HPV, Marijuana and Oral Cancer: READ this if you smoke pot!!! (1st post)

• By KLS123
• Posted August 18, 2008 at 1:20 am
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http://www.oralcancerfoundation.org/hpv/index.htm

http://www.oralcancerfoundation.org/hpv/pdf/100-6_risk_Gillison.pdf

Distinct Risk Factor Profiles for Human
Papillomavirus Type 16 – Positive and Human
Papillomavirus Type 16 – Negative Head and
Neck Cancers
Maura L. Gillison , Gypsyamber D ’ Souza , William Westra , Elizabeth Sugar , Weihong Xiao ,
Shahnaz Begum , Raphael Viscidi


HPV-16 was detected in 92 of 240 case subjects. HPV-16 – positive HNSCC was independently associated
with several measures of sexual behavior and exposure to marijuana but not with cumulative measures
of tobacco smoking, alcohol drinking, or poor oral hygiene. Associations increased in strength with
increasing number of oral sex partners ( P trend = .01) and with increasing intensity (joints per month, P trend =
.007), duration (in years, P trend = .01), and cumulative joint-years ( P trend = .003) of marijuana use. By contrast,
HPV-16 – negative HNSCC was associated with measures of tobacco smoking, alcohol drinking, and poor
oral hygiene but not with any measure of sexual behavior or marijuana use…………………..

There is insufficient evidence to either implicate or exonerate
marijuana as a carcinogen in humans
( 28 ). In this study, marijuana
use was strongly associated with HPV-16 – positive HNSCC. By
contrast, no association between marijuana use and HNSCC was
observed in a California cohort study
( 29 ) or in three previous
case – control studies ( 22 , 30 , 31 ).
A dose – response relationship
between marijuana use and HNSCC that was reported in a single
hospital-based case – control study
( 32 ) has been questioned ( 30 )
because of the low prevalence of ever marijuana use (7%) among
the blood-donor control subjects. In our study, the prevalence of a
year or more of marijuana use among control subjects (16%, Table
4 ) was similar to that observed in a previously published populationbased
study (approximately 18%; 30) that reported no association
between marijuana use and HNSCC. In this study, ACASI
technology allowed us to measure lifetime cumulative marijuana………………..

It is biologically plausible that marijuana could act to promote the
development of HPV-positive HNSCC. Carcinogens in marijuana
smoke, like those in tobacco smoke ( 34 ), can induce molecular
alterations of the airway epithelium
( 35 , 36 ). However, although a
pathogenic role for DNA-damaging carcinogens in marijuana
among HPV-16 – positive cases is possible, the known immunomodulatory
effects of cannabinoids may be more relevant for a virally mediated cancer. Cannabinoids bind to receptors (CB2)
expressed on B cells, natural killer cells, macrophages, dentritic
cells, and T cells, including those in human tonsillar tissue ( 37 ).
Endogenous cannabinoids are increasingly being recognized as
important immunomodulatory compounds that act in a paracrine
fashion to alter responses in the local microenvironment. In animal
models, cannabinoids suppress T helper (T H -1) proinfl ammatory
cytokines (eg, interleukin 12 and interferon gamma) while
augmenting production of T H -2 anti-infl ammatory cytokines (eg,
interleukins 4 and 10) ( 38 , 39 ). As a result, cannabinoids suppress
humoral and cell-mediated immune responses, reduce host cell
resistance to intracellular (eg, Listeria, legionella) and viral
(eg, herpes simplex virus) pathogens
( 40 ), and may also suppress antitumor
immunity ( 41 , 42 ). Preliminary studies indicate that cannabinoids
may alter immune responses in humans ( 43 ). For instance,
in marijuana smokers, the function of alveolar macrophages ( 44 ) is
impaired, and CD4 and natural killer cell numbers and lymphocyte
proliferative responses are suppressed ( 45 ). Cannabinoid derivatives
are in development for treatment of chronic infl ammatory
disease in human subjects ( 38 , 46 ). It is therefore biologically possible
that cannabinoids promote progression of an HPV-positive
HNSCC at multiple steps, including by increasing the risk of
infection upon exposure, promoting persistence of an infection,
and inhibiting antitumor immunity………….

The data presented in this manuscript are the first, to
our knowledge, to suggest that marijuana use may be a cofactor for
HPV-16 – mediated carcinogenesis in the head and neck; thus,
these results will need to be confirmed in other populations.

