oral sex

Michael Douglas: ‘Throat cancer’ was really tongue cancer

Source: cnn.com
Author: Jen Christensen, CNN

Michael Douglas never had throat cancer, as he told the press in 2010.

The actor now says he had tongue cancer. Douglas said he hid the diagnosis at the urging of his doctor to protect his career.

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“The surgeon said, ‘Let’s just say it’s throat cancer,’ ” Douglas told fellow actor Samuel L. Jackson for a segment that ran on British television as a part of Male Cancer Awareness Week.

Douglas says that the doctor told him if they had to do surgery for tongue cancer, “it’s not going to be pretty. You could lose part of your tongue and jaw.”

When Douglas first talked about his cancer diagnosis in the summer of 2010, he was on a worldwide publicity tour for the movie “Wall Street: Money Never Sleeps.”

Douglas and Jackson joked that could have been the end of his acting career. Douglas said if he had surgery he could see the director saying, “What’s your good side? I’ve got no side over here.”

“There really is no such thing as throat cancer per se,” explained Brian Hill, an oral cancer survivor and the founder of the Oral Cancer Foundation. Douglas has taped a public service announcement to raise awareness about oral cancer for Hill’s foundation.

“Throat” cancer and tongue cancer are both colloquial terms that fall under the oral cancer umbrella. Throat cancer usually refers to cancerous tumors that develop in your pharynx, voice box or tonsils. Tongue cancer refers to cancerous cells that develop on your tongue.

“The treatment up until just recently can be very brutal,” Hill said of tongue cancer. “Your career as a leading man could be over. If you have signed a contract to promote a movie, you would have a strong motivation not to say … ‘Maybe in six months I won’t have a tongue or lower jaw.’ ”

Douglas apparently did not need the potentially disfiguring surgery. He told Jackson he was instead treated with an aggressive form of radiation and chemotherapy. The treatment, he said, lasted five months.

In June, Douglas kicked off an animated conversation about the cause of oral cancer when he told The Guardian that he got throat cancer after engaging in oral sex. Oral sex can expose individuals to the human papilloma virus, which can cause cancer.

Later, Douglas’ publicist told CNN that Douglas did not blame HPV solely for his cancer; Douglas said he was also a smoker and a drinker. Smoking and drinking, particularly when combined, are considered the most significant contributing factors to oral cancer, according to the Centers for Disease Control and Prevention. So is Douglas’ gender. Men are twice as likely to develop oral cancer as women.

Oral cancers account for 2% to 4% of all cancer diagnoses in the United States. An oral cancer diagnosis is particularly serious; only half of the people diagnosed with oral cancer are still alive after five years, according to the CDC. In large part, that’s because of the late diagnoses of this disease. Most signs of this cancer are difficult to detect and are often painless.

Douglas told Jackson that initially his doctors treated him with antibiotics. Douglas had been complaining of a soreness at the back of his teeth. Three months later when it still hurt, the doctor gave him another round of antibiotics. Nine months later, after talking to a friend who was a cancer survivor, he went to the oncology department where a doctor did an initial exam and then a biopsy. He was diagnosed with stage four oral cancer in 2010.

Douglas is not the first celebrity to misidentify the kind of cancer they have.

Actress Valerie Harper, who first came to fame on the TV show “Mary Tyler Moore,” announced her cancer on the cover of People magazine in March. The story said she had little time left to live and was suffering from terminal brain cancer. It turns out the “Dancing With the Stars” celebrity actually had lung cancer that had spread to the lining of her brain.

“I see a lot of people with ‘brain cancer’ who actually have… lung cancer or breast cancer or some other cancer (that spread) to the brain,” Dr. Otis Brawley, the American Cancer Society’s chief medical and science officer, told CNN. “We treat cancer according to its origin.”

Harper’s kind of cancer, leptomeningeal carcinomatosis, can be slowed but the cells are adaptable and can develop a resistance to treatment. A complete remission is unlikely.

Douglas, on the other hand, has had regular check-ups since the diagnosis. At his two-year mark, he told Jackson, his doctors said he was clear of the cancer.

“There is a 95% chance it’s not coming back,” he told Jackson.

October, 2013|Oral Cancer News|

Celebrity confession linking sex to oral cancer raises local awareness

Source: www.vancouversun.com
Author: Pamela Fayerman

Michael Douglas is credited for raising awareness about the links between oral sex and oral cancer, but experts worry his disclosure could cause public panic and stigmatize the disease to the point of bringing shame to those afflicted. Or worse, prevent patients with symptoms from getting examined promptly.

Miriam Rosin, a BC Cancer Agency scientist, said the actor’s candid revelation that his throat cancer was caused by human papillomavirus (HPV), which he picked up from performing cunnilingus, is raising awareness of a growing problem around the world, and in B.C. “It’s created a lot of noise. I think it’s important to talk about this disease … but not in a headline-grabbing way, which may damage the cause by labelling it as a sexually transmitted disease,” said Rosin, who is also a Simon Fraser University professor.

