How saliva may have a role in detecting head and neck cancer

Head and neck cancer

12 Jun 2019

Can you sum up the aim of this research in 10 words?

Detecting human papilloma virus (HPV) associated head and neck cancer earlier using saliva.

What have you discovered in this area so far?

There are five subtypes of head and neck cancers and we are researching HPV negative oral cancer and HPV positive oropharyngeal cancers. The HPV virus resides in the throat and hides in the tonsillar crypts, making it difficult to screen. However, with the use of a salivary rinse sample, we are able to capture these cells, creating a new non-invasive test. Currently this test identifies cancer free high-risk individuals in the community with high accuracy. The next step is to conduct a large multi-centre clinical trial to determine the sensitivity and specificity of the test.

Apart from detecting human papilloma virus, how else can saliva tests help tackle head and neck cancers? 

We have discovered a plethora of biomolecules (DNA methylation and miRNA) that are significantly elevated in saliva samples from head and neck patients compared to cancer-free controls. We are currently exploring the possibility of using these biomarkers to detect these cancers early. In addition, we have also shown significant changes in microbiome profiles in saliva samples from head and neck patients compared to cancer free individuals, indicating the role bacteria plays in our mouth.

We are also developing a blood-based assay to detect cancer spread early as well as to determine how well a patient will respond to treatment. As a result, we will be able to predict patients who are likely to relapse at an earlier stage than currently possible.

What’s something fascinating about saliva? Have we previously underestimated its usefulness in screening and diagnostics?

A person produces 1 to 1.5 litres of saliva a day, the equivalent of two to three Olympic-sized swimming pools during their lifetime. Saliva is emerging as an alternative diagnostic fluid since the invention of sensitive technologies. It is easy to sample, multiple samples can be collected by an individual, and it can be used in the comfort of their own home making it ideal for rural and remote settings.

What aspect of this research excites you the most?

I have a personal reason for developing better diagnostics in this space as my brother-in-law passed away within 6 months of being diagnosed at the age of 38 years. For the first time, we will be able to detect head and neck cancer early, which leads to 80% survival compared to late diagnosis, which has a 20% survival rate over five years.

How long before your work might impact patient care?

I am in the process of talking with clinicians Professor Liz Kenny and Associate Professor Brett Hughes from the Royal Brisbane and Women’s Hospital to find a way to implement this assay. But we need to show the validity of the assay before that. Once the clinical trial has been completed, it will be able to be used by the wider community.

What’s your Holy Grail – the one thing you’d like to achieve in your research career?

50% of patients with oral cancer die within five years. 30-50% of oropharyngeal cancer patients develop recurrences within two years of diagnosis. I want to use saliva to identify early head and neck cancer, and tailor targeted therapy to create better patient outcomes and improved survival rates.

What is your biggest research hurdle?

Head and neck cancer is the 7th most common cancer in the world. Sadly, in Australia, HPV-positive head and neck cancer is increasing. In Australia, 1,500 deaths every year from head and neck cancer and 500 deaths are caused by HPV. The majority of cancer funding goes to more common cancers such as breast, prostate and lung. We require funding to accelerate our vital research.

Who has inspired you in work or life?

My mother is my role model in work and life. As a woman of colour from a culturally and linguistically diverse background, I have overcome multiple hurdles in my academic career. Knowing the difficulties, I am a huge supporter of women in STEMM with a special interest in diversity and inclusion. My academic role model is two times Nobel Prize winner Marie Curie as she worked under appalling conditions during a time when science had no respect for women. Growing up in South Africa under Apartheid when discrimination by colour was the norm, my third inspiration is Nelson Mandela who united all Africans together.

‘There’s an app for that.’ What’s new on your phone?

LinkedIn is my favourite app. I use it to talk about my research and connect with other researchers.

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