Monday, March 19, 2012

HPV and Oral Sex

Found via reddit, a look at HPV and throat cancer in men:

Researchers examined 271 throat-tumor samples collected over 20 years ending in 2004 and found that the percentage of oral cancer linked to the human papillomavirus, or HPV, surged to 72 percent from about 16 percent, according to a report released yesterday in the Journal of Clinical Oncology. By 2020, the virus-linked throat tumors -- which mostly affected men -- will become more common than HPV-caused cervical cancer, the report found.

HPV is known for infecting genitals. The finding that it can spread to the throat and cause cancer may increase pressure on Merck & Co., the second-largest U.S. drugmaker, to conduct large-scale trials to see if its vaccine Gardasil, which wards off cervical cancer in women, also prevents HPV throat infections.

“The burden of cancer caused by HPV is going to shift from women to men in this decade,” Maura Gillison, an oncologist at Ohio State University and study senior author, said in a telephone interview. “What we believe is happening is that the number of sexual partners and exposure to HPV has risen over that same time period.”

[...]Gardasil is approved for preventing cervical, vaginal and anal cancers and genital warts, and is recommended for girls and women ages 9 through 26. It is also approved for preventing genital warts and anal cancer in boys and young men of the same ages. Glaxo’s Cervarix is approved for preventing cervical cancer in females ages 9 through 25.

Both vaccines target the HPV strain linked to oral cancer, Gillison said.

HPV-linked throat cancers, or orophyaryngeal cancer, are increasing so rapidly that by 2020 there will be 8,700 U.S. cases, with 7,400 cases in men, versus 7,700 cases of cervical cancer, the study said. Male cases alone will outnumber cervical cancer cases soon after 2020, Gillison said. The Ohio State study is based on tumor samples from several U.S. states.

Roughly 20 million Americans have genital HPV infections, according to the Atlanta-based Centers for Disease Control and Prevention. At least half of sexually active women and men get it at some point in their lives, the CDC says. Most of the time it doesn’t cause health problems.

Until recently, head and neck cancer mainly occurred in older patients and was associated with tobacco and alcohol use. The HPV-linked head and neck cancers, usually of the tonsils, palate or tongue, hit men their 30s, 40s, and 50s, Gillison said. It is unclear why women are affected much less often than men, she said.

The decline in HPV-negative oral cancers mirrors the decline of smoking in the U.S., the study said.

[...]In a 2007 epidemiology study published in the New England Journal of Medicine, Gillison and her colleagues found that having a high number of oral or vaginal sex partners are risk factors for HPV-associated throat cancer. The cancer may also be spread by open-mouth kissing, Gillison said in the interview.

“Nobody paid attention to oral HPV infections until 2007,” she said. “We are about 15 years behind in the research” compared with the data on cervical cancer and HPV, she said.

An editorial accompanying the study concluded that trials to see whether vaccines prevent oral cancer “are needed, given that prevention through vaccination will almost certainly be the ultimate solution” to HPV-positive oral cancers. - Source

It is a common theme that men's issues are overlooked and under-researched. So that is not really a surprise here.

Rates of oral cancer are on the rise among men, and researchers say the culprit isn't the devil you might think.

The rising rates of oral cancer aren't being caused by tobacco, experts say, but by HPV, the same sexually transmitted virus responsible for the vast majority of cases of cervical cancer in women.

Millions of women and girls have been vaccinated against HPV, or human papillomavirus, but doctors now say men exposed to the STD during oral sex are at risk as well and may have higher chances of developing oral cancer.

About 65 percent of oral cancer tumors were linked to HPV in 2007, according to the National Cancer Institute. And the uptick isn't occurring among tobacco smokers.

[...]HPV-16, the strain of the virus that causes cervical cancer in women, has become the leading cause of oral cancer in non-smoking men, Hill said, citing research in the New England Journal of Medicine.

"When the No. 1 cause of your disease goes down [tobacco use], you would expect that the incidence of disease would go down, but that hasn't happened," he said. "In our world, this is an epidemic."

Dr. Jennifer Grandis, the vice chairwoman for research at the University of Pittsburgh and an expert on head and neck cancers, said doctors have been seeing the HPV virus in most oral cancer tumors. She said the massive push to vaccinate girls and women between the ages of 11 and 26 against HPV should have included boys and men from the beginning. Gardasil, one of the two major vaccines used to prevent HPV, wasn't approved for use in males in the United States until 2009, three years after it was approved for women.

"The thinking is changing," Grandis told AOL News in a phone interview. "But at the time [the vaccine] was licensed, there wasn't such an awareness about head or oral cancers or a willingness to accept that males played a part in the transmission of the virus," she said. "I think this idea that we only protect our daughters with the vaccine is nuts anyway, particularly because they're having sex with our boys."

Men have a greater chance of contracting the HPV virus from oral sex than women do from the same behavior, though researchers aren't exactly sure why. Oral cancer has a low survival rate because it is generally not discovered until it has spread to other areas, according to the CDC. Only half of people who've been diagnosed with oral cancer will live longer than five years. - Source

A common theme indeed.

A huge spike in the number of head and neck cancers linked to HPV over nearly two decades is raising alarms about the risk of the sexually contracted infections in a whole new population: men.

Between 1988 and 2004, head, neck and throat cancers that tested positive for the human papilloma virus rose an astounding 225 percent, according to a new study in the Journal of Clinical Oncology.

Within the next decade, the study authors argue, the incidence of such cancers — which are almost always contracted as a result of oral sex — will surpass that of cervical cancer, and the majority of those cases are going to be in men.

That’s a point often missed in public talk about HPV infection — and the vaccine that can prevent it.

In the recent controversy over comments made by presidential candidate Michele Bachmann about the HPV vaccine, the focus was squarely on young women and cervical cancer. But HPV, mainly a strain called HPV-16, also causes oropharyngeal and anal cancer, a fact not often publicized because medical organizations, the government, and academics would rather not step into any debates about sex practices.

Consultants to drug companies that make HPV vaccines are represented among the study’s authors; clearly the companies have an incentive to suggest that males be vaccinated. But in many cases, health experts believe that economics and health are aligned on this issue and that boys and young men ought to be receiving the HPV vaccine right now. For instance, Dr. James Turner, a past president of the American College Health Association and a liaison to the Advisory Committee on Immunization practices has long advocated vaccinating all boys against HPV.

Yet neither the Centers for Disease Control and Prevention nor medical organizations such as ASCO have recommended it, although the vaccines are approved for use in males. The reason, suggested Masters, is squeamishness.

“When we get more comfortable as a society with the whole discussion of sexually-related cancer, then you will, I think, see us saying it makes a lot of sense for all boys and girls to get vaccinated … I am not, as a representative of ASCO, saying we recommend it, but I think (such recommendations) are forthcoming.”

Meanwhile, suggested a commentary accompanying the study, “patients should be encouraged to minimize behaviors that put them at risk.” - Source



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