• 9/17/2007
  • web-based article
  • Claudia Pinto
  • The Tennessean (Tennessean.com)

Smoking and drinking alcohol aren’t the only habits that increase the risk of head and neck cancer, there is a lesser-known but just as deadly contributor: oral sex.

The disease is striking an increasing number of younger adults aged 20 to 44, and the cause is attributed to a sexually transmitted disease known as human papillomavirus or HPV, according to a report in next month’s issue of Cancer, the American Cancer Society’s peer-reviewed journal.

Dr. Wendell Yarbrough said he’s seeing the trend in patients he treats at Vanderbilt University Medical Center.
“The rate of positive HPV tumors are increasing in the younger folks,” said Yarbrough, who is a Vanderbilt associate professor of otolaryngology and cancer biology and an Ingram professor of cancer research. “We’ve treated some people in their 20s. We used to never see it in people that young.”

“Head and neck cancer used to be a disease of people in their 50s and 60s who smoked and drank a lot.”

Yarbrough believes the reason for the change is an increase in HPV infection among the general public, due in part, people having more sexual partners and engaging in sexual activity earlier in life. Studies back up his views.

Twenty-nine percent of American men and nine percent of American women have had 15 or more sexual partners in their lifetime, according to a study by the National Center for Health Statistics, a branch of the Centers for Disease Control and Prevention. The center conducted another survey that found more than half of U.S. teenagers aged 15 to 19 have had oral sex.

While statistics indicate that oral sex may be more widely practiced, many people still feel uncomfortable talking about it, Yarbrough said.

“That’s working against us in informing people that it puts them at risk,” he said.

Dr. Kimberlee Wyche-Etheridge, Metro Health Department’s director for family, youth and infant health, said oral sex carries less of a stigma for teenagers than it did for their parents.

“It’s not considered a big deal,” she said. “It’s not considered sex.”
She said teen’s comfort level with oral sex might be linked to the misperception that the act doesn’t pose health risks.

“It’s a false sense of security,” Wyche-Etheridge said. “Besides HPV, you can get herpes and gonorrhea in the throat. It’s also a great portal for HIV.”

There are roughly 45,000 new cases of head and neck cancer diagnosed each year in the United States, Yarbrough said. It’s estimated that more than 10,000 of those cases are caused by HPV.

In Tennessee, there were more than 3,000 cases of head and neck cancer from 1999-2003, according to statistics from the state’s department of health.

HPV is a common virus that is passed on through genital contact. Every year in the U.S., about 6.2 million people get HPV, according to the Centers for Disease Control and Prevention.
Most times, HPV infection has no symptoms and the body’s immune system is able to ward it off on its own. Because it’s typically symptomless people get it and pass it along without realizing it.
Two ways to protect against HPV

Yarbrough said there are two ways to protect yourself from getting HPV: abstinence and a vaccine, called gardasil, which has been shown to block some strains of the virus.

The vaccine is available and is marketed as a way to prevent cervical cancer, which is also caused by HPV. It’s recommended that girls get the shot as early as age 11, before they become sexually active and put themselves at risk for infection.

Carol Hopkins of Nashville had both of her teenage daughters vaccinated. She said she didn’t know that the shots could also protect them from getting head and neck cancer, but sees that an added bonus.

“I just want to protect their health in whatever way I can,” Hopkins said.

Studies are underway to see if the vaccine protects boys against HPV infection. The authors of the report in Cancer said the rise in HPV-positive tumors in younger adults only elevates the importance of determining that.

If the vaccine is found to be effective, the authors said boys should be vaccinated. Yarbrough agrees.
“If we can prevent 10,000 cases of cancer each year, that’s a huge deal,” he said.