Monday, October 25, 2010

Oral Sex Linked to Rise in Men's Throat Cancer

Studies Show Epidemic That Could Be Stemmed by Cervical Cancer Vaccine Gardasil

 
By SUSAN DONALDSON JAMES

Oct. 20, 2010
ABC News HERE...

For years now, doctors have urged young women to be vaccinated against the human papilloma virus (HPV), which is believed to cause cervical cancer.

But now, growing research in Europe and the United States is implicating HPV in a rising number of cases of head and neck cancers in men, and many doctors are recommending that all boys be vaccinated as well.
Doctors say that changing sexual behaviors -- earlier sex, more partners and especially oral sex -- are contributing to a new epidemic of orpharyngeal squamous cell cancers, those of the throat, tonsils and base of the tongue.

These cancers can be deadly, and are striking men at a younger age and in increasing numbers.
"There's a lag in information," said Dr. John Deeken, a medical oncologist at Georgetown University. "We physicians have done a poor job of advertising the fact that boys and girls should have the vaccine."

"This kind of cancer traditionally affects males who have been smoking and drinking all their life, and now in their mid-60s they are getting head and neck cancer," he said. "However, HPV cancer we are seeing in younger patients who have never smoked."

Two decades ago, about 20 percent of all oral cancers were HPV-related, but today that number is more than 50 percent, according to studies published by the American Association for Cancer Research.

Similarly high rates have also been seen in Europe, where a new Swedish study has shown a strong correlation between oral cancers and oral sex. Oddly, the rising rates have not been seen yet in the Southern Hemisphere in Australia and New Zealand.

Each year, more than 30,000 new cases of cancer of the oral cavity and pharynx are diagnosed, and more than 8,000 people die from oral cancer, according to the Centers for Disease Control and Prevention (CDC).

Cure rates are higher than for smoking-related throat cancers, but still only 50 percent.
Today, men are more likely to get oral cancer than are women, but as the epidemic grows, that could soon change.

"We expect in head and neck cancers that 85 percent are men and 15 percent are women," said Deeken. "But over the coming years that could become equal."

"It's going to take a couple of decades to see the trend turning around," he said. "The epidemiological risk factors are past sexual partners as well as marijuana exposure, not just oral sex."

Human Papilloma Virus Affecting More Men


HPV is the most common sexually-transmitted infection. Those who are infected often have no symptoms and pass it on to their partners through genital contact during vaginal and anal sex. It can also be transmitted during oral sex and, more rarely, during deep kissing through saliva.

Research increasingly shows that Human Papilloma Virus (HPV), believed to cause cervical cancer in...

Research increasingly shows that Human Papilloma Virus (HPV), believed to cause cervical cancer in women, may also be causing head and neck cancers in men, perhaps because of an increase in oral sex. Women can be vaccinated against HPV. Many doctors are recommending that boys be vaccinated as well.

(Digital Vision/Getty Images)There are more than 100 strains of the virus. Some cause genital warts, but others can result in cell changes that decades later can become cancerous. Each strain is identified by a number; oral and cervical cancers are caused by HPV sub-types 16 and 18.

HPV can also cause cancers of the vulva, vagina, penis and anus, and there is some evidence it is associated with esophageal and lung cancers.

The Food and Drug Administration (FDA) approved the use of Gardasil for girls in 2006 and for boys for treatment of genital and anal warts in 2009. The vaccine can be given at any age, though it is most effective given young people before any sexual exposure.

Doctors say it could prevent 10,000 more cases of oral cancer a year.

Several deaths associated with the vaccine led doctors to advise caution in the rush to promote widespread use of the vaccine, and doctors say there is a lack of public awareness of its role in preventing cancer.
"With any new vaccine, you have to err on the side of caution, but every year we know more about it," said Deeken. "But we have to ask the question: What do we do for the spouses and kids of our patients? I don't see any downside to vaccination at this time. My son and daughter will get it."

Because humans are the only reservoir for HPV, "it could be eliminated like smallpox," he said.
The research isn't new, but it has not received wide attention, perhaps because of taboos associated with oral sex.

Oral sex has become more commonplace; people have more sex partners and have sex earlier in life -- all behaviors linked to HPV-related oral cancers, according to a study in the Centers for Disease Control and Prevention's (CDC) Emerging Infectious Diseases report.