Regardless, the public is finally getting the message that HPV, the most common sexually transmitted virus in the world – and the one that causes virtually all cases of cervical cancer – is accounting for the surge in throat cancers located at the back of the throat.

In B.C., if trends continue, HPV-caused throat cancers are expected to overtake cervical cancers in incidence. About 150 cases of cervical cancers are reported annually in this province. Of about 500 head and neck cancers, 115 are HPVcaused throat cancers, according to the BCCA.

Douglas’s interview with The Guardian newspaper last month was followed by an avalanche of sensational media reports that apparently gave the Hollywood celebrity a twinge of regret. Douglas’s publicist later claimed the 68-year-old meant only that oral sex and HPV were a potential cause of such cancers while not specifically referring to his own. The U.K. newspaper, however, stood by the story and released an audio of the interview to rebut Douglas’s backtracking. Excessive smoking and drinking alcohol are also risk factors for various forms of oral cancer, and when the actor was first diagnosed in 2010, he had previously blamed his cancer on many years of indulgence in those habits.

Up to 70 per cent of throat cancers are HPV-related. There are numerous places to get oral cancers – such as the lips, cheeks, gums, palate, tongue and tonsils – and while smokers and drinkers once fit the typical profile of an oral cancer patient, now, because of waning smoking prevalence, HPV infections have emerged as the dominant risk factor for throat tumours such as the one Douglas had.

Rosin said there was a whopping 300-per-cent increase in the age-adjusted incidence rate for throat cancers in B.C. between 1980 and 2010. It’s more commonly diagnosed in mid-life, and the ratio of males to females getting such cancers is three-to-one.

Earlier this year, the American Cancer Society issued a report showing the proportion of HPV-linked oral cancers has risen from 16 per cent of all oral cancers in the mid-1980s to 72 per cent two decades later.

Dr. John Hay, a radiation oncologist at the BC Cancer Agency and an expert in oral cancers, said HPV tumours are squamous cell clusters that surface in places where skin tissue is thin and delicate.

There are more than 100 strains of HPV. Some are benign, causing common skin warts, but high-risk strains cause cervical and oral cancers, vaginal and vulva cancers, penis and anus cancers, and genital warts. HPV infections and their links to cancer are a relatively new scientific area of study so there are many questions still to be answered, including whether the relatively new HPV vaccine will prevent future generations from getting throat cancers.

The Vancouver Sun has reviewed the latest research and developments to address expected curiosity on the subject.

How common is HPV?
Very. By age 25, a quarter of Canadian women are infected by it, and by age 50, about 85 per cent of sexually active people (males and females) have been exposed to it at one time or another. The vast majority of the time, the immune system knocks the virus out within a few years. In a minority of individuals, the virus persists, potentially leading to an HPV-linked cancer.

What is fuelling the rise in HPV over the past three or four decades?
Experts believe the advent of oral contraceptives. (The Pill) five decades ago unleashed sexual freedom and changes in sexual behaviours: more sexual partners and consequently more sexually transmitted infections, including HPV. Hay said before oral contraceptives came along, condoms were the common barrier method. “Condoms keep things in and they keep things out,” he said, referring to the fact that condoms can help prevent sexually transmitted infections while oral contraceptives do not.

Is the massive increase in throat cancers attributable to better detection methods or an increase in HPV infections?
Experts say they are seeing a true increase in the proportion of throat cancers caused by HPV. Hay said typical patients are 45 to 65 years old who may have been infected with HPV up to 20 years earlier.

Does oral sex really cause throat cancer?
The HPV virus is very common; nearly everyone who has sex will get it at one point or another. The HPV micro-organisms can reside in the cervix or other body canals (anus) and the virus can also be transmitted through skin contact and saliva. One Finnish study showed that HPV could even be detected in babies under one year, possibly through skin-to-skin contact during breastfeeding.

Men are more likely to get throat cancer and one theory is that there may be more HPV in vaginal fluid than other genital areas.

“We don’t well understand how oral HPV is transmitted except to know that oral sex is the most likely way of transmitting HPV to the mouth,” said Gypsyamber D’Souza, an epidemiologist and viral cancer expert from Johns Hopkins Bloomberg School of Public Health, at the recent annual meeting of the American Society of Clinical Oncology.

What are the risk factors for contracting HPV?
Studies have shown that men are three times more likely to get HPV-related throat cancers than women, but risk for both genders goes up in those with more sexual partners. Those who’ve had six or more oral sex partners over a lifetime are 8.6 times more likely to get HPV throat cancers, compared with those who have never had oral sex. HPV is more prevalent in sexually promiscuous individuals and those already carrying other sexually transmitted infections (STI). A B.C. study done on men attending a Vancouver STI clinic found that 70 per cent were HPVpositive.

What are some of the most common symptoms of throat and other oral cancers?
Hoarseness, chronic sore throat, pain or difficulty swallowing, a painless lump in the neck area, swollen lymph nodes in the neck, ear pain and mouth sores that don’t heal.

