ADEA CCI Liaison Ledger

HPV Calls for an Interprofessional Approach

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By Jacquelyn L. Fried, Associate Professor and Director of Interprofessional Initiatives, University of Maryland School of Dentistry

By 2020, the prevalence of HPV-related head and neck cancers associated with the human papilloma virus (HPV) is anticipated to reach epidemic proportions. This pressing public health issue provides an opportunity for interprofessional education (IPE) where oral health is a key focal point. Students across the health professions must understand how prevention, detection, referral and treatment are essential to the eradication of HPV and associated oropharyngeal cancers (OPC). Dental hygiene and dental school faculty are in ideal positions to develop curricula related to HPV and OPC, share curricula interprofessionally and increase the visibility of these contemporary health threats.

The HPV-knowledge base is relevant to all helping professions, and HPV’s alarming growth makes a strong case for including cross-disciplinary perspectives in an expanded curriculum that examines HPV, its transmission and its association with OPC. Traditional curriculum content on oral cancer often does not apply to OPC as it currently manifests itself, so the reassessment and amplification of current curriculum are warranted.

What might a new interprofessional HPV/OPC curriculum look like? Essential content areas would include epidemiologic data, associated risk factors, the virus’s pathophysiology and mechanism of action, evolution of the infection, strains of the virus, transmission routes, vaccinations, prevention, patient education, treatment and prognosis. Students of dentistry, dental hygiene, psychology, health education, medicine, social work and nursing could share didactic experiences, but faculty must ensure that the delivery of didactic content promotes student interaction and makes use of diverse learning activities and environments. The Interprofessional Education Collaborative (IPEC) Core Competencies for Interprofessional Collaborative Practice outlines four competency domains (teamwork, values/ethics, roles and responsibilities and communication) to guide faculty through the process of creating interprofessionally competent graduates.

A new interprofessional curriculum must also emphasize communication; in particular, how to address sensitive issues with patients and other health care providers. In general, the scientific literature describes health professionals as having ineffective communication skills and a penchant toward ignoring sensitive issues. Role-playing with diverse groups of students and faculty could help learners assess what they would say, how they would say it and how they feel about addressing HPV with a patient. Practicing communication skills together through peer teaching will help these future providers learn how to discuss sensitive topics with their patients and each other. Since baseline communication skills and exposure to teamwork may vary among different groups of professional students, self-paced activities might be especially engaging. Case studies with small group discussions could provide additional learning opportunities.

On a population-based level, oral health professionals could work with nurses, physicians, social workers, gynecologists, community groups and professional organizations to support efforts to prevent HPV-associated OPC. Oral health professionals could devise and lead a public health campaign to prevent HPV transmission and HPV-associated head and neck cancers. Dentists’ and dental hygienists’ involvement in supporting the use of preventive vaccines and providing education on safe sexual practices could catapult the oral health professions into prominence and demonstrate their commitment to breaking down professional education silos.

Forces shaping the health care delivery system are dynamic. So are lifestyles and behaviors that trigger changes in society’s health. Likewise, health professions educators must adjust their curricula to respond to new health care challenges. Currently, bona fide curriculum content related to HPV must be developed and shared across health professions schools and programs. The increase in HPV-associated OPC provides an opportunity for oral health professionals to increase their visibility and take the lead in promoting IPE while addressing a serious public health threat. 

To Whom It May Concern:
I commend ADEA on calling for an HPV-associated oropharyngeal cancer curriculum for dental schools. HPV has been linked with 72% of all OPC and is the only oral and pharyngeal cancer that is increasing, particularly among white males. Although the majority of oral cancers are still associated with tobacco and alcohol use, it is important for dental health care providers to be familiar with this growing category or cancers. However, although there are many studies being published weekly on the subject matter, there is still much we don't know about how the virus is transmitted, how it can be prevented, and how likely it is to develop an HPV-associated OPC from an oral HPV infection. These cancers are very far back in the mouth which makes visual screening extremely difficult. There are no FDA-approved tests to diagnose oral HPV infection and there have been and will likely be no clinical trials to evaluate the effectiveness of the vaccine in preventing oral infection (although since the same high risk HPV type is involved, it seems likely they would be effective). Although studies have associated certain sexual practices with HPV OPC, some studies have shown no association. For these reasons, CDC has no recommendations for dentists or other oral health care providers supporting the HPV vaccine, testing for oral HPV, or promoting safe sexual practices for their patients. While increasing the awareness and knowledge among dental providers about these cancers is very important, we need to acknowledge our limited understanding of the natural history of this disease. I would be more than happy to discuss further, should you wish.

Thank you for the opportunity to comment on this important matter.

Jennifer L Cleveland, DDS, MPH
Dental Officer/Epidemiologist
Division of Oral Health
Centers for Disease Control and Prevention
4770 Buford Highway Mailstop F-10
Atlanta, GA 30341
770-488-6066 phone
770-488-6080 FAX

Cleveland JL, Junger ML, Saraiya M, Markowitz LE, Dunne EF, Epstein JB. The connection between human papillomavirus and oropharyngeal squamous cell carcinomas in the United States: Implications for dentistry. (Cover Story) J Am Dent Assoc 2011;142(8):915-924.

HPV and oral health. Response from Dr. Cleveland and colleagues. Cleveland JL, Junger ML, Saraiya M, Markowitz LE, Dunne EF, Epstein JB. J Am Dent Assoc 2012:143(5):440-2.
Posted by: 115350( Visit ) at 2/3/2014 4:58 PM

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