NI mouth cancer spike – sexually transmitted HPV virus linked to tonsil cancer

Hospital admissions for mouth cancer in Northern Ireland have risen faster than any other UK nation over the past five years, figures reveal.

By Philip Bradfield
Tuesday, 24th November 2020, 6:30 am
Updated Tuesday, 24th November 2020, 9:10 am
Experts say that HPV may be linked to a rise in tonsil cancer in Northern Ireland, especially in men.
Experts say that HPV may be linked to a rise in tonsil cancer in Northern Ireland, especially in men.

Analysis by JPI Investigations reveals hospital admissions for mouth cancer increased by 25% in NI between 2014 and 2019 compared to 18% in England and 11% in Wales.

JPI Media Investigations found 776 admissions for mouth cancer in NI in 2018. However, a closer look suggests that NI has actually fewer mouth cancer patients per capita than England, but that is because cases tend to be diagnosed later here, and therefore need many more hospital admissions.

Helen Mitchell, a statistician at the NI Cancer Registry at Queen’s University Belfast, said that the rate of mouth cancer diagnosis per capita – as opposed to hospital admissions – is actually slightly lower in NI at 13.1 people per 100,000, than in England, at 13.6. Wales is even lower at 10.8 patients while Scotland is the highest of any UK region at 17.7 patients.

She said that in this period, 54.6% of oral cancers in NI were diagnosed at the latest stage possible – stage four.

“A later stage diagnosis will require more aggressive treatment if that is even possible and sometimes just palliative treatment depending on how far it is spread,” she said. “So you would be going into hospital more often if you were getting palliative treatment.”

She added: “And also the impact of Covid is going to be quite great on mouth cancer because people are not getting their regular check ups. I would suspect there will be an increase in late diagnosis – stage four – because of Covid and people not going to the dentist.”

Chair of the BDA NI Hospitals Group Dr Gerry McKenna said: “A large number of the cases that I see are very advanced cases with very large tumours.

“This inevitably complicates treatment and means that both initial treatment and follow up care are very complex. Early cases can be managed much more easily.

“We know that the main risk factors for oral cancer are smoking and alcohol consumption, usually in combination. Unfortunately patients who fall into this high risk category are those who routinely don’t access any branch of healthcare including dentists, therefore they miss out on screening services offered.”

He said that dentists are the most experienced health professionals in recognising oral cancer and making the best referral for specialist care. Dentists are also excellent at picking up very early stage cancer, but this is impossible if patients do not have regular dental check-ups or go to GPs instead.

Experts have advised that the sexually transmitted HPV virus may be a factor contributing to a rise in oral cancer rates here.

Helen Mitchell of the NI Cancer Registry said the rise of HPV oral cancer is “particularly in men”. She said tonsil cancer in NI has also risen quite steadily from 32 cases in 2014 to 44 cases in 2018 – and it is three times more common in men.

Dr Gillian Prue from the QUB School of Nursing and Midwifery agreed there is a rise of HPV-related oral cancers in younger males, especially in the back of the mouth and throat. “This suggests that oral HPV infection increases the risk of developing tonsil cancer,” she said.

Richard Graham of the British Dental Association said experts are not 100% certain why but say the rise is probably linked to HPV. “They also suggest – although this isn’t proven – that this could be down to the fact that we don’t take everybody’s tonsils out anymore,” he added.

Cancer Focus NI says cases of mouth cancer in Northern Ireland are expected to almost double by 2035. To reduce the risk of developing mouth cancer, it advises;-

:: Stop smoking

:: Check for changes in the mouth and have regular dental check ups

:: Limit alcohol consumption

:: Eat at least five portions of fruit and vegetables per day

:: Use sunscreen with at least (SPF) factor 15 and 4 stars regularly on the lips if outdoors

:: Take regular exercise – at least 30 minutes daily

:: Reduce HPV risk by practising safer sex and limiting your number of partners

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