Who should get the HPV vaccine?
There are two HPV vaccines licensed for use in Canada: Gardasil and Cervarix. Neither will wipe out infections once individuals have been exposed, so it’s best to get the vaccine before becoming sexually active. B.C. research has shown that HPV is most prevalent in women under 20, suggesting that the risky period for getting infected is when females first start having sex.

Gardasil (which protects against multiple high-risk HPV strains as well as genital warts) is approved for women aged nine to 45 and males nine to 26. Health Canada approved the vaccine for girls in 2006 and for boys a few years ago. It’s part of school-based immunization programs, but the major focus of public funding is on Grade 6 girls in B.C. The series of three shots costs up to $500 if purchased at pharmacies by parents wishing to vaccinate boys or older children who missed getting vaccinated.

The vaccine is also licensed for males up to age 25. As with girls, experts recommend boys get vaccinated before they become sexually active. Only a few provinces are considering public coverage of the vaccine for males; B.C. is not one of them at this time.

Dr. Perry Kendall, chief medical health officer for B.C., said studies have not yet proven it would be cost effective to extend public funding for vaccination of boys. “Ninety-nine per cent of cervical cancers are caused by HPV, and 70 per cent of vaginal cancers,” he said, while noting that HPV is “attributable” to about twothirds of throat cancers. B.C. spends about $3 million a year on HPV vaccines and about 60 to 70 per cent of eligible girls (Grade 6 cohorts) have been vaccinated so far, but it could take decades for the vaccine to have a significant effect in reducing both cervical and oral cancers in the younger generations.

Is the vaccine safe and effective?
A Universit y of B. C. researcher Dr. Simon Dobson has called Gardasil an “excellent vaccine.” HPV-infection suppression rates range from 70 to 90 per cent, with the highest immunity response occurring in those who get the vaccine at the youngest age.

Minor side effects such as pain at the site of injection, swelling, dizziness, nausea and headache have been reported in about six per cent of subjects, according to Dr. Monika Naus of the B.C. Centre for Disease Control in a report in the BC Medical Journal. Rare, serious adverse effects – such as deaths, stroke, embolisms and seizures – have not been directly linked to the vaccine.

How can you get tested for HPV?
Doctors scrape cells from the cervix area, similar to the way specimens are collected during a Pap smear. The test is not covered by the public medical plan so private labs charge about $90. It is not possible to swab the back-of-throat area for HPV because of gag and vomit reflexes. Saliva tests are used to detect throat HPV infections only for research purposes so far.

In women and men, swabs can be taken of the anal cavity to detect pre-cancerous changes.

Is there a treatment for HPV?
There’s no treatment for the infection but there are for the serious cancers that may result from it, such as surgery, chemotherapy and radiation.

What’s the prognosis for someone who gets HPV oral cancer?
Even those who get advanced HPV-caused throat cancers, such as actor Michael Douglas, have a fiveyear survival rate of at least 80 per cent, whereas advanced non-HPV linked oral cancers – those caused by smoking and alcohol – have a survival rate about half that. Non-HPV cancers usually affect the front of the tongue, floor of the mouth, cheeks and gums, while HPV cancers tend to affect the back regions of the mouth: the base of the tongue and tonsil area.

Is there a screening program for HPV-related oral cancers?
There’s no way to screen for HPV-related throat cancers, but a B.C.-developed device called the VELscope is used by some dentists to detect abnormalities in the front parts of the oral cavity. The device utilizes special light to detect suspicious cells, but it has not yet been shown to find HPVtype cancers in the furthest reaches of the throat. The tonsil area has folds and crevices where HPV tumours can hide out. BC Cancer Agency scientists are trying to improve the imaging system for the hardto-reach sites at the back of the throat and tonsil area.

Does it take a long time for an HPV infection to arise or should you blame the last person you had sex with?
If you do get HPV, you can’t necessarily point the finger at the last individual you had sex with. HPV infections wax and wane over lifetimes so getting an HPV-linked cancer may be more likely caused by the “sum total of your life experiences,” according to Rosin. A 2010 study in the British Medical Journal found that in those who developed throat cancers, a third had HPV antibodies (meaning they had been exposed to the virus) up to 12 years before the onset of disease.

How can one prevent or lower the chances of getting HPV-related cancers?
Talk to your doctor about getting vaccinated against the high-risk strains of HPV, reduce intake of alcohol and tobacco, limit your number of sexual partners, get tested for HPV if you have any symptoms or concerns. Women should get Pap smear tests of their cervix, which can show abnormal cellular changes that point to a possible HPV infection.

How prevalent is the oral HPV virus in the general population?
A recent snapshot-in-time U.S. study published in the Journal of the American Medical Association found that about seven per cent of Americans aged 14 to 69 are infected by HPV. But only one per cent of the 5,500 people in the study had HPV-16, the most strongly linked strain to oral and cervical cancers. If the figure is extrapolated to the whole population, it would mean that millions have HPV, but fewer than 15,000 Americans develop HPV-linked throat cancers each year. Lead author Dr. Maura Gillison, of Ohio State University, said that should be seen as reassuring; most people with oral HPV don’t get throat cancer.

