claiming as many as 5,000 deaths each year. The Ministry of Public Health recommends that from the age of 25 women should receive regular screening for cervical cancer every five years.
Prof. Dr. Orawan explains that cervical cancer is a sexually transmitted disease, mainly caused by the human papillomavirus (HPV). The use of condoms as protection cannot prevent such transmission, and the HPV vaccine is not yet prevalent or provides 100% protection against cervical cancer.
She also stressed that “Most of those who have been affected are asymptomatic which makes it necessary for us to still be tested regularly since that is a crucial way to prevent us from the disease and death.”
The HPV paper-based DNA sensor testing kits
The cervical cancer testing kits are easier and much faster than the Pap Smear or Pap Tests currently in use. It eliminates the need to insert a tool and hold the vaginal walls open as well as swabbing over the cervix to take cell samples that are sent to the lab for testing.
“HPV paper-based sensor testing is a way to test the DNA of the HPV virus by using PNA (Peptide Nucleic Acid) which is a synthetic substance that imitates our DNA designed to be specific according to the cells being tested which can be specified since HPV comes in many different strains and not all strains cause cervical cancer. When designing the substance, we needed to determine which strains there were when it comes to HPV infection,” said Prof. Dr. Orawan.
The HPV paper-based sensor testing kit is something that a lot of us are already familiar with from the ATK tests we have undergone for COVID-19.
“The urine is mixed in a solution then dropped onto the paper after which we notice the change in color of the solution. Normally the color of the solution is bright red but if the urine is contaminated by the virus the color appears lighter. The brightness of the color varies according to the amount of the virus. We have an additional tool, used with the colorimeter application on smartphones that helps make the color more visible.”
Prof. Dr. Orawan assured us that the HPV paper-based sensor testing kit has been tested and shows a high level of accuracy with a sensitivity of 85%, specificity of 78%, and reproducibility rate of 100%.”
The HPV Testing Kits have not been produced for home use. They are, however, being used in health centers and community hospitals.
“In the urine, there are fewer DNA materials than in tissues, which means we need to have a device that increases the DNA level so that the change of color is more visible and the device is already in use in the clinics and community hospitals.”
How to watch over our health to stay away from cervical cancer
Prof. Dr. Orawan left us with some tips on how to help women stay safe from cervical cancer. “First, women should make sure they always keep their vaginal areas clean. Vaccinations are good but the prevention they offer isn’t a hundred percent. The best way is to have regular cervical cancer checkups for early detection and treatment.”
The research team hopes that this innovation will motivate women to get themselves tested regularly, with a simple and painless process, at an affordable price. Each test kit should not exceed 500 baht.
Prof. Dr. Orawan left us with these words. “We’d like to see women getting cervical cancer tests regularly as advised by the Ministry of Public Health. Therefore, we have tried to make the cost of these kits as low as possible to make them easily accessible. It would be ideal if women can be tested regularly, for example once a month at a health center nearby.”
Nursing facilities or agencies interested in these HPV paper-based DNA sensor testing kits may contact Prof. Dr. Orawan Chailapakul at the Department of Chemistry, Faculty of Science, Chulalongkorn University, email address orawon.c@chula.ac.th for more information.
A blood test that detects circulating tumor DNA can predict recurrence of HPV-driven oropharyngeal cancer following treatment, according to research presented February 24 at the 2022 Multidisciplinary Head and Neck Cancers Symposium. The multi-institutional study, presented by Dr. Glenn Hanna from the Dana-Farber Cancer Institute, indicated that the biomarker test may detect recurrent disease earlier than imaging or other standard methods of post-treatment surveillance. Hanna said this allows physicians to personalize treatment more quickly for patients whose cancer returns.
Researchers looked at data from 1,076 patients who had one or more blood tests to detect circulating tumor tissue modified viral (TTMV) – HPV DNA as part of their post-treatment surveillance. Of the 80 patients who tested positive for the biomarker in surveillance, 95% were confirmed through imaging, biopsy, and/or endoscopy as having recurrent HPV-positive disease. The presence of TTMV-HPV DNA was the first indicator of recurrence for 72% of the patients whose cancer returned, and 48% of the recurrences were found in patients tested more than 12 months after completing therapy. Reach out to us to learn more about blood test and HPV.
