When Sandy Wexler went to see her dentist in July 2012, she was expecting a run-of-the-mill dental cleaning.
After a quick examination, Wexler’s dentist noticed that her lymph nodes were enlarged on the right side of her neck and recommended that she get it checked out by a specialist. Promptly afterwards, Wexler met with an ear, nose and throat doctor, who biopsied her lymph nodes. The test results confirmed that Wexler had the most common type of oropharyngeal cancer: metastatic squamous cell carcinoma, caused by human papillomavirus (HPV) infections.
As a retired pediatric nurse for Texas Children’s Hospital, Wexler recalled encouraging parents to allow their children to receive the HPV vaccine.
“I had been giving HPV vaccines to the kids,” Wexler said, “but it’s just a completely different shock when you hear that your tumor is HPV-positive when it happens to you.”
HPV is transmitted through intimate skin-to-skin to contact—having vaginal, anal or oral sex with someone carrying the virus. HPV comprises more than 150 related viruses, some of which can lead to cancer, including cancers of the cervix, vagina and vulva in women; cancer of the penis in men; and cancer of the anus and the back of the throat in both men and women.
The U.S. Centers for Disease Control and Prevention estimate 30,700 cancers are caused by HPV each year in men and women in the country, but with the vaccine, approximately 28,000 of those cases can be prevented.
Wexler was admitted to The University of Texas MD Anderson Cancer Center, where she underwent six weeks of proton therapy and seven weeks of chemotherapy. As a side effect of the grueling treatment, the skin around her neck broke down with second-degree burns and she lost 10 percent of her body weight. The entire experience “was a big ordeal,” Wexler said, but she eventually beat her cancer thanks to the treatment she received at MD Anderson and the examination her dentist performed.
“I really credit my dentist with saving my life,” Wexler said. “I’m grateful that she found it because my routine physical exam from my primary care doctor wouldn’t be scheduled until December. Five months later, there’s no telling how much further it would have gone and if I would even be here to be talking about it.”
Last month, MD Anderson announced a new partnership with the American Dental Association focused on the need to increase awareness for HPV vaccinations to prevent oropharyngeal cancer. The two organizations hosted a panel discussion at the ADA’s annual symposium to discuss the joint efforts to fight oropharyngeal cancer and featured a panel of cancer patient survivors, including Sandy Wexler.
“We hope that this collaboration can influence the health care system in the U.S. and make changes in terms of vaccinations and education to the public,” said Marcelo Araujo, D.D.S., PhD., vice president of the ADA Science Institute. “We are health care professionals. It is our duty to tell our patients and their parents what the benefits of HPV vaccinations are and have the hard conversations with the parents because they worry about the stigma behind the vaccinations.”
The American Cancer Society estimates 50,000 new cases of cancers of the oral cavity and pharynx this year in the U.S.; rates in men are more than twice as high as in women. Because these cancers are often not diagnosed until late stages and, thus, more difficult to treat, the MD Anderson and ADA collaboration is focused on strengthening prevention and early detection initiatives by educating and training the 160,000-plus ADA members to screen for any signs and symptoms, such as lesions, red spots or white spots, unusual lumps and sore areas of irritation. Most importantly, dentists need to check beyond the mouth on the lips and look for any type of enlarged or swollen nodes around the neck.
“With these HPV cancers, they’re usually silent. People don’t show up until they feel that lump in the neck, which doesn’t hurt,” said Erich Sturgis, M.D., professor of head and neck surgery and co-lead of the HPV-Related Cancers Moon Shot. “By that point, [the cancer] has already spread to a lymph node because that’s not a tonsil you’re feeling. It’s usually stage 3 or 4 when they show up.”
While all dental students are trained to look for signs and symptoms of oral cancer, the new collaboration will strengthen and reinforce the role of the dentist in preventing oropharyngeal cancer and increasing HPV vaccination rates.
“A lot of times, the general practitioner or the physician [during an annual checkup] does not look into or around the mouth,” Araujo said. “For dentists, that’s our main area of work, so we’re always looking for any signs that could indicate that there is any type of issue in the area.”
In most cases, people see their dentists more often than they do their primary care physician, visiting at least twice a year for teeth cleanings. Considering the HPV vaccine is given in two doses, it’s the perfect time for dentists to talk to patients or their parents, Araujo said.
“A lot of patients that we see that make it to the head and neck center were first seen by their dentists,” Sturgis said. “It’s a missed opportunity if dentists or their staff aren’t asking, ‘Has your child been vaccinated for HPV? If not, let’s give you an opportunity to go to the pediatrician to get vaccinated.’”
Sturgis and Araujo both said they hope dentists can administer HPV vaccines in the future to increase vaccination rates. In previous years, Illinois State Dental Society proposed legislation that would allow dentists to administer vaccination shots. Allowing dentists to vaccinate, the society argued, would benefit patients and improve public health. Ultimately, the proposal was unsuccessful, but Araujo said they will try again to push for new legislation in the future.
In the meantime, Araujo emphasized the important roles dentists can play in preventing cancer.
“It’s an easy conversation to have about HPV vaccination with their patients,” Araujo said. “By following our clinical practice guidelines, the dentists can help save lives, just like the dentist who saved Sandy Wexler’s life.”
In addition to increasing awareness of HPV vaccinations, the second phase of the collaboration between MD Anderson and the ADA will include reducing tobacco use, which remains the leading preventable cause of oral cancer.
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