Abstract: Oropharyngeal cancer (OPCa) caused by Human Papilloma Virus infection has risen steadily in the past two decades. It is primarily associated with sexual risk behavior, specifically oral sex in MSM. Oral cancers associated with HPV, when detected early by oral examination by medical and dental practitioners, can be successfully diagnosed and treated, with significantly increased survival. To improve screening and detection, we propose a 3-part study. First, to interview medical and dental teams, both private and in a Federally Qualified Health Center, with large GBM client bases in two large US metropolitan areas, to understand the screening and reasons for screening for oropharyngeal cancers and guidelines used. Second, we will survey 1500 GBM in the US to determine knowledge and beliefs about OPCa, HPV vaccination knowledge and uptake, experiences with providers and screening, and willingness to engage in screening. Finally, given the potential visibility of OPCa tumors to oral visual examination, we will assess the feasibility of a remote patient monitoring telecommunications-based intervention. We will ask GBM to take oral “selfies” with a cell phone, of sufficient clarity in regard to standard oral landmarks, and to send these photos to a central site where assessment can be made by an OPCa specialist clinician. The interview and survey data, and the feasibility results will be used to inform increased screening guidelines and education for both GBM and the practitioners who treat them, and to develop programs for increased awareness and screening in GBM. The acceptability, feasibility and preliminary efficacy data will assess whether self-examination and oral “selfies” are realistic and have the necessary clarity to form the basis of a telemedicine- based screening campaign for those at risk of developing OPCa, and its rigorous evaluation.

Lay Narrative: Cancer of the back of the mouth and throat caused by Human Papilloma Virus is significantly increasing in sexual minority men. We will investigate what medical and dental practitioners know and how they screen for this cancer, and what sexual minority men know about this cancer and the need to be screened and/or vaccinated to enable early detection and treatment. Finally, we will determine if sexual minority men can take oral “selfies” in sufficient detail to enable detection from a photo by a specialist who received the emailed photo.