Source: The Oregonian (www.oregonlive.com)
Author: Cynthia Billhartz Gregorian St. Louis

Ten years ago, most of Dr. Brian Nussenbaum’s oral cancer patients were men over 60 who used tobacco and drank heavily. Today, his patients with oral cancer look different. And so does the risky behavior that seems to be leading to their cancer.

Nussenbaum, an ear, nose and throat doctor at Washington University, estimates that 70 percent of his cancer patients have tumors on the back of their tongues and tonsils caused by human papillomavirus-16. Most patients are between ages 45 and 55. About half are women.

And experts suspect that all got the HPV from oral sex.

“We know now that 98 percent of cervical cancer is caused by HPV, and mostly HPV-16,” says Nussenbaum. “But no one talks about how you can also get mouth cancer from it.”

Last week, Dr. Harald zur Hausen, a German doctor and scientist, was awarded the Nobel Prize for medicine for finding human papilloma viruses that cause cervical cancer, the second-most-common cancer among women.

In awarding zur Hausen the prize, the Nobel assembly said he “went against current dogma” in the 1970s when he discovered that certain types of HPV caused the cancer and that the DNA of HPV could be found in tumors.

More than 20 years passed before researchers at Johns Hopkins Kimmel Cancer Center reported a link between HPV and these specific throat cancers in 2000. They and other medical experts suspect the increase in HPV oral cancer stems from a shift in sexual behaviors about 40 years ago, combined with a dramatic decrease in the number of tonsillectomies performed. Cancer from the HPV virus often develop on the tonsils.

In the John Hopkins study, researchers compared healthy people to patients with HPV oral cancer and concluded that people with HPV infections were 32 times more likely to develop the oral cancer than those without HPV. And people who had more than six oral sex partners in their lifetime were 8.6 times more likely to develop the HPV-linked cancer.

These findings have ramifications for anyone who is sexually active. Parents have another reason to think hard whether they want their adolescent daughters, and perhaps even sons, vaccinated with Gardasil, which helps protect against human papillomavirus. And even baby boomers who thought they’d dodged the STD bullet might not have after all.

Experts think HPV lies dormant for years, perhaps decades, before causing the cancer. No one knows how long, because there’s so little data. The National Cancer Institute determined recently that the rate of oral cancer caused by HPV has risen steadily since 1973.

Nussenbaum says a lot of doctors spend very little time, if any, discussing the cancer’s link to oral sex. He’s given second opinions to several patients whose diagnosing doctors never mentioned HPV or its link to sexual behavior.

“In clinic, I let patients direct the conversation,” Nussenbaum says. “I don’t push or force the issue. It can get a bit uncomfortable, especially when there are other family members, like children or spouses, in the room.”

Symptoms of HPV oral cancer can include difficulty swallowing, a sore throat that won’t go away, ear pain and a lump in the neck. Blood tests won’t detect this type of cancer. But blood and saliva tests can detect HPV. None is being used in mainstream clinical settings yet.

The only good news with this type of cancer is that the tumors are highly sensitive to radiation and chemotherapy.

Nussenbaum says that even with stage 3 and 4 HPV cancer, the chance of living for three years is nearly 90 percent. For patients with non-HPV cancer, the survival rate is usually about 55 percent.

Meanwhile, everyone agrees, practicing safe oral sex with condoms and dental dams is the best way to guard against oral HPV, which can lead to the cancer. So is getting the word out that it exists.

Nussenbaum recalls telling a patient that she had HPV oral cancer and that patient turning to her two teenage daughters, looking them right in the eyes and saying, “See. I told you sex can kill you.”