Oral Sex Can Lead to Cancer-Causing HPV in Mouth
Major, major ladies - take care of yourselves, HPV is finding its way into your mouths.
Health Risks of Oral Sex
Long known to cause cervical cancer, the pervasive but often silent human papillomavirus (HPV) has been finding its way into women's mouths
By Alyssa Giacobbe
Mische Eddins, 37, awoke with a head cold. Or what seemed like one anyway. Postnasal drip. Sore throat. Swollen lymph nodes. No biggie—it was the fall of 2007, and a seasonal bug was winding its way through Seattle. "I had just been bragging to my friends about how I'd managed to avoid getting sick," she says. "But I was healthy, so it all passed quickly." Everything, that is, except a swollen node on the left side of her neck, which, months later, hadn't gone away.
Christmastime came, and the little bump was still there. Sans appointment, Mische walked into her doctor's office and left with a script for antibiotics. No improvement. She then bounced from M.D. to M.D., and finally, six months after that seemingly innocuous head cold, she had a PET/CT scan. The results were a total shock: Mische had stage III oral cancer, and the disease had spread from her tonsil to her lymph nodes.
Within hours, her docs had scheduled a tonsillectomy and were talking about chemo and radiation. Someone suggested she prepare a will. "I was floored," she says. "A will?" A professional singer, Mische exercised almost every day, ate a mostly organic diet, didn't booze heavily, and never smoked as an adult. Even her doctors were stymied.
Searching for answers, one physician tested Mische's cancer cells for human papillomavirus (HPV), the sexually transmitted infection notoriously linked to cervical cancer. Mische was taken aback; she'd spent the past 16 years in two monogamous relationships and was fastidious about getting annual Pap smears, which had never been abnormal. Why were they now testing her mouth? Her doctors
explained the worrisome new link between oral cancer and HPV, which can be transmitted to the mouth through oral sex. And indeed, she tested positive. Her oral cancer was HPV-related.
Ten years ago, oral cancer among women was practically unheard of. Patients were nearly always male and over 50, heavy smokers or drinkers, or both. (When actor Michael Douglas, 66, was diagnosed with the illness this past summer, the media pointed to his longtime half-a-pack-a-day habit.) But according to the Journal of Clinical Oncology, there has been a major upswing in HPV-related oropharyngeal cancer, a deadly disease often found in the base of the tongue and the tonsils. In fact, roughly a quarter of all oral cancers are now HPV-related, according to the American Cancer Society, and approximately 25 percent of cases occur in women—some as young as 19, says Gregory Masters, M.D., an oncologist at the Helen F. Graham Cancer Center in Newark, Delaware.
But how could HPV, a "down there" disease, be causing so many mouth problems? It's something the best doctors and public-health experts out there have long feared, thanks to the rampant spread of the virus. You've likely heard the daunting stats: Approximately 20 million Americans currently have HPV, with 6 million new infections discovered each year through Pap or cervical swab tests, according to the Centers for Disease Control and Prevention. What's more, the virus—which can have zero symptoms or bloom into a series of visible warts—will affect up to 80 percent of sexually active women at some point in their lives.
In the vast majority of cases, the body's immune system will clear HPV on its own within two years (there is some debate over whether the same HPV infection can ever return to cause cervical lesions later, but research is still in early stages). However, a small percentage of infected women—around 11,000 per year—will not clear HPV and may develop cervical cancer. This has prompted the federal government to recommend, somewhat controversially, that all girls be vaccinated for HPV by age 12.
To date, safe-sex campaigns have typically blamed the spread of HPV on unprotected vaginal intercourse. But it's now clear that the disease can be contracted orally too. And that's where things got dangerous for Mische Eddins and thousands of other women. Their mouths were infected with HPV-16, the particular type that most doctors believe is responsible for the majority of cases of HPV-related oral cancer.
Just how long HPV-16 lingers in the mouth before turning into cancer is uncertain. But what is evident is that more than 14 percent of cases aren't caught until very late stages, possibly because some physicians are slow to consider the cancer in young female patients. "Since HPV-related oral cancers don't affect the traditional group of those at risk for mouth cancer, a lot of these cases are missed or diagnosed late," affirms Eric J. Moore, M.D., an otolaryngologist at the Mayo Clinic in Rochester, Minnesota. "Usually, the patient is healthy, exercises regularly, and eats right. She doesn't fit the profile."