The same study found that oral HPV infection was more common in men (10 per cent) than women (four per cent). HPV infection was most common in people aged 55 to 59.

How common is oral sex?
The Canadian Youth, Sexual Health and HIV/AIDS study, along with other studies and surveys in the U.S. and Canada, have shown that oral sex is enjoyed by two-thirds of adults. Results have shown it’s increasingly popular among Canadian teenagers. In 1994, nearly half of Grade 11 students (47.5 per cent) reported having oral sex at least once. When the survey was repeated in the same age group in 2002, more than half (52.5 per cent) indicated they had done so.

Should you swear off oral sex?
Since there is a long latency period for HPV infections to inflict serious damage, it’s unlikely there’s any benefit for adults to change sexual practices and preferences, especially if they are in monogamous relationships. But Rosin and Hay agree it may be prudent for individuals to be discriminating when it comes to sexual partners. They can consider asking partners about whether they’ve had HPV, if they’ve been vaccinated against HPV, or about their health and sexual histories.

July, 2013|Oral Cancer News|

HPV vaccine still fights for acceptance, despite benefits

Source: www.floydcountytimes.com
Author: Tom Collins

Last month, actor Michael Douglas caused a stir in the media when he suggested his throat cancer might have been caused by oral sex.

He could be right. Although smoking and alcohol use have long been regarded as the key risk factors, new research indicates that HPV, a sexually transmitted virus, is now the leading cause of mouth and throat cancers in the United States.

But there’s an important take-away message to this story: Some cancers caused by HPV can be prevented easily, with a simple series of three vaccinations.

Since 2000, scientists have known that certain strains of HPV are responsible for nearly all cervical cancer in women. But newer studies indicate HPV can cause other types of cancer as well. Recent findings have also linked HPV to oral, head/neck, anal, vaginal, vulvar and penile cancers, and even some cases of lung cancer.

About half of all Americans will become infected with HPV at least once during their lifetime. The most common visible symptom of an HPV infection is genital warts, although the majority of HPV infections do not display symptoms.

That’s why the Centers for Disease Control and Prevention recommends that boys and girls alike be vaccinated against HPV. Ideally, they should be vaccinated between the ages of 11 and 12. Vaccination can be initiated as early as age 9, and the U.S. Food and Drug Administration has approved the vaccine to be given up to age 26.

Yet HPV vaccination rates remain low. In Eastern Kentucky, the percentage of women who die from cervical cancer is significantly greater than in the rest of state or the nation as a whole. But the percentage of girls and young women in Eastern Kentucky who receive the full three doses of the HPV vaccine is lower than both the state and national averages.

The University of Kentucky’s Rural Cancer Prevention Center, a CDC-funded project, has conducted research over the past four years around the acceptance of the HPV vaccine. In an initial study, conducted in 2009, UK researchers found they literally could not give the vaccine away to young women in Eastern Kentucky.

A community advisory board was assembled to guide research into improving acceptance of the vaccine and completion of the three-shot series. Researchers learned that in order to increase acceptance they had to promote the vaccine in a culturally acceptable manner.

They hosted community hog-roasts, where local people helped promote the vaccine. They developed a DVD, designed to encourage completion of the three-shot series, to be shown to young women when they took the first shot. Numerous school systems sent home consent forms to parents to get permission for school nurses to provide the vaccine to their children.

Researchers at the center hope that if a community is engaged in the process and allowed to direct the delivery of the necessary change, outcomes can be achieved that will lead to a healthier population.

Note: Tom Collins is the associate director of the University of Kentucky Rural Cancer Prevention Center.

Oral cancer sneaks up

Source: well.blogs.nytimes.com
Author: Donald G. McNeail Jr. and Anahad O’Connor

The actor Michael Douglas has done for throat cancer what Rock Hudson did for AIDS and Angelina Jolie did for prophylactic mastectomy. By asserting last week that his cancer was caused by a virus transmitted during oral sex, Mr. Douglas pushed the disease onto the front pages and made millions of Americans worry about it for the first time.

In this case, it was a subset of Americans who normally worry more about being killed by cholesterol than by an S.T.D. The typical victim is a middle-aged, middle-class, married heterosexual white man who has had about six oral sex partners in his lifetime.

The virus, human papillomavirus Type 16, also causes cervical cancer. So is there any early oral screening that a man can have — an equivalent to the Pap smear, which has nearly eliminated cervical cancer as a death threat in this country?

The answer, according to cancer experts and a recent opinion from the United States Preventive Services Task Force, is no. And for surprising reasons.

The Pap test — invented in 1928 by Dr. George N. Papanicolaou — involves scraping a few cells from the cervix and checking them under a microscope for precancerous changes. Precancerous cells have a “halo” around the nucleus, while cancerous ones have larger, more colorful nuclei, said Dr. Paul D. Blumenthal, a professor of gynecology at Stanford University Medical School.

In theory, it should be similarly easy to scrape and examine throat cells. But in fact, cancer specialists said, doing so would be useless.

Virtually all cancers on the mouth, tongue, gums, hard palate or anywhere in front of the uvula (the “punching bag” dangling from the soft palate) are caused by tobacco and alcohol.

