Michael Douglas made headlines when he revealed that his throat cancer was caused by the human papillomavirus (HPV), which he felt he contracted due to his practice of cunnilingus. After some bad publicity, his publicist called his statement a misunderstanding. But regardless of the cause of Mr. Douglas’ cancer, the link between oral sex, HPV, and oropharyngeal cancers has been receiving more attention in recent years.

The link between HPV and oral cancers wasn’t even on a physician’s radar 5 years ago. The HPV 16 and HPV 18 strains were recognized for causing almost 70% of cervical cancers and, until recently, oropharyngeal cancers were believed to be caused almost exclusively by smoking cigarettes, chewing tobacco, and/or heavy alcohol consumption. It is now confirmed that HPV can also lead to oral cancers. In fact, throat cancer contracted via smoking and/or drinking is now thought of as a separate disease from throat cancer contracted via HVP.

Symptoms of oral and throat cancer include mouth sores that don’t heal over a period of time, hoarseness, a lump in the neck, consistent sore throat, pain when chewing or swallowing, or having difficulty swallowing.

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To put it in perspective, oral cancers are uncommon. They’re the 14th most-common type of cancer diagnosed in women and the 8th most-common cancer that affects men. Researchers have identified no fewer than 120 strains of HPV, 40 of which are spread through sexual contact and 15 of which are known to cause cancer. Many HPV strains have no symptoms. HPV primarily causes cancer of the tonsils, the tonsillar pillars, the back regions of the throat or mouth, and the base of the tongue, whereas non–HPV-positive cancers tend to develop inside the cheeks, or on the floor of the mouth, the ridge around the teeth, or the front of the tongue. HPV can also cause genital warts; if undetected and untreated, it can lead to cancer of the anus, cervix, penis, vagina, or vulva, or cancers of the head and neck.

HPV can be spread through either genital or oral contact, regardless of whether the sexual contact is heterosexual or homosexual. The Centers for Disease Control and Prevention (CDC) reports that approximately 60% of oropharyngeal cancers are related to HPV. The CDC estimates that, in the US, more than 1700 women each year are diagnosed with HPV-related oropharyngeal cancers; for men, the estimate is higher: over 6700 males contract oropharyngeal cancer via HPV annually. The majority of men who contract oral cancer are middle-aged Caucasians.

The CDC also reports that about 79 million Americans are currently infected with the virus. At the present time, it’s not known why more men than woman contract HVP or why only a small percentage of people who have HVP will develop oral cancers. However, it is known that tobacco use and alcohol consumption increase the risk of contracting HVP.

Risk of Contracting HPV

Certain lifestyle choices increase one’s risk. Smokers are 3 times more likely to contract HPV. And compared with those who have never had oral sex:

  • People who have had 1 to 5 oral sex partners are 2 times more likely to contract HPV
  • People who have had 6 or more oral sex partners are 8.6 times more likely to contract HPV

Risk of Contracting Cancer Caused by HVP

In general, oral cancers are twice as common in men compared with women. However, HPV-related cancers are 6 to 7 times more common in men than in women. A clinical study found that people with 6 or more oral sex partners had a 3.4 times higher risk of developing throat cancer; the same study showed that people with 26 or more vaginal sex partners were 3.1 times more likely to develop throat cancer. However, HPV-positive throat cancer has also been identified in individuals who report few or no sexual partners.

Rare but on the Rise

Although uncommon, HPV-positive oral cancers are on the rise. In 2011, Dr. Maura Gillison headed a study that analyzed the proportion of cancers of the head, throat, and neck associated with HPV. The study found that between 1984 and 2004, the incidence of these oropharynx cancers rose from 16% to 72%. Dr. Gillison notes, “The incidence is rising pretty rapidly in the US…by approximately 10% per year, particularly among Caucasian middle-age men.” Another study showed that over the past 10 years, HPV infections that caused tonsillar cancer and cancer at the base of the tongue increased 4 to 5 times, particularly among young men. What’s more, data presented by the American Association for the Advancement of Science suggest that HPV is surpassing tobacco as the leading cause of oral cancers in Americans under the age of 50.

Spread through skin-to-skin contact, HVP is, in fact, the most common sexually transmitted infection. The CDC website reports that “HPV is so common that nearly all sexually active men and women will get at least one type of HPV at some point in their lives.” Yet few people will even know they have the disease because HVP is typically asymptomatic.

The Good News

In about 90% of cases, the immune system will clear up an HPV infection within 1 or 2 years. Regardless of whether the strain causes warts or cancer, the virus tends to disappear without leading to any health problems. At the present time, there’s just no way of knowing which people infected with HPV will develop cancer. People who do develop oral cancers have an 85% to 90% survival rate, when the cancer is detected in its early stages. In addition, tumors in people with HPV-positive cancers cause less genetic damage to the body, which may be why they are more responsive to cancer therapies than oral cancers associated with smoking or chewing tobacco. Still, about 8000 people in America succumb to oral cancers each year.

Treatment

Oral or throat cancer linked to HPV can be treated with conventional radiation therapy or chemotherapy, or a combination of the two. Surgery is also an option; specialized facilities across the nation now use a new type of robotic surgery that is minimally invasive and reduces scarring and side effects. Unfortunately, at the current time, there is no method to screen for oral HPV.

HPV vaccines are available that can help prevent the most common types of HVP. Both the CDC and the American Academy of Pediatrics recommend routine vaccination for boys and girls at around 11 or 12 years of age. Physicians believe the vaccine should be administered before boys or girls are sexually active.

Reference

  1. Can I get cancer from oral sex? Mount Sinai Hospital website. 2011. http://www.mountsinai.org/patient-care/service-areas/ent/areas-of-care/head-and-neck-cancer/oral-cancer/hpv/infographics/hpv-oral-sex-cancer.
  2. Joannides P. Oral cancer and oral sex. Psychology Today website. June 7, 2013. http://www.psychologytoday.com/blog/you-it/201306/oral-cancer-and-oral-sex.
  3. Nordqvist C. Can oral sex cause throat cancer? Medical News Today website. June 4, 2013.  http://www.medicalnewstoday.com/articles/261453.php.
  4. Sifferlin A. It’s true. You can get throat cancer from oral sex. Time website. June 3, 2013. http://healthland.time.com/2013/06/03/its-true-you-can-get-throat-cancer-from-oral-sex/.
  5. Wilson J. Yes, oral sex can lead to cancer. CNN website. June 4, 2013. http://www.cnn.com/2013/06/03/health/hpv-oral-cancer-explainer/.