ASCO: Actor’s Oral Sex Remarks May Aid HPV Prevention

 

CHICAGO — Actor Michael Douglas’ apparent claim that he got throat cancer from human papillomavirus (HPV) contracted through oral sex may help aid prevention efforts, experts suggested.

Douglas, now 68, was diagnosed with a “walnut-sized” stage IV tumor at the base of his tongue in 2010 after months of oral discomfort. His well-known tobacco and alcohol habits — both risk factors for oropharyngeal cancers — had been thought to be the cause, but he appeared to indicate otherwise in an interview appearing in British tabloid The Guardian yesterday.

While one of his representatives has since challenged that interpretation of the interview, the spotlight on HPV as a cause of cancer should promote awareness of the need for HPV vaccination, head and neck cancer and HPV specialists contacted here at the American Society of Clinical Oncology meeting said.

“It’s no surprise to physicians such as myself, because probably 80% of the tonsil and tongue cancers I see are related to HPV,” Eric Moore, MD, an oropharyngeal cancer specialist at the Mayo Clinic in Rochester, Minn., noted in an interview with MedPage Today.

Most adults become exposed to the virus at some point but clear it like any other infection. Those who become chronically infected are at elevated risk of cervical, anal, and head and neck cancers, particularly from subtype 16.

The tonsils and base of tongue are the predominant areas affected in the head and neck because of the deep pockets in the tissue there that allows the virus a foothold, similar to the cervix, Moore explained.

Oral sexual contact is how HPV is thought to spread to the mouth and throat, and men appear to more readily acquire the virus from women than women do from men, as is true in other sexually transmitted infections, noted William Schaffner, MD, an infectious diseases specialist at Vanderbilt University in Nashville, Tenn.

While many patients worry about who they may have gotten the virus from and who they have given it to, clinicians can reassure patients that testing family members and partners isn’t necessary.

“It’s impossible to know in people with multiple sexual partners how they got it,” he said. “If you went back and tested their partners, you wouldn’t even know because they may have cleared the infection.”

Moreover, there isn’t an established and reliable test for oral HPV unlike for the cervix.

Examination of the mouth, tongue, and head and neck lymph nodes during a dental exam should help catch oropharyngeal cancers at an early stage, Schaffner noted.

But there isn’t a treatment for chronic HPV infection or any evidence supporting HPV testing for nonsymptomatic individuals, added Marcia Brose, MD, PhD, a head and neck cancer specialist at the Abramson Cancer Center in Philadelphia.

“We’re not even near that yet,” she told MedPage Today.

But those considerations make prevention all the more important, and for that reason public awareness of Douglas’ case could be helpful, Schaffner said.

“It will generate many conversations,” he said. “I don’t believe it will change a great deal of behavior, but certainly knowledge that HPV is increasing and HPV is a cause of cancers may make understandable CDC recommendation that all children should be vaccinated against HPV.”

Brose and Moore agreed that physicians can take advantage of conversations about HPV- and oral-sex-related risk to promote vaccination of adolescents.

“It’s not as clear cut whether adults should be vaccinated,” Moore noted. “After you’ve already seen the virus, the vaccine doesn’t work because you’ve already been ‘auto-vaccinated’ by clearing the virus.”