November is Mouth Cancer Action Month, and this year we want to talk about a cause many people have never connected with their dentist: the human papillomavirus, or HPV.
When people think of mouth and throat cancer, they usually think of smoking and alcohol. Those remain the main risk factors. But a large share of cancers at the back of the throat are now linked to HPV instead, and there is a vaccine that protects against it.
There is no national screening programme for mouth or throat cancer in the UK. That makes your routine dental examination one of the few regular chances for a trained clinician to look closely at these areas. It is also why we raise HPV with our patients, particularly parents of young teenagers.
What is HPV?
HPV is not one virus but a very common group of viruses. It spreads easily through skin-to-skin contact, including any sexual contact.
Most infections clear by themselves. In most people, the body gets rid of HPV naturally, without treatment and often without them ever knowing they had it.
A few types are high risk. When a high-risk type persists, it can lead to cancer over many years. HPV is linked to cervical, vaginal, vulval, anal and penile cancers, and to some cancers of the head and neck.
Having HPV says nothing about a person's character. It is a very common infection, and there is no need for embarrassment when we discuss it.
In summary
HPV is extremely common and usually harmless.
The concern is the small number of persistent, high-risk infections.
How HPV is linked to throat cancer
The part of the throat most affected is the oropharynx: the area just behind the mouth that includes the tonsils, the back of the tongue and the soft palate. Cancer here is called oropharyngeal cancer.
What the UK evidence shows
About half are HPV-related. A national study of nearly 1,500 oropharyngeal cancers from 11 UK centres found that around 52% were HPV-positive between 2002 and 2011.
Cases roughly doubled. Over the same decade, the rate of oropharyngeal cancer in the UK rose from about 2.1 to 4.1 cases per 100,000 people.
HPV is not the whole story. The HPV-positive share stayed steady while overall cases climbed, so the researchers concluded that HPV alone does not explain the rise. Smoking and alcohol still matter.
A more hopeful outlook when found
HPV-related throat cancers tend to respond better to treatment. In a large trial, 82% of people with HPV-positive oropharyngeal cancer were alive three years after diagnosis. For those whose cancer was not HPV-related, the figure was 57%. Finding any cancer early still gives the best chance.
In summary
About half of UK throat cancers at the back of the mouth are linked to HPV.
Tobacco and alcohol remain the main risk factors for head and neck cancer overall.
The HPV vaccine: who can have it in Wales
Boys and girls aged 12 to 13: offered one dose in school year 8, given in school.
Anyone who missed it at school: one dose as a catch-up until their 25th birthday. This covers boys who were in year 8 from September 2019 onward, and girls who became eligible from September 2008 onward.
Gay, bisexual and other men who have sex with men, up to age 45: available through sexual health and HIV clinics. Those aged 25 to 45 need two doses.
People who are immunosuppressed or living with HIV, under 25: may need three doses, so ask your GP or practice nurse.
Since 1 September 2023, Wales and England have used a single dose for the school programme, because one dose gives excellent protection.
Does it protect the mouth and throat?
The vaccine was first designed to prevent cervical cancer. Studies have since looked at whether it also stops HPV infecting the mouth.
A clinical trial in Costa Rica looked at women four years after vaccination. Oral infection with the two main high-risk types was about 93% lower in vaccinated women than in unvaccinated women.
A large study of young adults in the United States found oral infection with vaccine-covered types was about 88% lower in those who had been vaccinated.
These studies measured infection, not cancer. Throat cancers take many years to develop, so the effect on cancer rates themselves is still being studied. Preventing the infection that causes them is the logical first step.
In summary
In Wales, boys and girls are offered one dose in year 8, with catch-up until 25.
Vaccination is strongly associated with far fewer oral HPV infections.
If your child missed their dose, contact your GP or the school immunisation team.
Signs to look out for
Many harmless conditions cause similar symptoms, so these are not a reason to panic. They are a reason to get checked if they persist.
