Have you ever considered the critical link between oral health and your overall well-being, particularly in relation to oropharyngeal cancer? Are you aware of how the Human Papillomavirus (HPV) could be silently impacting your health, and the vital role early detection plays?
In this enlightening episode of me&my health up, host Anthony Hartcher is joined by Dr. Mohammad Kamal, a renowned expert in pathology, to delve deep into the intricate world of HPV and its undeniable connection to oropharyngeal cancer. Dr. Kamal sheds light on the silent nature of HPV, explaining how this prevalent virus can reside in the body for years without showing any symptoms, yet have a profound impact on one’s health.
Discover the importance of early detection and the proactive steps you can take to protect yourself and your loved ones. Dr. Kamal emphasises the crucial role dental professionals play in identifying early signs of oropharyngeal cancer, highlighting the need for regular dental check-ups and open conversations about HPV and its associated risks.
Tune in to empower yourself with knowledge and learn why HPV awareness is more crucial than ever. Don’t miss out on this opportunity to take a proactive stance in your health journey and contribute to the global fight against oropharyngeal cancer.
About Dr, Mohammad Kamal:
Connect with Dr. Mohammad Kamal and OmniPathology:
Any information, advice, opinions or statements within it do not constitute medical, health care or other professional advice, and are provided for general information purposes only. All care is taken in the preparation of the information in this Podcast. [Connected Wellness Pty Ltd] operating under the brand of “me&my health up”..click here for more
That's a great question Anthony, a patient with positive HPV may not show anything, they would look exactly the same internally like if you do examination there will not be anything abnormal about it. A patient with cancer can have of course, like difficulty swelling, they can have the sense of foreign body they can. There's so many other things. And of course, there may be a visible lesion. But one thing that is really that wasAnthony Hartcher:
Dr. Muhammad Kamal, and you have landed on the me&my health up podcast. I'm your host, Anthony Hartcher. I'm a clinical nutritionist and lifestyle medicine specialist. The purpose of this podcast is to enhance and enlighten your well being. And today, we have Dr. Muhammad Kamal, who is a pathologist. He owns a pathology lab called on the pathology. And he was one of the pioneers in terms of the COVID PCR testing. Yes, he developed the test. He was one of the leading pioneers in the US. And we have him on the show today to share some insight around oropharyngeal cancer and the links to the HPV, the human papillomavirus, and it's a sexually transmitted virus. And so we're going to be discussing who's susceptible to getting this and it's on the uptake, it's on the uptake. So it's on the rise. And we really want to make sure we get the education out there to stop the rising rates of oropharyngeal cancer due to the links to the HPV virus. And we have Dr. Muhammad Kamal sharing his insights, and who's susceptible and what we can do about it. So without much further ado, I'd love to welcome you into the discussion I'm having with Dr. Muhammad. Kamal. Welcome, Dr. Muhammad. Kamal, how are you today?Mohammad Kamal:
I'm doing very well. Anthony, thank you for having me.Anthony Hartcher:
Thank you for coming on the me&my health up podcast and we really look forward to you enhancing and enlightening the well being of our listeners today on oropharyngeal cancer and the links to HPV. Just to really bring them up to speed with the advancements around screening and what they could do to make sure that they're proactive in the sense that they're getting ahead and not leaving it too late. So we're certainly going to cover the you know, I guess who's most susceptible and should be taking, I guess, advanced action towards getting this screen done. But before we get into that, Dr. Kamal, I would really like to hear your backstory as to how you have arrived at ending up being a pathologist.Mohammad Kamal:
Okay, excellent. I'm glad to be on your show. And I really happy to share my story. So I was born in Washington, DC I grew up in Egypt. I went to med school and Cairo University after I finished I came to the United States to pursue my medical career. Before I started my residency, I did some work in clinical laboratory. I did some research on medical diagnostics and medical devices, which made the choice for pathology much easier than what I intended. When I was in med school. I wanted to be a cardiologist and actually on that my my older brothers are an ophthalmologist, so my mom became extremely disappointed that none of her sons is going to wear a stethoscope. One is ophthalmologist., and one is a pathologist, but she was eventually happy with our choices. When I finished pathology. I did a break and I finished my residency, I did a fellowship in GI Pathology at UCLA. And after that, I took a few positions and I had some leadership roles in national laboratories. And at one point in 2009, I decided to start my own lab on the pathology and they wanted to do that because I felt that I had a certain vision and a philosophy about laboratory medicine and I wanted to serve patients in a specific way, particularly with the fact that pathologists are not in direct patient contact, we are behind the scenes. So it becomes very easy for one to forget that we are still in the patient care service. And this is our area and I felt okay, this is what I want to do, I would have more control of the vision and mission and philosophy. So we built the lab and as a when I built it I said I'm gonna build it specimen by specimen and that's exactly what we did. We started doing GI Pathology, which is riveting biopsies coming from endoscopy procedures, upper and