Your yoga mat is like your water bottle — you know you should clean it every now and then, but you probably rarely do. However, if you examined your mat under a microscope, what you’d find lurking about might change your mind (and give you the heebie-jeebies). Yep, an unwashed mat is a breeding ground for all kinds of creepy crawlies including bacteria, fungi and viruses. This includes the risk of HPV. Which makes it an especially fertile incubator for many infections (more on this later).
We spoke to Kelly Reynolds, PhD, director of the Environment, Exposure Science and Risk Assessment Center at the University of Arizona, to find out what happens if you let your mat accumulate muck, plus tips on how to clean a yoga mat
3 Reasons to Clean Your Yoga Mat Regularly
1. It Can Cause a Skin Infection
Your yoga mat may be harboring harmful germs — including viruses, bacteria and fungi — which can produce nasty skin infections. “These microbes can live on surfaces for days to months and spread from person to person via surfaces like exercise mats,” Reynolds says. Common pathogens that can be transmitted by a dirty yoga mat include:
Fungi that cause athlete’s foot and other types of ringworm: These pathogens multiply in warm, moist environments (like gym showers or around swimming pools). They are especially well adapted to thrive for long periods of time on yoga mats, Reynolds says, which is why fungal infections flourish so easily.
Staphylococcus or staph bacteria: It’s a pathogen commonly found on the skin that’s usually harmless but can cause infection when it gets into a cut. Staph infections can cause red, swollen and painful skin infections that look like pimples or boils, and can even leak pus or become crusty, according to the National Library of Medicine. They can also lead to bone infections, which can cause flu-like symptoms such as fever and chills.
Human papillomavirus (HPV): Some strains of HPV can cause warts on the skin. Plantar warts are warts on the bottom of the feet.
And while bringing your own yoga mat to the gym (versus borrowing a rarely cleaned communal mat) can help mitigate your risk of infection, it doesn’t eliminate it completely. You can still become infected by someone simply stepping on your mat on their way to the water fountain. Or you could pick up germs from the gym floor and transfer them to your mat.
“Either way, add sweat and a warm environment, like a hot yoga studio, and you may have your own fungal colony established,” Reynolds says.
2. It Can Make You Break Out
Your filthy yoga mat might be bringing on bouts of breakouts. Excess oil, dirt, dead skin cells and bacteria –— which can block your pores and produce pimples — can easily spread from an unclean exercise mat and promote acne, Reynolds says. To make matters worse, acne typically appears on areas of your body that boast the most oil glands such as your chest, upper back and shoulders, per the Mayo Clinic. And these oilier body parts are often the ones exposed to your yoga mat.
3. It Can Make You Sick
A dirty yoga mat can also ramp up your risk for catching the common cold, a respiratory infection or the stomach flu. This happens when cold and flu viruses are released into the air through a sick person’s coughs or sneezes, Reynolds says.
And someone doesn’t have to be particularly close for their germs to reach you. The spray from a sneeze or cough can travel up to 6 feet, per the Centers for Disease Control and Prevention (CDC). In fact, an April 2014 study in the Journal of Fluid Mechanics found that smaller droplets can cover even longer distances (as far as 2.5 meters or more than 8 feet).
These meddling microbes rapidly settle on surfaces — like your yoga mat — where they can survive for days and spread to others, Reynolds says. Usually, an infection occurs when you touch your germy mat and unknowingly transfer the virus to your eyes, nose or mouth from your hand.
And while the common cold or flu may be a temporary inconvenience (read: mostly harmless) for healthy individuals, those with compromised immune systems may become sicker.
For instance, people with certain medical conditions such as asthma, diabetes and heart disease, and older adults and pregnant people all have a higher risk for serious flu complications, per the CDC.
So, how often do you need to clean your yoga mat? More often than you think.
“Given that exercise mats are placed on dirty floors, often shared among users and come into direct skin and face contact, I recommend cleaning and disinfecting them before every use,” Reynolds says. “Cleaning alone will not kill most of the germs, but it will reduce dirt, sweat and oils that bacteria and fungi feed on.”
If you’re sticking to solo at-home workouts (i.e., you’re the only one coming into contact with the mat), you have a little more leeway. In this case, cleaning and disinfecting it once a week should suffice. That said, if you sweat profusely, or you’re prone to acne, you might want to wipe down your mat more often.
Here are Reynold’s tips for how to clean a yoga mat and keep it microbe-free.
If Your Mat Is Machine Washable
Toss it in the wash (by itself) and follow the manufacturer’s instructions. To properly disinfect your mat, also use a laundry sanitizer, Reynolds says. A product like Lysol Laundry Sanitizer will kill bacteria and viruses that a regular detergent might miss.