Throat
A lump in the neck
A sore throat that won't settle
Pain or difficulty swallowing, or a feeling that something is stuck
Ear pain
Changes to your voice or speech
Unexplained weight loss
Mouth
A mouth ulcer that doesn't heal
A persistent, unexplained lump in the mouth
What we check at your examination
Every examination at Whitland Dental Co includes a soft-tissue check, not just your teeth.
We look at your lips, cheeks, gums, tongue, the floor and roof of your mouth, and as far back into the throat as we can see.
We feel your neck and under your jaw for any lumps or swelling.
We ask about changes you have noticed, and about smoking, vaping, nicotine pouches and alcohol.
We refer quickly if anything concerns us, using the urgent cancer pathway.
The tonsils and the back of the tongue can only be partly seen during a dental examination. That is why it matters to tell us about symptoms like a lasting sore throat or a lump in your neck, even if your mouth looks healthy.
In summary
Persistent symptoms deserve a check, by your dentist or GP.
Your routine examination is a cancer check as well as a dental one.
The key points
HPV is very common and usually clears by itself, but persistent high-risk types can cause cancer.
About half of UK cancers at the back of the throat are linked to HPV.
In Wales, boys and girls are offered a single vaccine dose in year 8, with catch-up until age 25.
There is no national screening programme, so your dental examination is an important opportunity to spot early changes.
Do not wait for your next appointment if a symptom persists.
Book your examination
Please get in touch if it has been more than a year since your last check, or if you have noticed any of the signs above. Every examination at Whitland Dental Co includes a full mouth cancer check, carried out calmly and without rush.
Call us on 01994 238 660 or email info@whitlanddental.co. You are welcome to speak to us in Welsh.
Whitland Dental Co: a sanctuary, not a surgery.
References
Ang, K. K., Harris, J., Wheeler, R., Weber, R., Rosenthal, D. I., et al. (2010). Human papillomavirus and survival of patients with oropharyngeal cancer. New England Journal of Medicine, 363(1), 24–35. https://doi.org/10.1056/NEJMoa0912217
Cancer Research UK. (n.d.). Screening for mouth and oropharyngeal cancer. https://www.cancerresearchuk.org/about-cancer/mouth-cancer/getting-diagnosed/screening
Chaturvedi, A. K., Graubard, B. I., Broutian, T., Pickard, R. K. L., Tong, Z. Y., Xiao, W., Kahle, L., & Gillison, M. L. (2018). Effect of prophylactic human papillomavirus (HPV) vaccination on oral HPV infections among young adults in the United States. Journal of Clinical Oncology, 36(3), 262–267. https://doi.org/10.1200/JCO.2017.75.0141
Herrero, R., Quint, W., Hildesheim, A., et al. (2013). Reduced prevalence of oral human papillomavirus (HPV) 4 years after bivalent HPV vaccination in a randomized clinical trial in Costa Rica. PLOS ONE, 8(7), e68329. https://doi.org/10.1371/journal.pone.0068329
NHS 111 Wales. (n.d.). Cancer of the head and neck. https://111.wales.nhs.uk/canceroftheheadandneck/
NHS 111 Wales. (n.d.). HPV vaccine. https://111.wales.nhs.uk/livewell/vaccinations/HPVvaccine
Public Health Wales. (n.d.). Human papillomavirus (HPV) vaccine. https://publichealthwales.nhs.wales/topics/immunisation-and-vaccines/hpv/
Schache, A. G., Powell, N. G., Cuschieri, K. S., Robinson, M., Leary, S., Mehanna, H., … Jones, T. M. (2016). HPV-related oropharynx cancer in the United Kingdom: An evolution in the understanding of disease etiology. Cancer Research, 76(22), 6598–6606. https://doi.org/10.1158/0008-5472.CAN-16-0633
Before publishing, please complete the full author lists for Ang, Herrero and Schache from their DOI pages. APA 7th lists up to 20 authors, and I've only included the ones I could confirm.
