[Question #4992] HPV risk

26 months ago
Hello Dr. Handsfield - I asked you a question in this ballpark last year and I am having a tough time wrapping my head around some information.  So I hope you don't mind if I ask a follow up. 

I am a 34 year old male with concerns that I have had oral HPV 16 in the past which might then lead to an HPV throat cancer.    My concern about HPV 16 orally is that I had a bout with oral lichen planus for a few months in my late twenties when I was most sexually active, and OLP can be evidence of oral HPV 16 being present. 

My questions are.. 

1)  Should I be assuming or concluding that because I had OLP in my twenties that I likely had HPV 16? 

2)  Last time you explained to me using some quick hypotheticals that even if I did have HPV 16 for sure that I am still far more likely to get some other more common cancers.   But I'm not sure if I understand... 

According to Dr. D'Souza, baseline risk for men to ever get HPV throat cancer is .7 percent   (https://www.healio.com/hematology-oncology/head-neck-cancer/news/in-the-journals/%7B6c0c610a-54d6-4cd2-9ef6-75a7c2973826%7D/screening-for-oral-hpv-would-be-challenging-due-to-low-throat-cancer-risk)

In some other studies they estimate that HPV 16 infection gives someone up to 32-fold increased risk for HPV throat cancer at the high end or 14-fold increased risk at the low end.   
Links:  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037092/
https://www.cancer.org/latest-news/more-evidence-that-hpv-can-cause-head-and-neck-cancers.html

Sooo... that would mean on the high end lifetime risk for HPV throat cancer is 22.4 percent if someone has had HPV 16.  Correct?  Wouldn't leave me far, far more likely to face HPV throat cancer than any of the other more common cancers as we originally discussed?    And 22% percent chance doesn't seem like something to sneeze at.  Shouldn't I be getting tested or screened?  

I'm hoping my back of the envelope math here is wrong obviously!
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome back to the Forum.  On this occasion, I will be answering your question.  I'm sorry that you continue to worry about this.  I agree with Dr. Handsfield's earlier statements and my comments will, hopefully, build on those.  If you consider a prevalence of about 5% (1 in 20) both oral lichen planus (OLP) and oro-pharyngeal HPV are relatively common.  Thus it should not surprise you that both co-exist occasionally enough to provide a statistical association.  Please remember that there is no specific, known cause of OLP.  In your own case, you also do not know that you have or have had oral HPV.  You are overthinking this.

A few more comments.  Over 99% of genital HPV infections regress without progression.  Thus it is unlikely that IF you had oral HPV (again, you do not know), that it would progress.

Further, I would dispute the idea that 16-22% of oral HPV 16 infections lead to cancer. this is an overstatement and the numbers of diagnosed oral cancers, simply do not match up.

Also, dentists now regularly check patients for evidence of oral pathology.  If you see a dentist regularly, you are being screened for oral cancers and pre-cancerous lesions. 

My suggestions.  Take a deep breath.  Give up on the idea that you have oral HPV or that your prior OLP was an STI.  Stay off the internet.  While a great method for communication, medical "information" found on the internet is more often misleading than not, because it is often out of date, taken out of context or just plain wrong.

I hope these comments are helpful. EWH
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26 months ago
Dr. Hook -

Thanks so much for your insightful response. 

Just hoping to clarify.  

FWIW, this is the link that set off alarms about my OLP possibly being an indication that I have had an oral HPV 16.  
Here’s another..

Both make it sound like there is a strong link between OLP and HPV 16 but I’m not an expert.  Am I wrong in reading it that way?  

Also, the American Cancer Society website cites the 22 fold increase for HPV throat cancer in people who have oral HPV 16 infections.  So if I take the .7 lifetime risk of HPV theoat cancwr and multiply it by 22, that’s where I got the 15%/16% chance.   Hoping I’m wrong in arriving at that conclusion but I thought it was wrong with sound number.   Still confused tho. 

Sorry to keep asking. I think it’s easier for me to calm down when I see the error in how I drew my conclusions than it is to just forget about it altogether.  

Any other insight in that regard would be appreciated. Thank you.  

26 months ago
Thought I was *using* sound numbers on the American cancer Societty calculation I meant to say.  Sorry. 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Once again, I think you are overthinking this.  As I have already told you, the link between HPV and OLP is controversial,and not clear. The newspaper report of the article you found says that the mechanisms by which the two processes affect cells are similar and then goes on to support a POSSIBLE linkage.  Scientists and even more so newspapers reporting their work like to call attention to their work through making attention-getting statements.  Clearly this worked for you.  If you are anxious to start with (and you clearly are) the Internet will only exacerbate those fears.

Regarding cancer risks, oral cancer is multi factorial and while HPV is related, co-factors like smoking and tobacco remain the major contributing causes.  You can play games with numbers as you go down a "what if" path starting with that you do not know that you have oral HPV of any sort.  My recommendations remain the same.  EWH
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26 months ago
Thanks again for your response.  As I read about HPV and OLP,  I failed to see the difference between association and cause.  One article hypothesized that OLP lesions are more suspectible to HPV, which would explain the association.  Who knows. 

I guess that eases my mind a bit.  

Much Appreciated.
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
There are important differences between scientifically associations and causation.  By way of illustration, association means that things tend to occur but it does not mean that one causes the others.  As a perhaps silly example- everyone who gets lung cancer breathes.  That association does not mean that the breathing causes the cancer but they tend to occur in the same people.  This is an association.

You are correct, the hypothesized association of OLP and HPV may help to understand the mechanisms of both processes.  

Glad my comments were helpful.  As you know, now that you have received three comments in response to your questions, this thread will be closed.  

On last piece of advice- please stay off the internet.  All too often it will mislead you. EWH


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