The kind of chronic HPV 16 infection that leads to oral cancer occurs much farther down, near the base of the tongue. Adding to the difficulty, the infection is often “deep down in the crypts of the tonsils,” said Dr. Eric J. Moore, a Mayo Clinic surgeon specializing in such cancers.

The tonsils, an expanse of lymphoid tissue that includes much more than the two back-of-the-throat bumps removed in tonsillectomies, have deep folds and crevices.

“If you spread them out, they’re 2 feet by 2 feet, said Dr. Marshall R. Posner, medical director for head and neck cancer at Mount Sinai Medical Center. “You can’t swab them. It’s just not possible.” By contrast, the end of the cervix swabbed during a Pap test is only about two square inches and easily reached with a speculum. It is impossible even to see deep tonsillar tissue without a scope that goes through the nose. Probing this area would set off gag and vomit reflexes so strong that patients might have to be anesthetized.

A saliva test can detect an oral HPV infection. But that’s not useful, since 85 percent of the population catches at least one of the 100 different human papillomaviruses that circulate. Most infections are beaten by the immune system in a year or two. Even among those who get an oral HPV 16 infection, less than 1 percent will go on to develop throat cancer.

“If I tell you that you have HPV in your mouth, it’s not going to help you if I don’t have anything to offer you, and you’re going to live with the anxiety and fear that you might get cancer,” said Dr. Robert I. Haddad, chief of head and neck cancer at the Dana-Farber Cancer Institute in Boston. “But if I tell a woman that she has an abnormal Pap smear, there’s something she can do about it.”

Someone with chronic HPV 16 year after year would be at the highest risk for throat cancer — but even then it is not clear what to do. Probing through all the tonsillar tissue under anesthesia looking for something worrisome to biopsy would be difficult and expensive and could set off bleeding near the entrance to the lungs.

Even when surgeons find large, cancerous lymph nodes, the primary tumor that seeded them sometimes turns out to be a speck only a sixteenth of an inch wide buried by healthy tissue, Dr. Moore said.

Although throat cancer caused by HPV is increasing, it is relatively rare. About 25,000 cases a year are diagnosed in the United States, compared with 226,000 lung cancers. But it is growing in importance as smoking-related oral cancers decline.

Oral sex has become more common since the sexual revolution of the 1960s, but not astonishingly so. According to Debby Herbenick, a director of Indiana University’s Center for Sexual Health Promotion, the mean number of lifetime oral sex partners reported by American men 35 to 54 is six. Men 55 to 64 report five, and men 25 to 34 report four. Men over 65 and under 25 report three.

However, such “fairly modest changes” in sexual habits do not explain why the cancer risk has doubled or tripled over the years, said Gypsyamber D’Souza, a viral cancer specialist at Johns Hopkins Bloomberg School of Public Health. It has risen the most in white men 45 and up. The older age is explained by the fact that, like cervical cancer, it can take decades to develop.

Men are twice as likely as women to get it, according to Dr. D’Souza, and it is more common among whites than blacks, perhaps because whites are more likely, by 90 percent to 69 percent, to have ever performed oral sex.

And straight men are more likely to get the cancer than gay men. One theory is that there may be more HPV in vaginal fluid than on the penis, said Dr. Lori J. Wirth, a head and neck cancer specialist at Massachusetts General Hospital.

The lack of a screening test means that a doctor should be seen as soon as symptoms appear: a lump in the neck, a sore throat or ear pain that persists for two weeks, or what Dr. Posner called “the hot potato voice: the way you talk when something is burning the back of your throat.”

Though no studies proving it have been done, Gardasil and Cervarix, the vaccines to prevent cervical cancer from HPV Types 16 and 18, should also prevent this oral cancer and should be offered to boys and young men, several doctors said.

Health Experts Praise Michael Douglas For His Oral Cancer Revelation

June 3rd, 2013 7:20pm EDT
Source: starpulse.com

 

Michael Douglas

 

Health experts have commended Michael Douglas for speaking out about link between throat cancer and oral sex.

The 68 year-old actor, who endured a six-month battle with the illness, hit headlines over the weekend when he voiced his belief that his cancer was caused by HPV, the human papillomavirus, which can be contracted through oral sex.

The Behind The Candelabra star told Britain’s The Guardian newspaper, “Without wanting to get too specific, this particular cancer is caused by HPV, which actually comes about from cunnilingus… I mean, I did worry if the stress caused by my son’s incarceration didn’t help trigger it. But yeah, it’s a sexually transmitted disease that causes cancer. And if you have it, cunnilingus is also the best cure for it.”

Douglas’ frank admission has now won him praise from Brian Hill, executive director of Oral Cancer Foundation, who tells the New York Post, “I’m really quite proud of Michael saying this. This (oral sex) is not an aberrant sexual behavior. But the willingness to talk about this openly can be difficult.”

