Oral Sex and Oral Cancer
With recent reports in the press linking oral cancer and oral sex, Dr Vinod K Joshi gives the low-down on everything you ever wanted to know about oral sex and mouth cancer, but were too afraid to ask.
In the past decade, Scotland has seen an almost 50 percent increase in oral cancer among under- 45s, and in the last 40 years a fourfold increase in younger patients suffering from it. Now it is thought that there may be an uncomfortable explanation to account for this. The human papilloma virus (HPV) is an extremely common sexually transmitted infection, and has long been known to cause cervical cancers. It had long been suspected, that HPV could cause oral cancers. HPV is one of the most common virus groups in the world to affect the skin and mucosal areas of the body.
Genital HPV infections are common. Genital warts can be sexually transmitted. The warts tend to be infective, but can be treated. The problem is that HPV is often clinically undetectable. At any one time, around a third of 25-year-old women in the US are infected. It is thought that only 10 percent of infections involve cancer-causing strains, and that 95 percent of women will get rid of the infection within a year. Most HPV infections of this type are very common, harmless, non cancerous and easily treatable. The higher risk HPV-16 viruses are also spread by sexual activity.
Once in the body, the virus persists and moves to other mucosal sites via self-inoculation from the genitalia or oro-genital contact between sexual partners. Mothers harbouring the virus can transmit the virus to their babies during birth. HPV-16 virus is detected in the buccal cells of just under 50 per cent of their asymptomatic pre- pubertal children. So avoiding initial exposure to the virus is impossible. HPV is the most prevalent STD in the US at present. It is estimated that well over one third of youngsters are infected.
Men are at greater risk than women of developing oral cancer. This is thought to be related to significant differences in male sexual behaviour. Men with oral cancer self-reported a lower age for their first sexual intercourse, an increased number of sexual partners, and a history of genital warts. In a high proportion of women with oral cancer, the same HPV type was also found in their cervical smears. `Fifty to 60 percent of US college-aged women have HPV, but only 10 percent have lesions.’ Abstinence, Condom use, and sensible behaviour, is considered to be protective against HPV infection. HPV16 is the strain seen most commonly in cervical cancer, was found in most of the oral cancers too.
It was more common amongst people who reported having more than one sexual partner or who practiced oral sex, than in cancer patients who smoked or chewed tobacco. The people with oral cancers containing the HPV16 strain were three times as likely to report having had oral sex as those whose tumour did not contain HPV16. Patients with mouth cancer were also three times as likely to have antibodies against HPV compared to the healthy controls. For cancers of the back of the mouth, the link was even stronger. It is thought that the transmission of the virus is facilitated by oral sex.
`Oh, Behave!’ `Watch your Mouth!’ and if you can’t, `Wear (flavoured?) Condoms!’ About the author Dr Dr Vinod K Joshi BDS DRDRCS FDSRCPS is Consultant in Restorative Dentistry, Restorative Dentistry Oncology Clinic, St Luke’s Hospital, Bradford and Pinderfields Hospital, Wakefield.
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