Oral Sex and Throat Cancer

by Dr. Philip S. Chua.

Sept 3, 2010

The recent revelation of movie actor Michael Douglas that he has throat cancer put the spotlight on this dreaded malignancy. The rate of throat cancer in the United States has not declined, compared to most head and neck malignancies. I suspect that the statistics could also be true, when extrapolated, for other countries, like the Philippines, since most Filipinos are westernized in their lifestyle, habits and behaviors, etc.

The most logical explanation why cancer of the throat has not diminished has been attributed to the Human Papilloma virus (HPV), a bug that causes a sexually-transmitted disease. HPV is popularly known to cause genital warts and most cancer of the cervix (mouth of the womb). It has only been recently when scientists discovered and identified HPV transmission through oral sex as an etiology of throat cancer. M.D. Anderson Cancer Center in Houston reported that its research team found “the incidence of throat cancer (in the United States) to be stagnant and even rising in some populations, defying a downward trend in other head and neck cancers linked more closely with smoking.”

The American Cancer Society reports that the greatest risk factors in head and neck cancers are smoking and drinking alcoholic beverages, 90% of them either smokers or tobacco-chewers and about 80% of them also imbibed a lot of alcohol.

The good news is that a trend analysis in head and neck cancers in the United States shows a decline the past twenty years, trailing a decrease in smoking prevalence, which started in the 1970s, by 10 to 15 years. The bad news is that oropharyngeal cancers (which include the tonsils, base of the tongue and soft palate, and side and back of the throat) have been up in some population in the United States, and probably among people in other parts of the world who practice oral sex, where HPV takes its toll. “The findings underscore the importance of research aimed at determining if the newly available HPV vaccine is effective in males,” stated researcher Erich Sturgis, MD, MPH, to WebMD, as reported by Salynn Boyles.

Sample of the vaccine referred to is Gardasil, which is genetically engineered, and which blocks infection caused by two of the more than 100 types of Human Papilloma Virus (HPV), strains 16 and 18. These two sexuallytransmitted viruses are responsible for about 70% of cervical cancers. HPV, in one form or the other, afflicts about 20 million Americans. The other strains of the virus cause painful genital warts, and sometimes, cervical cancers too.

Let us momentarily discuss cervical cancer, since the HP virus is implicated in its causation in almost three quarters of this malignancy.

How prevalent is cervical cancer?

In the Philippines, there are about 5000 new cases of cervical cancer each year. However, more alarming than that is the fact that there are between 10,000 to 25,000 women walking around (not seen by physician) who have undiagnosed pre-invasive lesions in their cervix. If diagnosed early, these women could be saved. For every four survivors of breasts cancer, there are less than 3 women who survive cervical cancer, which shows how virulent cervical cancer is.

What causes cervical cancer?

Human Papilloma Virus (HPV, also known as genital herpes virus) accounts for most cervical cancers. At least 50% of sexually active men and women are infected with genital HPV, especially those with multiple partners. There are about 20 million American men and women infected with HPV, many linked with abnormal pap tests, genital warts and cervical cancer. It is estimated that at least 10,000 new cases of cervical cancers are discovered annually. Between half a million to a million Americans have genital warts, transmitted thru sexual contacts.

Is the cure for cervical cancer?

Better than the cure! A vaccine (Gardasil) that prevents cervical cancer, vulvar and vaginal cancer that was approved by the US-FDA in 2006 was found to be “effective 100%, in the short term, at blocking the cancer and lesions likely to turn to cancer” (like the pre-invasive lesions), according to Gardasil manufacturer, Merck & Co. “To have 100 percent efficacy is something that you have very rarely,” Dr. Eliav Barr, Merck’s head of clinical development for Gardasil, told The Associated Press. The UK’s version of the vaccine is known as Cervarix.

How early should the vaccine be given?

Students in grammar school, middle school and high school should be vaccinated before they become sexually active, because once they catch HPV infection, there is no cure; herpes is for life.

This was the recommendation of Dr. Gloria Bachmann, director of The Women’s Health Institute at Robert Wood Johnson Medical School in Brunswick, NJ., who said this vaccine is a “phenomenal breakthrough.” Prophylaxis Gardasil vaccination comprehensively eliminates HPV 16 and 18 associated non-invasive and invasive cervical cancer. The vaccine also cuts down infection with HPV 6 and 11, the causes of 90% of genital warts.

How about throat cancers?

Of the 45,000 head and neck cancers in the US each year, about 10,000 of them are oropharyngeal cancers, and tongue cancers among young adults have also increased. The evident conclusion is that the cause is the HP virus. “Over the last five years, 35% of the throat cancer patients treated at the M.D. Anderson Cancer Center had no history of smoking, and that close to 90% of patients who had never smoked showed evidence of oral infection with HPV,” says Dr. Sturgis on Web MD. The researchers felt that “vaccinating only females against HPV, which is currently the policy in the United States (for 11- to 12- year-old girls, and for women up to age 26 who have not received it), could result in a missed opportunity to prevent throat cancers.”

Currently, “the HPV vaccine is being offered to males in Australia, Mexico, and some other countries, but there is, as yet, no clinical proof that it works to prevent HPV infection in men”, according to Debbie Saslow, PhD, of the American Cancer Society. Studies on the vaccine among males are underway, aimed at an over-all protection of both populations. The use of cling plastic wrap used in kitchen placed over the woman’s groin has been advocated by some to prevent HPV transmission.

Mouth, tongue, and other throat cancers could be as grave and deadly as most other forms of cancers. I do not know how to put this more seriously, more effectively, and more delicately, but medically speaking, a moratorium on oral sex might be in order. #

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