The free love era of the 1960s and the anything-goes 1970s could — could being the operative word — explain the recent rise in oropharyngeal cancers that are caused by the human papillomavirus (HPV).
According to the National Cancer Institute, the prevalence of HPV in oropharyngeal cancers increased by 225 percent from 1988 to 2004 while non-HPV throat cancers (the kind caused by smoking) declined by 50 percent due to a drop in smoking rates. Two types of the HPV virus —16 and 18 — account for 70 percent of all cases of oral cancer. And if you get an HPV infection, you increase the risk of other factors contributing to cancer, such as smoking and a weakened immune system.
Most of the HPV cases affect men in their 40s and 50s. Changing sexual behaviors over the last 30 to 50 years, such as an increase in oral sex participation, could explain risk factors such as a high number of sexual partners (a 25 percent greater chance of developing oral cancer if you have had six or more partners) and a history of oral-genital sex (125 percent greater with more than four partners.)
While both men and women can contract oral HPV, it is three times more common in men, putting them at higher risk of developing oropharyngeal cancers. The virus is thought to cause the majority of cervical cancers, and if a woman has HPV and her partner engages with her in cunnilingus, it is thought to be a risk for infection.
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“We know HPV causes cancer of the cervix. The papillomavirus causes genital warts and on the tonsils and soft palette and can be transmitted from a woman’s genitals to a man’s throat. The same viral DNA is found in these cancers so that has led to the assumption that there’s a relation there. But it’s a hard thing to prove with absolute certainty, but it appears this is somehow related,” said Dr. Francisco Civantos, professor of Otolaryngology — Head and Neck Surgery at the University of Miami Miller School of Medicine.
He does not know the statistics regarding same-sex partners contracting HPV. “This disease is not associated with homosexuality. Homosexuals can get it, but it doesn’t appear increased in homosexuals.”
There are about 3.2 HPV cases per 100,000 males annually, according to a 2010 NCI report. “We are living through an HPV epidemic,” opined Dr. Dennis Kraus, director of the Center for Head and Neck Oncology at North Shore-LIJ Cancer Institute in New York, in a 2013 HealthDay News report. “We used to think of throat and neck cancer as a disease of smokers and drinkers, but the demographics have changed and it’s increasingly becoming a sexually contracted disease.”
The most commonly affected areas are the base of the tongue, the tonsil region, the soft palate, which includes the uvula and the pharyngeal walls. Symptoms can include pain, difficulty in swallowing, one tonsil that is larger than another, weight loss and a mass in the neck.
Tonsil cancer has increased by 4 percent every year over the last 30 years. Tongue base cancer has increased by 2 percent over the same period.
Some women have scoffed that since the science is not definitive, with some studies offering contradictory results, the topic “is just something men created to get out of an act they don’t want to do.”
Civantos chuckles at the comment. But he agrees that since the jury is still out on whether cunnilingus can definitely cause cancer the message isn’t a call for abstinence.
“We’re not saying have oral sex today and have cancer next week. These are people in their 40s and 50s who were very active in their 20s. This is proposed. I think it’s likely, but it’s not 100 percent proven that that theory is true,” he said. “The timing, and how to avoid it, we can’t say a lot. But clearly monogamy increases safety. And we can vaccinate our children for the papillomavirus, which will highly reduce this disease.”
A face to the disease
The cunnilingus-cancer link gained national attention in 2013 when actor Michael Douglas, who drank and smoked and was diagnosed with Stage 4 throat cancer in 2010, told the British newspaper The Guardian: “Without wanting to get too specific, this particular cancer is caused by HPV, which actually comes about from cunnilingus.”
But his comments were quickly retracted by his representative, who told USA Today, “Michael Douglas did not say cunnilingus was the cause of his cancer. It was discussed that oral sex is a suspected cause of certain oral cancers as doctors in the article point out, but he did not say it was the specific cause of his personal cancer.”
Douglas, 68 when he gave the Guardian interview, was reported to be free of cancer two years after receiving chemotherapy.
At the same time, Michel Apollon, 53, a pharmaceutical sales rep based in Port-au-Prince, sought Civantos’ help in Miami to treat a mass in his throat that turned out to be HPV-related.
“I had a bump in my throat very close to my tonsils,” he said. “I kept playing with it with Q-tips and I never had any pain. Nothing at all. One day I got caught by my wife — and you know women are tough.
“She told me, ‘Once and for all, listen. I’ve been watching you playing with something in your throat. You’re playing with fire. My recommendation is to go to the doctor and get a diagnosis of what is going on in your throat.’”
Apollon, a father of two and 51 at the time, listened.
First, Apollon saw a doctor in Haiti. Later, he saw a specialist at Baptist Hospital in Miami, who biopsied the mass. He was watching a soccer game broadcast on Lincoln Road Mall with his wife when his cellphone buzzed. The doctor informed him the mass on his tonsil was cancerous. More tests were needed to determine if HPV was the cause. He ultimately was referred to Civantos, who performed surgery to remove the mass.
Apollon did not require chemotherapy or radiation and, after about 12 hours of surgery, was back to normal within two weeks. He now visits Civantos every four months for checkups. Once a social smoker, he quit 35 years ago, he said. He’s not sure how he contracted HPV. “I never tried to find out, either.”
“These tumors are curable in most cases if detected relatively early, and the cure rates are quoted around 80 percent — even for advanced stages,” Civantos said. “Patients who test for HPV in their tumor have a better prognosis than other kinds of throat cancer, which are smoking related. The cure rates are higher, 80 percent versus 50 percent.”
Also encouraging: the use of robotic surgery with the surgical DaVinci robot. The procedure can remove the tumor with less invasion, quicker recovery and, for some patients like Apollon, they might not require chemo or radiation, which can cause dryness of the throat.
Said Civantos: “The most important thing from our point of view is that minimally invasive surgery is now available to reduce the side effects.”
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