Oral Sex Linked to Rise in Oral Cancers

Tuesday, April 23, 2013 - 12:39pm

What does your sex life have to do with your cancer risk? More than you might realize. This month, recognized as Oral Cancer Awareness Month, take a few minutes to understand how your sex life may affect your risk of oral cancer.

Although tobacco use and heavy drinking are the main risk factors for oral cancer, in recent years a growing number of cases have been linked to infection with the Human Papilloma Virus (HPV).  HPV is one of the most common sexually transmitted diseases in the United States; it’s estimated that most Americans will be infected at some point during their lives. Because it usually causes no symptoms, those who are infected may not know they have the virus.

How do you get HPV?

HPV is passed on during sexual activity, through skin-to-skin contact involving the mouth, vagina, vulva (the external female genitalia), penis, anus, or fingers. When it’s transmitted during oral sex, it can lead to cancers in the oral cavity (inside the mouth) or the oropharynx, which includes the base of the tongue, the soft area just behind the roof of the mouth, and the tonsils. Your odds of getting HPV are higher if you smoke, most likely due to the effects of smoking on the immune system.

“About 70 to 80 percent of adults in the U.S. population show evidence of current or prior HPV infection,” notes Martin C. Mahoney, M.D., Ph.D., Chair of Roswell Park’s Cancer Prevention & Detection Center.

How many people develop oral cancer as a result of HPV?

The number of HPV-linked cancers of the oropharynx has tripled over the past 20 years. The Centers for Disease Control and Prevention (CDC) reports that about 9,356 men and 2,370 women are diagnosed with HPV-linked oropharyngeal cancers every year. Those totals are expected to double over the next 10 years. The CDC notes that those statistics are just part of the picture: “These numbers are based on cancers in specific areas of the oropharynx and do not include cancers in all areas of the head and neck or oral cavity.”

Oral cancers are caused by specific types of HPV

There are more than 150 types of HPV, each identified by a number, and most do not cause cancer. But about 12 types can cause cancer. One of those, HPV 16 is responsible for almost all cases of cervical cancer and many cases of anal and genital cancer. HPV 16 can also lead to squamous cell oral cancer.

In most cases, the HPV virus clears up on its own, the same way in which a common cold goes away. But in some people, HPV infection can hang on for years, thriving in the warm, moist mucosal tissues found in such places as the genital areas and the mouth and throat. If it doesn’t clear up on its own, the virus “can change the normal cells and cause dysplasia, or pre-cancer,” explains Peter Frederick, M.D., Director of Minimally Invasive Surgery and Assistant Professor of Gynecologic Oncology at Roswell Park Cancer Institute. “Over time, that dysplasia can change into cancer.”

The period from infection to the development of cancer can take as long as 30 to 40 years. Most people develop oral cancer after age 50.

Who’s at greatest risk?

  • Men are six to seven times more likely than women to develop HPV-linked oral cancers.
  • Risk increases significantly among those who have engaged in oral sex with six or more partners.
  • Even if you have had sex with only one partner, if that person was infected during sex or oral sex with other people, you can acquire HPV (and other sexually transmitted diseases).

Early detection is important

When oral cancer is detected early, the chance of a cure is very good. When it has spread, or metastasized, it is more difficult to treat. If you have any symptoms of oral cancer that do not go away after two weeks, see your doctor promptly.

Symptoms of oral cancer           

Symptoms of oral cancer can vary, depending on where the cancer is located. It’s important to remember that these symptoms do not necessarily mean you have cancer; they can be due to other medical conditions. See your doctor if you have:

  • A mouth sore that bleeds or doesn’t heal
  • Red or white patches inside your mouth or the back of your throat
  • A lump or swelling in the mouth or neck
  • A sore throat, or hoarseness that won’t go away
  • Pain in your ears, neck, or throat
  • Trouble chewing or swallowing, or pain in the jaws/tongue
  • Loose teeth, or dentures that no longer fit well

What’s the best defense against oral cancer?

  • Tobacco use increases your risk of oral cancer. If you smoke or use chewing tobacco, quit now. Need help? The New York State Smokers’ Quitline has the tools you need, from nicotine-replacement patches or gum to coaching and other support.
  • Limit your alcohol consumption. Compared with nondrinkers, heavy drinkers have six times the risk of developing oral cancer. The CDC defines heavy drinking as more than two alcoholic beverages per day for a man or more than one for a woman.
  • Remember that your risk of developing HPV-related oral cancer increases if you engage in oral sex, especially if you have many partners.  You can decrease that risk by getting a vaccine that protects against specific types of HPV, but keep in mind that the vaccine does not protect someone who is already infected. It is effective mostly in people who are not yet sexually active.

    Two vaccines, Gardasil and Cervarix, can prevent four types of HPV, including HPV 16 and 18, the two types that cause most cases of cervical cancer.

    It is recommended that girls between the ages of nine and 26 receive either Gardasil or Cervarix, both of which are administered as three injections over a period of six months. Both protect against HPV-related cancer, and Gardasil also protects against the development of HPV-caused genital warts, which are not associated with cancer.

    In 2011, the CDC recommended that boys receive the Gardasil HPV vaccine to protect against HPV-related oral cancer and HPV-caused genital warts. Gardasil is approved for use in boys between ages nine and 26.

    Any man who has had sex with a man should also consider getting the Gardasil vaccine, which also protects against anal cancer. Anal cancer is also on the rise.

    Visit the CDC website to learn more about HPV vaccines.

  • Ask your dentist or dental hygienist to screen you for oral cancer during your regular dental exam.

If you think you are at high risk for oral cancer you may be eligible to participate in Roswell Park’s Early Oral Cancer Detection and Diagnosis Screening Program. For more information, call 716-845-5972.