If Your Mat Isn’t Machine Washable
First, scrub it with soap and water to remove any dirt, then use a disinfecting spray or wipe, which is your best defense against germs. “Alcohol-based wipes are safe for use with most surfaces,” says Reynolds, who recommends throwing a travel pack in your gym bag.
After you clean and disinfect your mat, pat it down to dry it thoroughly. “Be sure your mat is fully dry before rolling it up to store as trapped moisture can promote more germ growth,” Reynolds says.
So, How Bad Is It Really to Never Clean Your Yoga Mat?
Doing downward dog on a dirty mat may impact each of us differently — for some it’s NBD, but for others, it can be potentially harmful. If you have a weakened immune system and are more susceptible to infection, a clean yoga mat is more important, especially if you lug it to the gym or a hot yoga studio where germs love to gestate.
But a group class isn’t the only place where you can pick up pathogens. At home, your roommate or your partner can also pass on infections if they use your mat or inadvertently cough or sneeze on it. So if your immune system isn’t robust and you live with someone, stick to separate mats and stow yours away (out of reach of random sneeze sprays) when you’re not using it.
If you’re a generally healthy person who lives alone and only uses your mat at home (i.e., never shares it with another soul or carries it to the gym), you’re probably in the clear even if you don’t clean it as often. But if you’re noticing recurring body acne or an unexplained skin infection, you may want to scrub and disinfect your mat more often.
To extend the time between washings, you can even lay a towel on top to keep sweat and body oils off the surface of your mat. Keep in mind: This strategy only works if you launder the towel with each use.
Your yoga mat is like your water bottle — you know you should clean it every now and then, but you probably rarely do. However, if you examined your mat under a microscope, what you’d find lurking about might change your mind (and give you the heebie-jeebies). Yep, an unwashed mat is a breeding ground for all kinds of creepy crawlies including bacteria, fungi and viruses. This includes the risk of HPV. Which makes it an especially fertile incubator for many infections (more on this later).
We spoke to Kelly Reynolds, PhD, director of the Environment, Exposure Science and Risk Assessment Center at the University of Arizona, to find out what happens if you let your mat accumulate muck, plus tips on how to clean a yoga mat
3 Reasons to Clean Your Yoga Mat Regularly
1. It Can Cause a Skin Infection
Your yoga mat may be harboring harmful germs — including viruses, bacteria and fungi — which can produce nasty skin infections. “These microbes can live on surfaces for days to months and spread from person to person via surfaces like exercise mats,” Reynolds says. Common pathogens that can be transmitted by a dirty yoga mat include:
Fungi that cause athlete’s foot and other types of ringworm: These pathogens multiply in warm, moist environments (like gym showers or around swimming pools). They are especially well adapted to thrive for long periods of time on yoga mats, Reynolds says, which is why fungal infections flourish so easily.
Staphylococcus or staph bacteria: It’s a pathogen commonly found on the skin that’s usually harmless but can cause infection when it gets into a cut. Staph infections can cause red, swollen and painful skin infections that look like pimples or boils, and can even leak pus or become crusty, according to the National Library of Medicine. They can also lead to bone infections, which can cause flu-like symptoms such as fever and chills.
Human papillomavirus (HPV): Some strains of HPV can cause warts on the skin. Plantar warts are warts on the bottom of the feet.
And while bringing your own yoga mat to the gym (versus borrowing a rarely cleaned communal mat) can help mitigate your risk of infection, it doesn’t eliminate it completely. You can still become infected by someone simply stepping on your mat on their way to the water fountain. Or you could pick up germs from the gym floor and transfer them to your mat.
“Either way, add sweat and a warm environment, like a hot yoga studio, and you may have your own fungal colony established,” Reynolds says.
2. It Can Make You Break Out
Your filthy yoga mat might be bringing on bouts of breakouts. Excess oil, dirt, dead skin cells and bacteria –— which can block your pores and produce pimples — can easily spread from an unclean exercise mat and promote acne, Reynolds says. To make matters worse, acne typically appears on areas of your body that boast the most oil glands such as your chest, upper back and shoulders, per the Mayo Clinic. And these oilier body parts are often the ones exposed to your yoga mat.
3. It Can Make You Sick
A dirty yoga mat can also ramp up your risk for catching the common cold, a respiratory infection or the stomach flu. This happens when cold and flu viruses are released into the air through a sick person’s coughs or sneezes, Reynolds says.
