Human Papilloma Virus (HPV) Oral Prevalence in Scotland (HOPSCOTCH): A Feasibility Study in Dental Settings.

David I Conway,Sharon Kean,Jan E Clarkson,Heather Gray,Kate Cuschieri,Kimberley Kavanagh,Chris Robertson,Kevin G Pollock,Andrew J Winter,Lisa M Mcdaid,Jiafeng Pan,Heather Cubie,Christine Campbell,Ramya Bhatia,Linda Young,Jeremy Bagg

doi:10.1371/journal.pone.0165847

Abstract

The purpose of this study was to test the feasibility of undertaking a full population investigation into the prevalence, incidence, and persistence of oral Human Papilloma Virus (HPV) in Scotland via dental settings. Male and female patients aged 16–69 years were recruited by Research Nurses in 3 primary care and dental outreach teaching centres and 2 General Dental Practices (GDPs), and by Dental Care Teams in 2 further GDPs. Participants completed a questionnaire (via an online tablet computer or paper) with socioeconomic, lifestyle, and sexual history items; and were followed up at 6-months for further questionnaire through appointment or post/online. Saline oral gargle/rinse samples, collected at baseline and follow-up, were subject to molecular HPV genotyping centrally. 1213 dental patients were approached and 402 individuals consented (participation rate 33.1%). 390 completed the baseline questionnaire and 380 provided a baseline oral specimen. Follow-up rate was 61.6% at 6 months. While recruitment was no different in Research Nurse vs Dental Care Team models the Nurse model ensured more rapid recruitment. There were relatively few missing responses in the questionnaire and high levels of disclosure of risk behaviours (99% answered some of the sexual history questions). Data linkage of participant data to routine health records including HPV vaccination data was successful with 99.1% matching. Oral rinse/gargle sample collection and subsequent HPV testing was feasible. Preliminary analyses found over 95% of samples to be valid for molecular HPV detection prevalence of oral HPV infection of 5.5% (95%CI 3.7, 8.3). It is feasible to recruit and follow-up dental patients largely representative / reflective of the wider population, suggesting it would be possible to undertake a study to investigate the prevalence, incidence, and determinants of oral HPV infection in dental settings.

Highlights

Oropharyngeal cancer (OPC) is among the cancers with the fastest increasing incidence in the UK, with a near 3-fold rise in the past 15 years and incidence rates around 5 per 100,000 [1, 2, 3]
We achieved an overall participation rate of 33.1%, which was somewhat lower than the 67% participation rate in the National Health and Nutrition Survey (NHANES) used in the US oral prevalence study [10], but is higher than the approximate 10% reported in the Swedish study [15], and participation rates are unreported in other studies [11, 13, 16]
Our study demonstrates that it is feasible to investigate the prevalence, incidence, and determinants of oral Human Papilloma Virus (HPV) infection in dental settings

Summary

Introduction

Oropharyngeal (throat) cancer (OPC) is among the cancers with the fastest increasing incidence in the UK, with a near 3-fold rise in the past 15 years and incidence rates around 5 per 100,000 [1, 2, 3]. The only large population-based study of oral HPV prevalence has been undertaken in the United States of America [10] This cross-sectional study (n = 5579) found an overall population prevalence of 6.9% and a bimodal increasing pattern with age—a prevalence of over 7% among those in their 20s and 30s, and a further peak of over 11% in those in their 50s and early 60s. An earlier systematic review of 18 cancer case-control studies worldwide found an overall prevalence of 4.5% oral HPV infection in healthy individuals (cancer-free control subjects) [14]

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