Oral Sex Turns Deadly

By Edward C. Geehr, M.D., Lifescript Chief Medical Officer

Despite a decline in most head and neck cancers during the past decade, the incidence of a particular form of throat cancer is rising steeply, according to a recent report in the British Medical Journal. 

The greatest concern? The type of cancer identified is related to the human papilloma virus (HPV). Researchers say that sexual transmission of HPV may explain the rise in cases. If that’s true, then add throat cancer – in addition to cervical cancer – as a potentially deadly consequence of HPV infection.
Head and neck cancer is widespread around the world. There are about 640,000 new cases each year. The particular cancer of concern is esophageal squamous cell cancer, which is increasing only in the developed world. In the U.S., cases increased by 22% between 1999 and 2006 after being stagnant for the previous two decades. The United Kingdom has recorded a dramatic 51% increase in oro-pharyngeal cancer between 1989 and 2006. Much of it is attributed to a rise in HPV-related cancers.

Evidence for the HPV link can be found in biopsy studies of oro-pharyngeal cancers. HPV has been detected in 60%-80% of recent biopsy samples in a U.S. study compared with 40% in the previous decade. A Swedish study found a 70% rise in the detection of HPV biopsies since the 1970s.

The emergence of HPV-related oro-pharyngeal cancer is a relatively new phenomenon. Fortunately, it carries a better prognosis than non-HPV cancers, especially in non-smokers. It’s not understood why this cancer has improved survival.

Other studies have established that the risk of developing throat cancer is directly tied to the level of sexual activity. For example, the risk is increased in those with a history of six or more lifetime sexual partners, four or more lifetime oral sex partners, and for men, an earlier start of sexual intercourse.

The findings are likely to contribute to the debate over offering HPV vaccines to young men and boys. Two vaccines are currently available and approved for young women before they become sexually active – Cervarix and Gardsil, which can prevent HPV infection. Studies will now be needed to assess the cost-effectiveness of offering vaccines to boys.

HPV is the most common sexually transmitted disease, affecting more than 20 million people each year. More than 100 strains of HPV are known to exist, 30-40 of which are sexually transmitted. Virtually any skin to skin contact, oral, genital or anal can transmit the virus. Unless they develop skin or genital lesions, most infected individuals don’t know that they’re infected with the virus.

The virus is usually cleared by the immune system within 12-18 months and causes no further harm. But certain high-risk strains may not clear and cause precancerous lesions on the cervix. A Pap smear can detect these changes and can lead to early and effective treatment. The potential link to oral and throat cancers raises the issue of what kind of screening and immunizations programs are appropriate to prevent this latest form of the HPV scourge.


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