A study at the Swedish Karolinska Institutet showed the risk of developing oral HPV infection increased with a rise in lifetime oral or vaginal sex partners. It also cited "open mouth kissing."

The study included 542 American students, and noted similar increases in such cancers in Britain, Finland and The Netherlands.

But Dr. Kevin Cullen, director of University of Maryland's Marlene and Stewart Greenebaum Cancer Center, is not sure only oral sex is to blame.

"It's hard for me to believe sexual behaviors have changed that much in 15 to 20 years," he said. "It may be that as happens, epidemics get enough people infected and an infection begins to take off, and that may have happened with HPV at some point."

A study Cullen did last year found that HPV-related oral cancer in African Americans were less common than whites, perhaps because of negative cultural attitudes about oral sex.

"But it looks like blacks are beginning to catch up with whites," said Cullen.

Scientists also don't know why women tend to develop cervical cancer while men have more throat cancer. "Maybe women are better able to transmit to a man than a man to the oral mucosa of a woman," said Cullen.
Doctors also think that cancer is likely to develop in the first area of exposure ? in women, usually the vagina. The woman may then develop later immunity in the throat.

But with more oral sex, often before vaginal sex, female throat cancers could increase, they say.
Very little HPV was seen until the 1980s. "It was very rare in our archives," said Cullen. "But each year we looked, it was more prevalent. Why, no one is really sure."

And doctors say those numbers have not yet peaked.

"There is increasing evidence that boys as well as girls should be vaccinated," said Cullen. "Men and women are increasingly going to face the burden of cancer, and we have a tool to prevent it."

Why the medical community has not fully embraced vaccination is not clear.

"The lead time for development of oral cancer is in decades, so to do definitive studies would take decades to do," he said. "[The FDA] picked the simpler task of preventing HPV warts in the short time frame."

Resistance has also come from safety concerns, as well as the fear by some groups that vaccination for a sexually transmitted disease will promote sexual behavior.

Cervical cancer just may just be "sexier" than throat cancer, said Dr. Ranit Mishori, a family physician in the Georgetown University School of Medicine.

"We don't think about oral cancer except in smokers," she said. "There is no question HPV is the cause of most oral cancers, but it's partly an awareness issue relating to our kids' sex life, and who wants to talk about oral sex?"

Convincing parents to vaccinate their sons as well as their daughters is a "hard sell," said Mishori.
"Oftentimes it's the moms who take the kids to the doctor, and we tell them we have this great vaccine that can prevent their daughter from getting cervical cancer," she said. "Moms can easily relate."

But it's harder to tell her "to give her son three painful shots so that he won't transmit it to his girlfriend in the future and might not transmit cancer or have oral cancer himself," said Mishori.

As for potential side effects with the vaccine, Mishori said those concerns are "pretty minor compared to the potential."

"It hasn't been around too long, but it's been tested on thousands of women," she said. "The fact that the vaccine prevents cancer is astounding in itself."

4 comments:

Brian said...

A well presented article, but some of the points are missing. The reason that we are not seeing this so much "down under" isn't because it is not happening, it just isn't routinely being tested for at the time of diagnosis, (as it is increasingly being done in the US) since at the current time, the treatments for HPV+ oral cancers and those not HPV related are the same.

HPV 18 is not a component of the rise in oral cancers, it is the realm of HPV16, which is now also starting to replace Epstein-Barr virus in nasopharyngeal cancers as well.

As to Dr. Cullen not thinking there has been behavioral changes in developed countries since the 60's, he obviously is not involved in the world of sociology, or is too young to have been part of the "flower generation". That there was a sexual revolution in the 60's was obvious, and highly reported on in the media. It was a time of sex, drugs, and rock and roll. We never went back to the days of Ozzie and Harriet after those times. 60 minutes did a piece on high school aged kids who all admitted that in their teens that they engage in oral sex. Girls maintain their virginity, and they do not view it as sex, but "heavy petting." That kind of routine teenage sexual contact was not part of sexual behaviors 40 years ago. We have change as a people in developed countries. In third world countries tobacco is still the primary causative etiology.

B RH said...