The actor recorded a public service announcement for the Oral Cancer Foundation last year.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 
June, 2013|OCF In The News|

The Man’s Guide to HPV

Source: Men’s Health
By: Melaina Juntti

What men can do about HPV

 

What men can do about HPV

Michael Douglas caught major flak for saying oral sex gave him throat cancer. But if you’re laughing, it’s time to grow up. Oral cancers caused by the sexually transmitted human papillomavirus (HPV) have skyrocketed 225 percent in the past 15 years, with men accounting for 75 percent of all cases. The number-one culprit: HPV passed via oral sex.

It used to be that cigarettes caused most of these cancers. But since smoking rates have plummeted over the past few decades, and we’re having way more oral sex today than even our fathers’ generation, HPV has become the most common STD in the U.S. – inevitably leading to more oral cancer cases. It only takes one time going down on someone to contract HPV, and experts estimate that 80 percent of us will be exposed to the virus at some point in our lives. This STD sometimes causes genital warts, but according to the Centers for Disease Control and Prevention, that’s not very common. In most cases, HPV has no symptoms. And since no test exists to detect HPV in guys, you won’t know you have the virus until years later – if it turns into cancer.

“It’s very hard to determine when you acquired HPV,” says Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University. “It doesn’t usually come from just one sexual episode. That said, every once in a while, cancer develops within two years of when you think you acquired HPV. But most often it comes 10, 12, even 20 years later.”

Still, not all HPV cases lead to oral cancer. Far from it. So even though the rapidly rising prevalence of these cancers is scary – and nothing we should take lightly – we need to keep the actual risk in perspective. “It’s true that within the world of oral cancer, HPV-caused cases have become an epidemic,” says Brian Hill, executive director of the Oral Cancer Foundation. “They are rapidly increasing at a rate never seen before, and it’s going to get much worse by 2020. However, in the grand scope of the U.S. population, the term ‘epidemic’ is overstating the reality. Only a small percentage of sexually active people wind up with an HPV-related oral cancer. For 99 percent of those who get HPV, their immune system clears it within 12 to 24 months, and that’s that. So we have to look at the relative risk. Don’t stop having sex. That’s not an appropriate response.”

So what is the right response? To protect yourself without killing your sex life, there are HPV vaccines like Gardisil. These are proven to protect against HPV-caused anal and cervical cancers, and doctors overwhelmingly believe they also prevent oral cancers. However, the CDC recommends vaccination only for men under age 26, and most insurance plans won’t cover it for older guys. Still, that doesn’t necessarily mean you should rule out the vaccine if you’re past 26.

“The CDC’s recommendations are based on a generality,” Schaffner says. “Statistics show that most guys, by age 26, have had multiple sexual partners and have probably been exposed to HPV. But every individual is different. A guy may have been in a long-term monogamous relationship that’s ended, and now he’s reentering the social scene and going to have sex. It won’t do him any harm to get immunized. Insurance probably won’t cover the vaccine, but he can certainly pay the $300 to $400 out of pocket.”

But if you’ve had a handful of partners – and, if the stats are correct, have probably already come in contact with HPV – the decision boils down to whether you want that extra piece of mind, says Schaffner. After all, you could be one of the lucky few who’s had lots of sex but never been exposed. “It’s kind of like wearing a belt and suspenders,” he explains. “Wearing both may be unnecessary, but at least can be sure your pants won’t fall down. By getting the vaccine, you know you’ve done everything you can to protect yourself from HPV.”

Besides being immunized, which only spares you from HPV if you haven’t been exposed, you should limit your sexual partners and always use protection. But even then, condoms and dental dams aren’t surefire HPV blockers, Schaffner says, because you can get the virus from skin-to-skin contact. “HPV can be present on the penis shaft and vaginal lips, not just on mucus membranes, semen, or vaginal fluid,” he says. “Therefore, condoms – both male and female types – are very helpful, but they don’t offer complete protection, even if they’re used as directed and don’t break.”

Schaffner says gay men aren’t necessarily at less risk of oral cancer just because they’re not performing oral sex on women. It has more to do with how often a guy has sex and how many different men he’s slept with. However, the CDC says gay and bisexual men are 17 times more likely to develop anal cancer – also caused by HPV – than men who only sleep with women.

Even if you already have HPV – and don’t know it – you can take steps to decrease your chances of oral cancer. Schaffner says to stop smoking immediately and cut back on booze. “We’re not sure why, but smoking and drinking too much both increase HPV’s likelihood of developing into cancer,” he explains.

To be safe, you should also be on the lookout for early signs of oral cancer, which tend to be subtle, so guys often ignore them, says Hill. Unlike tobacco-caused oral cancers, which present in visible symptoms like white lesions or red spots on the tongue, HPV-related cancer cells love lymph tissue and the way back of your tongue. “HPV-caused oral cancers have very stealthy signs, so you really have to pay attention if you feel changes,” he says.

Here’s what to look for: “If you notice it’s become more difficult to swallow, or you’re suddenly always hoarse or have a sore throat, those are definite cancer red flags, and you need to get examined,” Hill says. “Also, if a lymph node in your neck becomes enlarged – and it’s painless – that’s a warning sign of cancer starting inside the mouth and spreading to your neck. When lymph nodes swell up from ear infections or abscessed teeth, they hurt. But these ones don’t. And if you can’t push it around, that’s a definite sign.”