36. Darling MR , Learmonth GM , Arendorf TM . Oral cytology in cannabis
smokers . SADJ . 2002 ; 57 ( 4 ): 132 – 135 .
37. Berglund BA , Boring DL , Howlett AC . Investigation of structural analogs
of prostaglandin amides for binding to and activation of CB1 and CB2
cannabinoid receptors in rat brain and human tonsils . Adv Exp Med Biol.
1999 ; 469 : 527 – 533 .
38. Klein TW . Cannabinoid-based drugs as anti-infl ammatory therapeutics .
Nat Rev Immunol . 2005 ; 5 ( 5 ): 400 – 411 .
39. Klein TW , Newton C , Larsen K , et al . The cannabinoid system and
immune modulation . J Leukoc Biol. 2003 ; 74 ( 4 ): 486 – 496 .
40. Cabral GA , Dove Pettit DA . Drugs and immunity: cannabinoids and their
role in decreased resistance to infectious disease . J Neuroimmunol . 1998 ;
83 ( 1 – 2 ): 116 – 123 .
41. Zhu LX , Sharma S , Stolina M , et al . Delta-9-tetrahydrocannabinol inhibits
antitumor immunity by a CB2 receptor-mediated, cytokine-dependent
pathway . J Immunol . 2000 ; 165 ( 1 ): 373 – 380 .
42. McKallip RJ , Nagarkatti M , Nagarkatti PS . Delt a-9- tetrahydrocannabinol
enhances breast cancer growth and metastasis by suppression of the antitumor
immune response . J Immunol . 2005 ; 174 ( 6 ): 3281 – 3289 .
43. Roth MD , Baldwin GC , Tashkin DP . Effects of delt a-9-tetrahydrocannabinol
on human immune function and host defense . Chem Phys Lipids .
2002 ; 121 ( 1 – 2 ): 229 – 239 .
44. Baldwin GC , Tashkin DP , Buckley DM , Park AN , Dubinett SM ,
Roth MD . Marijuana and cocaine impair alveolar macrophage function
and cytokine production . Am J Respir Crit Care Med . 1997 ; 156 ( 5 ):
1606 – 1613 .
45. Pacifi ci R , Zuccaro P , Farre M , et al . Combined immunomodulating
properties of 3,4-methylenedioxymethamphetamine (MDMA) and cannabis
in humans . Addiction . 2007 ; 102 ( 6 ): 931 – 936 .

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• By srvivrmom
• Posted August 19, 2008 at 1:38 pm
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How does one get tested for oral HPV?

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• By KLS123
• Posted August 21, 2008 at 1:21 am
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There is a saliva test (so I've heard).

Getting screened for dysplasia/cancer orally is done at the dentist usually. Make sure your dentist takes the time to do a proper test (especially base and back of tongue and tonsillar area. These are the common areas for HPV-positive oral cancers to be found.

Getting screened for dysplasia/cancer in the throat is not common because of it's high cost from what I understand.

People who have had HPV-positive dysplasias or cancers should be getting screened every 6 months to a year vaginally, analy, and orally (all squamous cell mucous membrane areas prone to HPV). Ask for it if your doctor doesn't suggest it. I'm going to.

All the best,

Karina

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• By flowershoplady
• Posted August 21, 2008 at 10:04 am
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there's no oral hpv test as there is for the cervix/vagina. and, there are some screening tools that use a special light to detect oral dysplasia but they have high rates of false positives (as well as negatives!). they're not standardized testing. your dentist should be looking in your mouth for abnormalities, but often when they're detected, there is already cancer. the hpv connection to oral cancers and their rise in incidence definitely indicates that better testing is needed!

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• By ktelleria
• Posted August 22, 2008 at 8:56 am
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This week, while having my teeth cleaned, my dentist talked to me about the screening for oral cancer. They have started doing this screening. It does not test for hpv it uses a liquid solution along with a special light to detect abnormalities. This is the first I have head of this and wanted to get more information on it as far as the reliability of the test.

In talking to my dentist by the time they see oral cancer it has often progressed severly.

Any dentist out there with more info?

Thanks

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• By flowershoplady
• Posted August 22, 2008 at 10:09 am
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hi, ktelleria. my dentist didn't have the testing at his office but referred me to another dentist. he told me about two different methods, both using the solution and then light detection, and recommended and used only one. they've both got high rates of false positives, one more than the other. i did a bit of research on it, and i decided not to have it done because i didn't want to risk the emotional and physical stress of false positives which seemed even more likely than a true problem being detected for me. i'd be interested to know if you have the test.

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• By Pirkar
• Posted October 17, 2008 at 10:06 am
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Hi,
does anyone know which doctor tests for tonsils cancer - dentist or the ear, nose and throat specialist? are there any tests available? I have one enlarged tonsil, and a white spot in back of my throat for years, and now I read that there are no specific cancer tests for oral cancer? I also have active HPV 16, so I am very scared at the moment.

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• By corellin
• Posted October 17, 2008 at 10:24 am
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HI Pirkar,
My dentist hadn't heard of HPV as a significant cause of oral cancer, even though she's fairly young. She did a visual screen and then referred me to an oral surgeon. The oral surgeon was about 70 and told me there was no connection between oral cancers & HPV and to stop worrying & did a cursory screen. So then I went to an ear, nose & throat specialist who did another visual examination, this time very thorough. None of them knew of any oral HPV tests, but the ENT did refer me to the Univeristy of Washington, since they have a group with more experience. I lost the referral information, so haven't gone yet. It occurs to me that I'm costing the healthcare system a lot of money and that it would be beneficial if they had one overall place (with expertise) to screen for HPV16 positive or exposed patients who've also had CIN and are at greater risk. This going from provider to provider to find answers is very costly.

