Oral sex and throat cancer
posted in - Medical Updates, - Palmdoc |Some bad news about oral sex – it’s linked to throat cancer. NewScientist reports:
People who have had more than five oral-sex partners in their lifetime are 250% more likely to have throat cancer than those who do not have oral sex, a new study suggests.
The researchers believe this is because oral sex may transmit human papillomavirus (HPV), the virus implicated in the majority of cervical cancers.
The new findings should encourage people to consistently use condoms during oral sex as this could protect against HPV, the team says. Other experts say that the results provide more reason for men to receive the new HPV vaccine.
Oral sex AFAIK is not illegal in Malaysia (can anyone confirm?). You may be surprised though it is illegal in Singapore though there were moves to decriminalise it sometime back.
Oral sex is sex. It should be practiced safely. If one cannot be monogamous, use a condom.
Ref:
Case–Control Study of Human Papillomavirus and Oropharyngeal Cancer NEJM May 10, 2007 (free full text)
Human Papillomaviruses in Head and Neck Carcinomas (accompanying NEJM Editorial, free full text)
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May 10th, 2007 at 9:44 pm
I thought this is nothing new. Since we already know that HPV is the causative agent to cervical cancer and is associated with the sexual activity, you don’t need to be an expert to know that oral sex will increase the risk of throat cancer. It will increase the risk of anal canal cancer as well if anal sex is practiced!
May 10th, 2007 at 9:53 pm
Well to “know this” requires evidence. But the scenario is certainly much more complex in head and neck cancer due to other etiologies and the NEJM editorial is worth reading.
May 10th, 2007 at 10:00 pm
Well, sometime we don’t need to wait for ‘evidence’ to practice precaution. WHile we can do PAP smear to screen precancerous changes of cervix but there is none for oral cavity or anal canal. Common sense and logical thinking will tell us that oral sex would not be safe especially with multiple sexual partners.
May 10th, 2007 at 10:07 pm
Absolutely. Unprotected oral sex with multiple partners would be like playing russian roulette with your life. And oral cancer would be the least of your worries.
May 11th, 2007 at 5:43 am
I just attended a Head & Neck Education Day recently and one local collegue tried to identify HPV in resected oropharyngeal cancer using the in situ hybridization technique. I cannot remember whether he looked at 20 or 40 tumours but he only found one tumour with HPV. This John Hopkin’s paper claimed that HPV were found in 70% of their tumours, that’s very high. I believe HPV has an aetiological role, but I am not sure it’s that prevalent among oropharyngeal cancer patients.
But the evidence of sexual practice causing oropharyngeal cancer is weak from this paper. It’s a case-control snap shot study and this always carries limitations.
If you read carefully, multivariate analysis did not show significant link among positive HPV serology, sexual practice and oropharyngeal cancer. Although there was difference for the lesser sexual partner comparisons, the odd ratio was really only impressive if one has 5 oral sex partners or 26 vaginal sex partners. Such epidemiological finding is perhaps still irrelevant to majority of Malaysian population.
For the Malaysian population, the big risk factors are still going to be the big tobacco, alcohol and the betel nuts.
May 11th, 2007 at 6:28 am
I forgot to say I am glad that you blogged about this topic. HPV is receiving a lot of research attention in H&N cancer at the moment and yes, people are talking about vaccination in the meetings, but they need more evidence.
May 11th, 2007 at 6:51 am
The mention of betelnut chewing and oral cancer brings back fond memories of a late great pathology teacher, Professor Prathap. I still can hear his words echo “It’s not the betelnut which causes the cancer but the lime (kapur)”…..
May 11th, 2007 at 7:33 am
Cancers caused by smoking, HPV and ‘kapur’
maybe three different entities, even though they are all squamous cell carcinoma. It will be very interesting to study if they behave differently clinically.
The other interesting point about HPV is the benign papilloma. We don’t follow up oral papilloma for a very long period at the moment. If completely excised, I then to discharge them very soon. Am I doing the right thing? The model of hyperplasia, dysplasia, papilloma and carcinoma is not established in H&N yet, but surely all carcinoma arise from steps of changes.
Most laryngeal papilloma are seen in the paediatric population, acquired from mother’s genital tract. Majority of them do not progress to carcinoma. (The odd ones that progress to carcinoma are those that descend into the lungs and cause pulmonary papilloma, which is a nightmare condition to treat.) So there is still a lot of work needed to establish the role of HPV in H&N oncogenesis.