In a cancer detection editorial published in JAMA, Ricardo J. Ramirez, MD and Jose P. Zevallos, MD, MPH, concluded that oral rinse samples are reliable when detecting the Human Papillomavirus (HPV) 16 sub-type.

This is important commentary since HPV16 is reported to be responsible for 60 - 70 percent of oropharyngeal squamous cell carcinoma (OPSCC) cases in the United States.

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HPV16 is increasingly being recognized now as a cause of infections that colonize the throat, including the tongue base and tonsils, and potentially a cause of cancer of the head and neck.

Over the last 10 years, there has been increasing interest in noninvasive biomarkers for cancer, including from blood and saliva.

Dr. Ramierez and Dr. Zevallos said ‘Oral rinse - gargle samples have been examined and found to contain reliable and reproducible HPV DNA data among patients with known HPV-positive OPSCC.’

These physicians say that ‘determining HPV infection status in patients with newly diagnosed OPSCC, most often with p16 immunostaining as a surrogate marker, is important for risk stratification and prognostication.’

Two previous studies also support saliva testing to detect HPV16:

During December 2018, a study reported the detection of HPV in saliva samples collected by either method yielded comparable results and showed good sensitivity for the detection of HPV. There was a significant correlation between the two sample methods in the ratio of HPV16 E2 to E6/7 DNA. Consistent with previous studies, a mixed HPV‐16 form, episomal and integrated, was commonly found in both saliva and tumor samples.

During 2017, a study reported the rate of HPV-DNA detection in both oral rinse and a tonsillar swab was significantly higher in OPC compared with non-OPC upper respiratory tract cancer and non-cancer diseases. Based on p16 immunostaining, the sensitivity and specificity of HPV-DNA detection in oral rinse were reported 75% and 100%, respectively.

This new JAMA editorial and the earlier studies are insightful since the Centers for Disease Control and Prevention (CDC) says ‘There is no approved test to find early signs of oropharyngeal cancer because more information is still needed to find out if those tests are effective.’

The CDC says about 10 percent of men and 3.6 percent of women have oral HPV, and oral HPV infection is more common with older age.

Most people clear HPV within one to two years, but an HPV infection persists for longer time frames in some people.

Commercial testing labs offer HPV16 saliva tests, such as Ulta Labs and OralDNA Labs.

Questions regarding saliva tests are best answered by your healthcare provider, says the CDC.

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