I got this from the recent article posted on oral cancers, in one of the public responses:

"I didn't see any mention of two new technologies for early detection, commonly used by Dentists. These are the Velscope and Visilight systems. Both can " highlight " early cancers and even dysplastic areas in the mouth and throat. The tests are relatively inexpensive and and take only a few minutes to screen for problems. Dr H.S.David Mock Springdale, PA." --maybe this guy would know how to find a knowledgeable person in your area.

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• By flowershoplady
• Posted October 18, 2008 at 8:43 pm
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those are the two systems i'd heard about as well, corellin. has anyone had this done?

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• By KLS123
• Posted October 19, 2008 at 12:07 pm
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On August 21st I posted that I had heard of a saliva test for hpv testing. Apparently I misunderstood. I have a friend who has been involved in a long term study at UCSF on hpv and the routine saliva test is to detect nicotine...not hpv. sorry if that was misleading...

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• By KLS123
• Posted October 19, 2008 at 12:15 pm
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Hi Pirkar,

I hope this helps...

Speech and Swallowing Center
UCSF
Dr. Mark Courey
415-353-3453

My understanding is he is a dysplasia specialist who can perform a laryngoscopy

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• By KLS123
• Posted October 19, 2008 at 12:39 pm
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Oh, and Dr. Courey was referred as an ENT by my ONC/GYN at UCSF dysplasia center.

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• By corellin
• Posted October 19, 2008 at 11:21 pm
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hi flowershoplady,

From your research, did you get a sense of how often the tests produce false positives and then how a dentist might follow up. Do you know if they would refer a patient out for biopsy? I'm wondering how the rate of false positives compares to cervical cancer screening, since I know there are many abnormal paps that turn out to be just inflammation.

Thanks!

KLS -- Here's a link to a saliva test under development that may detect oral cancers. It looks for a biomarker that generally indicates the presence of cancer. I wonder if it will catch cancer in an earlier stage so that it can be more readily treated.

http://health.msn.com/health-topics/cancer/articlepage.aspx?cp-documentid=1 00217285


For anyone interested,

I ran across this video that describes Vizilite Plus (one of the products marketed to detect oral precancer/cancer). The focus is on the market opportunities, since from the Wall Street Journal.

http://video.aol.com/video-detail/zila-ceo-details-oral-cancer-detection-pr oduct/3689094129

And, here's a provider locator for the United States for Vizilite Plus. It looks like dentists are providing it. I'm not at all advocating this product, but might check it out.

http://www.vizilite.com/patient_site/find_provider/index.asp

Here's an article entitled "Study questions effectiveness or oral cancer devices" which lists various devices and the JADA (Journal of American Dentistry) assessment of them. This may provide more information to help you determine whether any are worth pursuing,but I'd be really interested in hearing the perspective & experience of a provider using these devices.

http://www.drbicuspid.com/index.aspx?sec=nws&sub=rad&pag=dis&ItemId=300997


Here's an article that avocados may cut oral cancer risk. For people with cervical/oral cancer risk, the avoocado/kale smoothie might do the trick!

http://www.topix.com/forum/health/oral-cancer/T554DV33BGAI32RFN

Looking at cancer statistics, most of us have a much higher probability of dying of colon, lung or breast cancer than anything related to HPV (not that I'm diminishing our need for concern). But I wonder if our improved lifestyle & eating habits will reduce our risk of these other cancers to such an extent that we'll end up living longer than anyone (or at least healthier)! I would think an avocado/kale smoothie might keep just about any cancer at bay! Throw in a carrot, and we'll be unstoppable! At least our colons will be clear.

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• By flowershoplady
• Posted October 20, 2008 at 9:30 am
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corellin, i discussed the two light detection techniques with my dentist who was referring me to another dentist who did one of these screenings, and i don't have the specific statistics of the rate of false positives (nor did he), but one of the techniques was more than the other. the positive screening would result in unnecessary painful biopsies as well as all the anxiety that goes along with thinking something is wrong.

and, thanks for reminding us that statistically oral cancer is very unlikely, even with a history of cervical/vaginal hpv infection. and, yes, think how healthy many of us will be, with healthy eating/lifestyle, along with continued screenings (paps of course as well as hpv tests, as well as regular checkups and screenings including cholesterol tests, mammographies, etc.!).

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• By corellin
• Posted October 20, 2008 at 10:30 am
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Yikes -- not wanting any more painful biopsies!

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• By KLS123
• Posted April 7, 2009 at 2:20 pm
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Wow! Thanks for all the great information! I'm sending some of these links to my dentist, who is really interested in learning what he can.

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