lower endoscopy colonoscopy, and we diagnose cancer and we diagnose you know, gastritis and other diseases. And then at one point we wanted to expand the services to gynecologist so we had to add additional testing that is done for STI sexual transmitted infections. So we started getting into molecular testing and from there, we started to grow into other things and then COVID Hit in 2020, and then we decided that we really didn't decide we had no choice, there was shortage of testing. And as a high complexity laboratory, we knew that we could develop our own tests and get emergency use authorisation from the FDA. And that's exactly what we did. What I recall the day when I came to the lab, on a Monday morning in early March, and I told my staff would go to develop our own COVID test. And they looked at me as if I was just crazy. And I told them, we have to do it because there is a need for it. And when we did this, we had our tagline was led by science driven by service. And we never thought that this tagline is going to be as representative as the work that we have done. We got together as a group of scientists, we develop this test. We were one of the first labs that submitted to the FDA for the emergency youth authorisation. And we started serving the community. We started by serving our clients that were they were shut down, they couldn't do any procedures. We told them, we're going to test your patience and test your staff before the procedure. So we helped a lot of practices to open up. And then we started serving, we said we need to test schools. And we had a very good school program. So the schools in our area were being tested, the students were tested as teachers. And it became really a great story. Everybody in our organization was feeling extremely proud of what they do. And I think it was remarkable that we, I think it's a blessing that in a hard time like this, we were an organisation one we didn't lay off anybody, everybody was working, because we knew we had the tests, we knew we're going to need people to do this. So we started hiring people. And then we were really fulfilled about our mission in life and our work and our practice. So that was really the test that I think kind of transformed us as an organisation because it gave us confidence that we can do things. As the leader of the organisation, I know that we need to be ready for the post pandemic time. And because we had an HPV test that we were doing for cervical pap smears, I felt that the area that is not really being explored enough is HPV related throat cancer. So we decided to start validating that test. And we worked on it until we had a really good robust test that today we have tested sensitivity is 95.2%., the specificity is 100%. And we started testing, we're offering it for patients because we feel that there is an area here that is not really addressed properly.Anthony Hartcher:
Fantastic. So you go from pioneering the PCR test for the COVID and now you're going into pioneering the HPV test for the oropharyngeal cancer. So just for the listeners sake, can you just please talk a bit bit more about HPV just so that they're aware as to what it is? And who's most susceptible? Who's you know, and who should be tuning in as to? Yes, you've got a screen that I need to go and do.Mohammad Kamal:
Yes, yeah. So I know your audience are in Australia. I know you're also have audience all over the world. I apologise to the Australian audience that most of the data I will share with you is coming from the US data from CDC, but I think in the developed world, they share a lot of these data's and a lot of the trends. So HPV is the most common sexually transmitted infection in the United States. It is the virus that causes cervical cancer in women. It also causes anal cancer in men and women and it causes HPV and related HPV related oropharyngeal. Cancer, the oropharynx had historically been the cancer that develops that is caused by smoking, but in the last 20 to 30 years, the trend started to change where you're seeing less cases that are HPV related and gradually, oropharyngeal cancer HPV related oropharyngeal cancer has been rising to the point that today in America, you have more men with HPV related throat cancer than women with cervical cancer. The reason is, cervical cancer has well established screening guidelines. Every woman goes for pap smear pap smears sample is tested for HPV. There is a very well defined and if somebody's positive, there is a clear guideline on what to do with her. That is not the case in all oropharyngeal cancer. So and that is why it is rising because we don't have any guidelines nothing has been done for it. When when we looked at this came up with a few major points. One is several cancer orphans, a cancer are very similar. They're both squamous cell carcinomas and both caused by HPV. HPV infection resolves on its own in the cervical canal and in the oral pharynx. But you don't see anybody saying I don't want to test sort of a pap smear for HPV because the results on his own, what happens is persistent HPV infection is related to cancer develop. And that is the case in both cervical canal and the oropharyngeal area. So the idea is not to just test, and when you test an individual for HPV in the throat, and that person is positive, that doesn't mean that they have cancer. But what what it means is that this patient should be basically taken and focused on the species should be grouped in people that are at high risk, then you retest. And if this person becomes identified as someone with persistent HPV infection, then we need to refer this patient to an end doctor, you could refer the patient to doctor before that the anti doc would do an endoscopy, they will look at the area, if they don't see anything, they follow up the patient. And that is the chance to bring the patient back and trying to identify a precursor lesion. A precursor lesion is a lesion that has not become cancer or cancer in a very early stage. When you remove this lesion, you significantly improve, the patient survived, because one, if it's dysplastic, which is the stage before the development of cancer, then that patient, you remove it with good margin, that patient will not have cancer and will continue to follow up with that patient. But if you remove cancer early, that's also good, because most cases of oropharyngeal cancer today are presented by a positive lymph node, which is cancer that has gone out and invaded a local lymph node that is fairly late. So this is why we feel that it's really important to get the HPV tested because that is our chance for early cancer detection.Anthony Hartcher:
And you mentioned the high risk population. And can you just expand on that?Mohammad Kamal:
Sure. So HPV rate is higher in individuals, that who have multiple oral genital sexual partner that is a this is a practice that leads to HPV infection. Now, one of the things to help is to practice safe sex, and educating patients about these activities and about the risk that comes with whether activities like that is going to be helpful. And if somebody is doing this, and this is the person also that needs to be tested for oropharyngeal. Each one of my clients does that routinely on their patients and other things that could also increase the risk for HPV infection include reduced immunity, somebody who is diabetic, somebody who had chemotherapy, somebody who has any acquired immune deficiency, smokers are at a higher risk of developing HPV because smoking has a local impact on the cells and on the immunity that can result in higher susceptibility to develop HPV infection. So all of these are risk factors that need to be discussed. So when we thought about the test and said who should do this test, as far as healthcare provider, we think that dentists and dental hygienist have unparalleled access to patients throat. The reason is, if you wait for somebody to go to the doctor, they'll probably never visit any anti doc and that becomes very difficult. And the primary care doctors should also be doing this, but primary care doctors will not do the thorough exam that a dentist could do, or a dental hygienist. So today in America, if you go for your regular dental visit for cleaning, the dental hygienist would examine your mouth, examine your tongue, pull the tongue out, put it aside. And they look on both sides and they look in the back of the mouth and they palpate the neck and they basically felt better because we want to see if there are any lymph nodes, any positive lymph nodes or any large lymph nodes. This isn't a great opportunity for the conversation to start. Were doing this exam to look for oral and oropharyngeal cancer and to look for lymph nodes. And by the way, HPV related oral cancer or oropharyngeal cancer is rising. And HPV is a sexually transmitted disease. And that opens the conversation because dentists are not used to discuss it or not comfortable discussing sexual activities and behaviors and things like that. But this would be really a great opportunity for that conversation to start. Okay, and I'll go ahead.Anthony Hartcher:
And I was just wondering, in terms of the listeners, what sort of signs and symptoms should they be looking out for in either themselves or their friends, their family members, that could indicate that they may have HPV.Advertisement:
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That's a great question Anthony. A patient with positive HPV may not show anything, they would look exactly the same internally like if you do examination there will not be anything abnormal about it. A patient with cancer can have of course, like difficulty swelling, they can have the sense of foreign body they can. There's so many other things and of course, there may be a visible lesion. But one thing that is really interesting about oropharyngeal cancer is that the vast majority of these cancers are seen on the tonsils and based on the tongue, but mainly the tonsils. The reason we see this a lot in the tonsils because the tonsils have a very unique anatomic feature. There is something called consular crypts which are imaginations into the surface. These imaginations give access to the virus to the basal layer, which are the proliferating layers with cancer start, we look for high risk 14 high risk HPV viruses. HPV has over 100 types, and there are so many, most of them are high risk. And HPV 16 is the one that is more most commonly associated with oropharyngeal cancer. So there is a specific affinity of HPV 16 to that base layer. But it just happens that the tonsils because of this feature, and because also it has transitional epithelium, which is very similar to what we see in the cervical canal, the cancer develops into transformations or transitional area. So all of this allows for cancer to happen in the tonsils, right? So when we are when we're looking for that oropharynx is a large, fairly large area, but most cancer develops on the tonsils.Anthony Hartcher:
And when you say the base of the tongue, you're referring to the top of the tongue, so that the very back of it the row back. Okay. Okay. And in terms of like, so you mentioned that those that are having unprotected oral sex, they're the ones that are highly susceptible to HPV, which then you said is pretty much like a silent, a silent virus that you don't know you've got until some starts to really infiltrate such as you know, it becomes cancerous into the body. And that's when the you know, your, your lymph nodes will start to swell and it becomes a bit more obvious. So those people that are, you know, regularly practicing, or having oral sex unprotected should be the ones that, you know, have this conversation with the dentist or doctor to get tested for HPV.Mohammad Kamal:
Yes, it is the unprotected but also the multiple partners, multiple partners, that separate factor, so having multiple partners, but of course, you would assume that it would be a higher risk when it's multiple partners and it's unprotected. And that and that is the kind of behavior that could also trigger somebody who engages in in multiple sexual partners that they could be concerned about it and they could get tested because of that. And that actually happens in the genital area as well that people get tested after certain sexual encounters. So it especially if it's unprotected, so it is not an it's not it's a reasonable approach to say that this is behavior should also trigger the patient to go and proactively try to get tested. And the good news actually is that HPV related oropharyngeal cancer has a better prognosis than the non HPV related cancer. So the orphans, a cancer that is not HPV related has a much worse prognosis. So detecting that early would really would mean a lot to the patient.Anthony Hartcher:
And is there a particular age group that you're noticing in terms of the trend of the outward tech of people being reported with HPV cases and oropharyngeal cases? Is there a particular age group that's, that's showing that they're more susceptible than others?Mohammad Kamal:
The earlier data was higher in their 60s. And then the newer data shows more people in their 40s. But men are affected more than women.Anthony Hartcher:
Okay, fantastic. And it's so great that you're pioneering, you know, testing in this space and educating out there educating dentists and doctors, doctors and specialists in this area, the ENTt specialist in particular. So it's really great. And you mentioned that you have a YouTube channel where you provide further education and insight around the latest in terms of developments in this area.Mohammad Kamal:
Yeah, so I gave a lecture to the California Dental Association. Back in I think it was in May, and we put that whole lecture on the YouTube channel and we wanted to speak to dentists because we felt that this is really a great opportunity for the Dental in the medical community to work together. In Dentistry today there is an approach about the whole patient and whole health and that type. Oral Health is part of the overall health. So that approach, which is also looking for systemic diseases, and its impact on the oral cavity and the oral health when its impact on the systemic the entire body. So we felt that this is a really great opportunity for us to do to reach out to the dental community and tell them about this important this I actually believe that this is a great legacy for any healthcare provider to take part in trying to combat cancer that is rising, and I truly believe that we're advocating is adopted, you will eventually see a decline. Because what we're seeing is very logical, we are saying that persistent HPV infection is linked to cancer development, how are you going to identify patients with persistent HPV infection without testing for HPV, it's logical, and it is scientifically sound. And it's not any different than what has been done to reduce the incidence of cervical cancer.Anthony Hartcher:
So great to have you out there. And you know, being such an advocate, and and helping those that are most susceptible to be proactive with their health and to get tested and to pick it up early, detected early. So you know, they have a high probability of surviving. So really appreciate your work, Dr. Kamal, in terms of how can the listeners and viewers best connect with you,Mohammad Kamal:
You mentioned the YouTube channel, and I'm also we on Facebook, and we have account on Instagram, we publish a lot of things about pathology and about HPV testing, we do a lot of things also in GI pathology, because that's my specialty, and then coming soon.Anthony Hartcher:
Fantastic. I'd love to see you out there dancing and doing some of the tiktoks moves, so to speak.Mohammad Kamal:
No, hopefully, hopefully, we will do that well, and we all fall on our faces,Anthony Hartcher:
Your updating in terms of, you know, getting out there and advocating this work and, and you're really passionate about what you do. So I really appreciate you putting aside the time to you know, share your insights with me and my health listeners. And to the listeners. I'll include all those links that Dr. Kamal mentioned in the show notes. So you can go directly to the show notes and get in touch with his pathology lab or his team to get some further, you know, support in this area. So thank you, Dr. Kamal.Mohammad Kamal:
Thank you so much, Anthony. And thank you for all the great work you're doing. And I really feel that we are, we're doing you know, we're sharing a lot of values. And we're both advocating for health and advocating for people to be proactive about their health. And I really am very proud to be in that profession, but also proud to be in your company.Anthony Hartcher:
They are working together in the best interests of a well community essentially, that and I loved how you mentioned, you know, that this whole connection with doctors, specialists, dentists, all coming together and looking at the whole person that was really magical to hear that.Mohammad Kamal:
You know, the thing about it also, pathologists are sometimes forgotten that people you know, don't know what pathologist do. They think the pathologist to do autopsies all the time. And that's what we do. I actually tell people that as a pathologist and my lab as an organization, I say we are not in the business of cancer diagnosis. We are in the business of cancer prevention and that is really what we do because we we do screening and the screening is to catch cancer early. So this is our our domain is cancer prevention. Fantastic.Anthony Hartcher:
I love that that cancer prevention, be proactive with your health. Fantastic concluding words and I really appreciate your time.Mohammad Kamal:
Thank you so much, Anthony.Anthony Hartcher:
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