Since OCF first met Dr. Maura Gillison at the ASCO meeting in 1999, where she delivered her paper which correlated HPV infections as the likely cause of the increase in oropharyngeal cancers we were seeing clinically in the US, and that papers subsequent publication in 2000, OCF has been heavily engaged in the HPV issue, both as funders of research to understand it better, and as advocates later for preventative measure like the cervical cancer vaccine. Since then further research has been conducted into the relationship of HPV with many other cancer types, and with oropharyngeal cancers in particular. Historically, at least 25% of those diagnosed with oral cancer are non-smokers. From papers dating several decades ago, many organizations, the foundation included, have stated that the other 75% of those diagnosed have used tobacco in some form during their lifetimes. Many years of tobacco use, manifested itself in the later decades of life (with an average occurrence time of about 60 years of age) as oral/oropharyngeal cancers. Historically this information has been true. As smoking was the number one causative agent in oral cancers for so long, and the relationship of HPV had not yet been definitively established, (the research was early) it was generally felt in the early 2000’s that we could easily define the high-risk population by sorting out tobacco users. But today the research into the relationship of HPV16 and oral malignancies gives us unchallenged evidence as to the origin of cancer in many of those diagnosed individuals who did not smoke and were moderate alcohol consumers.  Along with American’s changing behaviors both in tobacco use and sexual practices, all of this is changing these numbers and ratios dramatically of those who come to the disease in dramatic ways. 

While the foundation speaks in public service messages about “oral cancers” for simplicity during public dialog, our cancers of interest are distinctly divided into two separate diseases based on anatomical site and etiology. Oral cancers are actually those cancers in the front (anterior) portion of the oral cavity. Oropharyngeal cancers are those located in the posterior portion of the mouth and oropharynx, and usually include the tonsils, the tonsillar pillars and crypts, the base of the tongue, and the back of the oropharynx itself.

Given the decline of tobacco use over the last twenty years in the US, (the historic primary cause of the disease) and the stable (or increasing in the 2004 – 2008 period) rate of incidence of oral cancers, particularly those of the posterior mouth/ oropharynx, it is likely that the 75% -25% statement which has been made by everyone at least since the Blot paper published in 1988, is no longer an accurate representation of the situation. It has been the foundation’s opinion, that HPV is playing a greater role in the incidence rates of the disease, and the now decades old Blot and Mashberg papers which presented these percentages are outdated. We now (2017) have an abundance of peer-reviewed published scientific evidence of this change. Unfortunately, the information people obtain in many parts of the web and from organizations who pay less attention to the changing science, much misinformation still live in this environment. We believe the rates stated on many websites no longer are representative of the actual realities of oral cancer etiology in the US today. Publications now existing in peer-reviewed medical journals establish HPV as a more important causative agent than tobacco in oropharyngeal cancers, and its impact will certainly be significantly larger than the 25% of what was previously described as “other causes.” A number closer to 70% would more accurately describe its impact in that anatomical site today. Most recently there was a study published in Sweden that looked at their current population of oral cancer patients and in that group, 60% were HPV positive. The foundation believes that the ratio of HPV+ disease rates have been significantly under-reported. Because until recently 

Because until recently the treatment protocols for the disease, regardless of etiology were the same, many institutions were reluctant until just recently to thoroughly explore the causative process. So data has been skewed for years from under-reporting and thorough exploration of the causative etiology. Patients joining OCF’s large support group for oral cancer patients, even today report that their treating institutions have not tested their biopsy specimens for the presence of HPV even when the primary is in an anatomical site characteristically known for HPV disease to occur. This leads us to believe that national numbers are short of giving us an accurate view of the extent of the problem.  Whatever the percentage, there is little doubt the HPV is the driving force behind the rapidly escalating numbers of oropharyngeal cancer patients. Today (2017) the treatments for HPV+ patients are changing, lesser radiation exposure protocols are being clinically trialed at numerous locations, the most surprising was the early 2-year results from Mayo Clinic on a 50% reduction that had identical outcomes at two years to those who received the normal dose of radiation. Neck dissections, so commonplace in treatment are now being done are in fewer cases as the disease responds so well to radiation alone. Clearly positive testing of tissue samples for the presence of HPV involvment is mandatory given these new opportunities to reduce the morbidity of treatments. We also have today published science showing a clear survival advantage to those HPV+ patients when compared to a tobacco etiology group that can be as large as a 30% improvement. 

The foundation, in lectures, news interviews, and in written opinions has often expressed this premise since 2001. We strongly believe that in a younger population of non smoking oral cancer patients, that HPV is presenting itself as the dominant causative factor, particularly in the oropharynx anatomical locations. Since the historic definition of those who need to be screened is now changed by this newly defined HPV etiology, and is no longer valid, it is NOT POSSIBLE to definitively know who is at risk for the development of the disease, and who is not. Simply stated, today

ANYONE OLD ENOUGH TO HAVE ENGAGED IN SEXUAL BEHAVIORS WHICH ARE CAPABLE OF TRANSFERING THIS VERY UBIQUITOUS VIRUS NEEDS TO BE SCREENED ANNUALLY FOR ORAL CANCER.

For this reason we are STRONG promoters of OPPORTUNISTIC annual screenings to catch this disease at its earliest possible stages, when it is most vulnerable to EXISTING treatment modalities and survival rates are the highest. We believe that this will bring the oral cancer death rate down as early detection and diagnosis takes place, and will reduce the treatment associated morbidity to patients who do present with oral cancers. If you combine that professional diligence with a public self-discovery and self-referral program like OCF’s “Check your Mouth” program, (www.checkyourmouth.or