And someone doesn’t have to be particularly close for their germs to reach you. The spray from a sneeze or cough can travel up to 6 feet, per the Centers for Disease Control and Prevention (CDC). In fact, an April 2014 study in the Journal of Fluid Mechanics found that smaller droplets can cover even longer distances (as far as 2.5 meters or more than 8 feet).
These meddling microbes rapidly settle on surfaces — like your yoga mat — where they can survive for days and spread to others, Reynolds says. Usually, an infection occurs when you touch your germy mat and unknowingly transfer the virus to your eyes, nose or mouth from your hand.
And while the common cold or flu may be a temporary inconvenience (read: mostly harmless) for healthy individuals, those with compromised immune systems may become sicker.
For instance, people with certain medical conditions such as asthma, diabetes and heart disease, and older adults and pregnant people all have a higher risk for serious flu complications, per the CDC.
So, how often do you need to clean your yoga mat? More often than you think.
“Given that exercise mats are placed on dirty floors, often shared among users and come into direct skin and face contact, I recommend cleaning and disinfecting them before every use,” Reynolds says. “Cleaning alone will not kill most of the germs, but it will reduce dirt, sweat and oils that bacteria and fungi feed on.”
If you’re sticking to solo at-home workouts (i.e., you’re the only one coming into contact with the mat), you have a little more leeway. In this case, cleaning and disinfecting it once a week should suffice. That said, if you sweat profusely, or you’re prone to acne, you might want to wipe down your mat more often.
Here are Reynold’s tips for how to clean a yoga mat and keep it microbe-free.
If Your Mat Is Machine Washable
Toss it in the wash (by itself) and follow the manufacturer’s instructions. To properly disinfect your mat, also use a laundry sanitizer, Reynolds says. A product like Lysol Laundry Sanitizer will kill bacteria and viruses that a regular detergent might miss.
If Your Mat Isn’t Machine Washable
First, scrub it with soap and water to remove any dirt, then use a disinfecting spray or wipe, which is your best defense against germs. “Alcohol-based wipes are safe for use with most surfaces,” says Reynolds, who recommends throwing a travel pack in your gym bag.
After you clean and disinfect your mat, pat it down to dry it thoroughly. “Be sure your mat is fully dry before rolling it up to store as trapped moisture can promote more germ growth,” Reynolds says.
So, How Bad Is It Really to Never Clean Your Yoga Mat?
Doing downward dog on a dirty mat may impact each of us differently — for some it’s NBD, but for others, it can be potentially harmful. If you have a weakened immune system and are more susceptible to infection, a clean yoga mat is more important, especially if you lug it to the gym or a hot yoga studio where germs love to gestate.
But a group class isn’t the only place where you can pick up pathogens. At home, your roommate or your partner can also pass on infections if they use your mat or inadvertently cough or sneeze on it. So if your immune system isn’t robust and you live with someone, stick to separate mats and stow yours away (out of reach of random sneeze sprays) when you’re not using it.
If you’re a generally healthy person who lives alone and only uses your mat at home (i.e., never shares it with another soul or carries it to the gym), you’re probably in the clear even if you don’t clean it as often. But if you’re noticing recurring body acne or an unexplained skin infection, you may want to scrub and disinfect your mat more often.
To extend the time between washings, you can even lay a towel on top to keep sweat and body oils off the surface of your mat. Keep in mind: This strategy only works if you launder the towel with each use.
A blood test that detects circulating tumor DNA can predict recurrence of HPV-driven oropharyngeal cancer following treatment, according to research presented February 24 at the 2022 Multidisciplinary Head and Neck Cancers Symposium. The multi-institutional study, presented by Dr. Glenn Hanna from the Dana-Farber Cancer Institute, indicated that the biomarker test may detect recurrent disease earlier than imaging or other standard methods of post-treatment surveillance. Hanna said this allows physicians to personalize treatment more quickly for patients whose cancer returns.
Researchers looked at data from 1,076 patients who had one or more blood tests to detect circulating tumor tissue modified viral (TTMV) – HPV DNA as part of their post-treatment surveillance. Of the 80 patients who tested positive for the biomarker in surveillance, 95% were confirmed through imaging, biopsy, and/or endoscopy as having recurrent HPV-positive disease. The presence of TTMV-HPV DNA was the first indicator of recurrence for 72% of the patients whose cancer returned, and 48% of the recurrences were found in patients tested more than 12 months after completing therapy. Reach out to us to learn more about blood test and HPV.