We have three main issues to deal with. The companies most likely to benefit from a long term study, are not going to spend the money to prove benefit in head and neck cancers. I deal with them both, and that is off the table, even though the business model makes sense. It is a long term very expensive process. Merck started a study proposal with Maura Gillison at Johns Hopkins, and then their stock holders opted to cancel that in favor of spending the money to buy another pharma company.

The FDA is not going to allow expanded marketing claims without a study. Sot this is a catch 22. It is going to take the scientific community to push for this "off label" indication for use and get the public to understand the benefits.

In the US there is a huge anti-vaccine (not just HPV) movement that is gaining ground as urban myth runs rampant through the Internet, and truth and scientific fact have never been part of their agenda. They are young parents, many with autistic children that blame vaccines for much. They are too young to remember how many people smallpox killed how may were taken with polio, or numerous other diseases that are now absent from our landscape that are poised to return if their lack of logic prevails. Then you have the push-back from the conservative religious right, who are afraid their sons and daughters will engage in sex earlier in life if they get vaccinated for HPV. The lack of logic in this is monumental. We already vaccinate for other sexually transfered diseases (hepatitis) and when we give our kids tetanus shots, you don't see them running outside to step on rusty nails to try out their protection.

The Oral Cancer Foundation argues these points routinely and is pushing for the CDC to make some pro vaccination comments that the public will pay attention to as this argument relates to oral cancers. But the science community at large needs to get behind this issue if we are to reduce the rapid escalation of HPV16 caused disease in our world, now that we have a tool to do so. OCF is just finishing a prospective look at the rapid ramp up of these cancers in the next ten years with statisticians from the NCI. We have not even seen the peak of the ramp up yet, and will not for another 5 years. There is nothing we can do to turn this around in our adult population. This is a typical viral spread, and not to be compared to lifestyle modification like tobacco cessation that would change that portion of the oral cancer incidence rate. The best we can do now is screen to find early stage disease when morbidity from treatments will be lower, and the death rate reduced. Combining that with protecting our children and grandchildren from even dealing with this are paths that we need to take. BRH for the OCF. www.oralcancer.org

Brian said...

We have three main issues to deal with. The companies most likely to benefit from a long-term study, are not going to spend the money to prove benefit in head and neck cancers. I deal with them both, and that is off the table, even though the business model makes sense. It is a long term very expensive process. Merck started a study proposal with Maura Gillison at Johns Hopkins, and then their stock holders opted to cancel that in favor of spending the money to buy another pharma company.

The FDA is not going to allow expanded marketing claims without a study. Sot this is a catch 22. It is going to take the scientific community to push for this "off label" indication for use and get the public to understand the benefits.

In the US there is a huge anti-vaccine (not just HPV) movement that is gaining ground as urban myth runs rampant through the Internet, and truth and scientific fact have never been part of their agenda. They are young parents, many with autistic children that blame vaccines for much. They are too young to remember how many people smallpox killed how may were taken with polio, or numerous other diseases that are now absent from our landscape that are poised to return if their lack of logic prevails. Then you have the push-back from the conservative religious right, who are afraid their sons and daughters will engage in sex earlier in life if they get vaccinated for HPV. The lack of logic in this is monumental. We already vaccinate for other sexually transferred diseases (hepatitis) and when we give our kids tetanus shots, you don't see them running outside to step on rusty nails to try out their protection.

Brian said...

The Oral Cancer Foundation argues these points routinely and is pushing for the CDC to make some pro vaccination comments that the public will pay attention to as this argument relates to oral cancers. But the science community at large needs to get behind this issue if we are to reduce the rapid escalation of HPV16 caused disease in our world, now that we have a tool to do so. OCF is just finishing a prospective look at the rapid ramp up of these cancers in the next ten years with statisticians from the NCI. We have not even seen the peak of the ramp up yet, and will not for another 5 years. There is nothing we can do to turn this around in our adult population. This is a typical viral spread, and not to be compared to lifestyle modification like tobacco cessation that would change that portion of the oral cancer incidence rate. The best we can do now is screen to find early stage disease when morbidity from treatments will be lower, and the death rate reduced. Combining that with protecting our children and grandchildren from even dealing with this are paths that we need to take. BRH for the OCF. www.oralcancer.org