Thankfully, all you dads and future fathers can help spare your sons from these health issues. Get them vaccinated long before they wind up going down on a girl in the back seat of your car. “Don’t put it off until they’re 17,” Schaffner says. “Have them immunized when they’re 11.”

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 
June, 2013|OCF In The News|

Michael Douglas pleased that oral sex story raised public awareness

By Agence France-Presse
Tuesday, June 4, 2013 18:40 EDT
Source: The Raw Story 

Michael-Douglas-and-Catherine-Zeta-Jones-via-Shutterstock-615x345

 

 

 

 

 

 

 

 

Michael Douglas said he would win a Nobel prize if he knew exactly what caused his throat cancer, in fresh comments Tuesday after a dispute with a British newspaper over an interview he gave.

The “Fatal Attraction” star, whose spokesman already denied he blamed his throat cancer specifically on oral sex, also said that, regardless, he was happy to raise awareness about causes of the killer disease.

“I never expected to become a poster boy for head and neck cancer,” Douglas said in comments issued by a representative.

“But, if after what started out as trying to answer a couple of questions about the suspected sources of this disease results in opening up discussion and furthering public awareness, then I’ll stand by that.”

In an interview with Britain’s Guardian newspaper, Douglas, who stars in the just-released biopic of flamboyant entertainer Liberace, “Behind The Candelabra,” said his cancer was caused by the human papillomavirus (HPV).

“Without wanting to get too specific, this particular cancer is caused by HPV, which actually comes about from cunnilingus,” he said, in comments the newspaper said amounted to blaming oral sex for his cancer.

Douglas’s spokesman Allen Burry said Monday that the 68-year-old actor was talking in general, not personal terms.

“This is not the cause of his cancer,” he said.

On Tuesday, Douglas himself added: “Head and neck cancer can be caused by many things including HPV virus, smoking, alcohol, drug abuse, genes, environment and stress. I do not know what caused my particular cancer.”

“If I did I’d have a Nobel Prize. I do know that I am here today because of all the incredible advances in cancer research and treatment. Early awareness is a key factor.”

“If this episode contributes to public awareness, all the better,” he said.

The British newspaper stuck to its guns over the issue, posted an audio clip of the interview on its website and insisted that Douglas had been referring to his own cancer being caused by cunnilingus.

“The Guardian firmly denies this charge of misrepresentation. Mr Burry was not present at the (interview); the only two people present were Mr Douglas and the Guardian writer, Xan Brooks,” the paper noted online.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

June, 2013|Oral Cancer News|

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

By: Crystal Phend, Senior Staff Writer
Published: June 03, 2013
Source: MedPage Today

 

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.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 
June, 2013|Oral Cancer News|

It’s True. You Can Get Throat Cancer From Oral Sex

By: Alexandra Sifferlin
June 03, 2013
Source: TIME

 

On Sunday, in an interview with the Guardian, actor Michael Douglas revealed that his throat cancer was not caused by tobacco and alcohol, but by HPV, which was transmitted through oral sex. He has since called the statement a misunderstanding, but it’s still true: you can get throat cancer from HPV.

In an eye-poppingly candid interview with the Guardian’s Xan Brooks, Douglas, who is married to actress Catherine Zeta-Jones, allegedly told the reporter his cancer was caused by the STD:

The throat cancer, I assume, was first seeded during those wild middle years, when he drank like a fish and smoked like the devil. Looking back, knowing what he knows now, does he feel he overloaded his system?

“No,” he says. “No. Because, without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus.”

From what? For a moment I think that I may have misheard.

“From cunnilingus. I mean, I did worry if the stress caused by my son’s incarceration didn’t help trigger it. But yeah, it’s a sexually transmitted disease that causes cancer.” He shrugs. “And if you have it, cunnilingus is also the best cure for it.”

Right, I say. OK. So what he is suggesting is that it all evens out? “That’s right,” says Douglas. “It giveth and it taketh.”

Human papillomavirus (HPV) is a sexually transmitted disease that can cause genital warts or present itself without symptoms. If left untreated, it can also cause cancers of the cervix, anus, penis, vulva, vagina — and head and neck cancers. “HPV being a cause of head and neck cancer was really only accepted about five years ago,” says Dr. Maura Gillison, a professor at the Ohio State University who studies HPV infections in the head, throat and neck. “Before then, no one really cared about oral HPV infections.”

According to the U.S. Centers for Disease Control and Prevention, about 60% of oropharyngeal cancers — cancers of the throat, tonsils and the base of tongue — are related to HPV. It is estimated that every year in the U.S., more than 2,370 new cases of HPV-related oropharyngeal cancers are diagnosed in women and about 9,356 are diagnosed in men; they are most common in white men.

“It is a known phenomenon,” says Gillison. “In the U.S., there is an active shift going on. Fortunately thanks to tobacco policy and public-health awareness, the incidence rate for the classical head and neck cancer caused by smoking is declining. But unfortunately, the rate of oropharynx cancer is still going up and it’s because of the HPV component.”