LINK TO ARTICLE: http://www.womenshealthmag.com/health/hpv-facts
Thanks to Samantha Harris for sending this my way.
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@Brian Hill
"The one thing that you do have control over is getting screened. It has brought cervical cancer , caused by the same virus, down from its high ranking as a killer, and it can do the same thing in oral cancers, if both the public and professionals become aware and engaged in OPPORTUNISTIC screening like we have done for cervical."
If only it were this easy. In my experience, the medical community at large is extremely uneducated on this topic. Some of the ENTs I have visited have gone so far as to say that they feel the importance of HPV may be overblown because they have heard that it may even be "spread through the air" and thus ubiquitous.
And what about the HPV screening that is so common for females? This simple testing would be sufficient to give someone who has been experiencing oral concerns and symptoms a path to the possible cause of the issue and thus, a hopefully early diagnosis. The problem is that unlike women, there is no standardized easily obtainable HPV test for men. I know this because when an ENT finally did send me for HPV screening with LabCorp and Quest Diagnostics, they both refused to do HPV serotype testing on males.
So I am left with pain, hoarseness, the occasional taste of blood, and even a small exophytic lesion on my right tonsillar pillar for the better part of 3 years (that lesion at least 1 year) and at least 4 ENTs now with no quantifiable diagnosis of any type. Even my tonsils were removed. I had a CT Scan recently, but found out via your site that CT can not detect these malignancies in their early stages. I have had many scopes of my throat, videostroboscopy, and even an esophageal endoscopy. All of this and the one test I can not obtain at any cost, is a simple blood test to determine the presence of HPV16 or 18 that might lead to sufficient evidence for a biopsy.
All of this leads me to believe that we are FAR from anything remotely approaching awareness of this issue. The public is encouraged to do everything possible to detect every other type of cancer as early as possible, yet with this type of cancer, it almost seems as if one fights an uphill battle against tons of misinformation and just plain incorrect facts, which is terribly frustrating.
As someone who is a survivor of a stage four HPV16+ oral cancer , and now a patient advocate in this arena, I am please to see that more people are spreading the word about this issue. This emphasizes the need for an annual oral cancer screening just like others cancer screenings that we routinely engage in.
It should be noted that there are about 130 versions of HPV, and only one, #16, is associated with these posterior of the mouth oral cancers. So when statistics are used to talk about the virus, they as in this article, do not reflect how many people get one of the 9 known cancer causing versions (another 6 are suspected) but how many get HPV in general. Most versions of HPV do nothing that we are aware of, others cause benign warts, and then there are the oncogenic ones. So when the CDC says that 80% of the US population is going to have some version of HPV in their lifetimes... you get a sense of how ubiquitous this virus is, some version of it is going to cross your path, and that is highly likely. But the more important issue is how many people will not only get HPV16 specifically, (we don't know) and how many people have an immune system that will not clear it. (We do not know specifically, but can guess based on the incidence rate of HPV16 caused cancers.)
The vast majority of people that get it (HPV16), 99% or more will have an immune system that clears it in a few months and that will be that. Some people like me, their immune system will not recognize it as a threat and it will persist. This is the important issue. Persistence. This allows it to alter cells and turn them malignant over time. Right now we cannot sift out of 300 million plus people in the US, who these people will be. Hence the need for an annual screening. To put this in perspective out of about 36,000 people that will get oral cancer this year, it is likely that the new statistics (not the historic tobacco carcinogenesis numbers) will be about 50% viral caused, or 18,000 people.
So awareness of all this is important. Engaging in protection during sex helps but is not a sure thing. Limiting your number of sexual partners limits exposure statistically, but again is not any kind of absolute means of avoidance. The one thing that you do have control over is getting screened. It has brought cervical cancer, caused by the same virus, down from its high ranking as a killer, and it can do the same thing in oral cancers, if both the public and professionals become aware and engaged in OPPORTUNISTIC screening like we have done for cervical. More information on all this in detail can be found on the Oral Cancer Foundation's website, http://www.oralcancer.org OCF is a registered non-profit charity with nothing to sell and no agenda other than bringing this disease down.
I would like to add that for those of us that are adults, the current vaccine to protect our children from HPV16 and 18, does not work once you have been exposed, and while not tested in oral cancers for its FDA approval, the science community at large believes it is an opportunity to protect people from persistent HPV infections and the other cancers besides cervical that they causes. Those would be oral, anal, penis, vulvar, and of course cervical.