Source: New York Daily News
HPV, otherwise known as the human papillomavirus, is a leading cause of cervical cancer for women but the nasty virus is now causing a spike in oral cancer and ravaging an entirely different group: men.
Cases of oral cancer resulting from exposure to the HPV-16 strain of the virus are hitting epidemic proportions in the U.S., doctors say.
Though the mention of oral cancer evokes images of gravely-voiced chain-smokers, the disease now has a new face: mostly white, male, non-smokers in their late 30s and early 40s.
The tumors forming on the back of their tongues and tonsils have nothing to do with nicotine – they are directly linked to engaging in oral sex with multiple female partners.
“If you’ve had more than five or six sexual partners, you are at a higher risk,” Dr. Eric M. Genden, professor and chair of head and neck surgery at Mount Sinai Medical center told the Daily News. “We’re only now beginning to see the beginning of a bell curve.”
Women can get it from men as well although their chances are lower, according to doctors.
The human papillomavirus (HPV), a nasty bug with strains that causes genital warts and cervical cancer in women, is now the top cause of oral cancer in men, beating out smoking and drinking, according to reports from the New England Journal of Medicine and the Journal of Oncology as well as other research and treating institutions.
The number of smokers in the U.S. has steadily declined in the past 50 years, yet the rate of oral cancer has remained relatively steady, and recently been on the increase.
The reason is an increase in HPV-16 in the U.S. population.
Oral cancer is frightening because it often goes undetected until a lump appears on the neck or a patient begins to suffer from a persistent hoarseness. By then, even though the patient may feel fine, he could be in the late stages of the deadly disease.
If detected early, the chance for surviving oral cancer from HPV is high, between 85 to 90%. Treatments – localized radiation, chemotherapy, and sometimes surgery – are effective when used in the early stages. When surgery is part of the solution, the options can be conventional surgery or a new robotic surgical technique, which reduces scarring and side effects in some patients.
Brian Hill, a medical device manufacturer, was in his mid-forties when found a hard spot on his neck 14 years ago. He went to his ear, nose and throat doctor, who dismissed the bump as an infection and prescribed antibiotics.
But a biopsy later found the lump was cancerous.
Though he had never smoked a cigarette, Hill was told he had a low chance of survival as the node in his neck was positive for squamous cell carcinoma, the most common oral cancer.
Hill has since founded the Oral Cancer Foundation and spends his time working with patients, doctors and dentists, as well as campaigning in Washington to raise awareness about the danger of oral cancer and the links to HPV.
“Anyone old enough to have engaged in sexual behaviors known to transmit this virus needs to be screened annually for oral cancer,” said Hill. “It’s the only way to catch this disease at its early stages.”
Hill believes many doctors and researchers are still in the dark about the ties between HPV-16 and oral cancer, despite the rise in diagnoses in the past decade.
“We don’t know exactly if or how long HPV-16 may lay dormant, or why it strikes certain people and not others,” he said. “What we don’t know exceeds what we do know.”
Nearly all sexually active Americans will come in contact with HPV, according to the Oral Cancer Foundation and the National Institutes of Health.
Young women are encouraged to get the HPV vaccine, but doctors say there is little point in vaccinating patients past the age of 26 since the likelihood of prior exposure to cancer-causing strains is so high.
Young people now are having a lot more oral sex with many more partners so exposure rates are higher.
HPV is the most common STD in the U.S. About 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year, according to the Centers for Disease Control and Prevention.
HPV is passed through skin-to-skin contact, not fluids. Besides conventional sex, oral sex and even deep French kissing may spread the virus.
Doctors are sounding the alarm, but have stopped short of advising men to abstain.
“This is not a call to stop having oral sex,” said Dr. Mark D. DeLacure, a head and neck surgeon at NYU’s Langone Medical Center. “People have to continue living their lives, however we make the best choices when we know all the risks.”
DeLacure said using condoms and dental dams during oral sex could reduce transmission, but acknowledges the idea is hardly appealing or practical.
“Limiting your sexual partners is a way to reduce your risk,” said DeLacure. “But still, there are no guarantees.”
Doctors also have this advice: Don’t panic.
Patients with HPV – even the cancer-causing strain – may never develop cancer and may never transmit the virus to a partner.
The vast majority of individuals have immune systems that recognize the virus as a threat, and easily defeat it.
Doctors instead recommend vigilance.
The important issue is persistence – meaning attention to how long an unusual symptom like a lump has lasted. When an abnormality persists for longer than 14 to 21 days, it’s time to see an expert.
“If you’ve got a sore tonsil that is still a problem after a couple of weeks, and particularly if it’s localized to one side, I would say that’s sign it’s time to talk to a doctor,” said DeLacure.
And talk to the person who sees your mouth the most: Your dentist.
Dentists, too, are becoming more aware of HPV and its role in the development of oral cancer.
A good dentist will know what to look for and where to look for it.