In 2011, Gillison and her colleagues conducted a study looking at the proportion of oropharynx cancers associated with HPV over time in the U.S. The proportion increased from 16% to 72% from the late 1980s to the early 2000s. “The incidence is rising pretty rapidly in the U.S.,” says Gillison. “Approximately 10% per year, particularly among Caucasian middle-age men.”

HPV-related throat cancer presents similarly to tobacco- and alcohol-related throat cancer, but they are considered two separate diseases, says Gillison. There are about 15 different HPV types that are established causes of cancer. The most common are HPV 16 and 18, accounting for about 70% of cervical cancers. “For oral infection, we find the same types of HPV in the oral cavity as we do in the cervix or genital region for men, but the infection is considerably less common,” says Gillison.

Oral HPV doesn’t benefit from the comprehensive testing and preventative procedures established for HPV of the cervix. Women who get regular Pap smears are quickly tested for cancerous changes that may be caused by HPV of the cervix.

“When HPV was recognized to be the cause of cervical cancer, the entire algorithm for doing Pap smears and referring a patient to a gynecologist was already established,” says Gillison. “The researchers were able to just piggyback all of their analysis and testing for HPV on the cervix onto something that was already established in the field. For oral, there is no established screening algorithm so there is no piggybacking onto routine clinical care.”

There is currently no method to routinely test for oral HPV, nor is there a way to test men for genital HPV. Researchers are working on developing clinical tests for the virus, which is among the most common STDs: researchers say most sexually active people will likely have an HPV infection at some point, but many never know. The infection doesn’t always present symptoms, and typically clears the body in one to two years.

According to the Johns Hopkins School of Medicine, it is estimated that 20 million people in the U.S. currently have HPV infection, and 1 in 49 people will contract a new HPV infection each year.

Physicians recommend the HPV vaccine for both young boys and girls to prevent infection from the disease.

 

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

June, 2013|Oral Cancer News|

Fact check: Michael Douglas on HPV and throat cancer

Source: www.huffingtonpost.com
Author: Meredith Melnick

A Michael Douglas interview in The Guardian caused waves when the publication reported that the “Behind the Candelabra” star revealed HPV, the human papilloma virus, to be the cause of his stage-4 throat cancer diagnosis in 2010.

“Without wanting to get too specific, this particular cancer is caused by HPV, which actually comes about from cunnilingus,” Douglas allegedly told The Guardian.

Douglas, through his publicist, has said that the statement was misinterpreted: He wasn’t saying that his cancer was caused by the sexually transmitted disease — merely that many cancers like his are HPV-positive. As The Daily Beast points out, there is scant research evidence to directly link the act of cunnilingus with HPV infection. But regardless of the details of his own cancer, the actor is right about one thing: A growing majority of oral cancer cases are caused by HPV.

While most strains of HPV clear up on their own, the sexually transmitted disease is responsible for an array of cancers. As Douglas describes, it’s true that oral sex is an avenue through which a person can contract HPV and especially the strains, HPV-18 and HPV-16, the latter of which is responsible for half of oral cancer cases, according to the National Cancer Institute. HPV-16, HPV-18 and some less-common strains can also cause cancers of the cervix, vagina, vulva, anus and penis.

Douglas’ experience follows trends in cancer diagnosis, according to a January report from the American Cancer Society, which found a rise in oral cancer caused by HPV in both women and men. As the report said, as of 2004, 72 percent of oral cancer tumors were HPV-positive — up from 16 percent of tumors in data collected between 1984 and 1989.

Previously, excessive drinking and tobacco use were the most common causes of the throat cancer Douglas developed, but HPV has replaced tobacco as the leading cause of throat cancers. HPV’s rise as the leading cause of oral cancer is not just the result of growing rates of the virus — it is also explained by drops in smoking, thanks to public health campaigns that describe the dangers of cigarette use.

HPV-16 and 18 are targeted by the vaccine Cervarix and are two of the four strains targeted by Gardasil, the other of the two approved vaccines against HPV. Gardasil is currently recommended for boys between the ages of 13 and 21 and both Cervarix and Gardasil are recommended for girls, aged 13 to 26, according to the Centers for Disease Control and Prevention. HPV-6 and HPV-11, both of which the Gardasil vaccine immunizes against, cause about 90 percent of genital warts cases.

Despite the growing rates of oral cancer, cases like Douglas’ are still relatively rare, with about 7,100 new cases each year, reported USA Today. But that doesn’t mean oral HPV infection is rare: According to a 2012 study of Americans, aged 14 to 69, about 10 percent of men and 3.6 percent of women currently have an oral HPV infection.

According to the CDC, there is no screening test to determine overall HPV status. While women are screened for HPV-associated cervical cancer via a Pap-smear test, other HPV-associated cancers don’t have a specific screening test. Despite the fact that there are no uniform screening techniques for oral cancer, the prognosis for the disease is good, with an 80 to 90 percent survival rate, according to The Oral Cancer Foundation.