• 10/23/2007
  • Colorado Springs, CO
  • Brian Newsome
  • Colorado Springs Gazette (gazette.com)

Several years ago, Dr. Joel Ernster noticed something strange in his Colorado Springs ear, nose and throat practice. A man with no history of heavy smoking or drinking developed an uncommon throat cancer usually caused by such habits. Over time, there were dozens more like him.

Ernster investigated the trend and after three years of research has found what appears to be the answer: a virus likely transmitted by oral sex.

In a study to be published in coming months in The Laryngoscope, a leading medical journal for ear, nose and throat specialists, the physician connects a significant increase in throat-cancer cases among men to the human papilloma virus that causes cervical cancer in women.

Men probably obtain the virus by performing oral sex on women who have an HPV infection of the cervix. Ernster said the cancer could develop as late as 20 years after the oral sex occurred.

“Oral sex has implications that are way beyond what we first thought,” he said.

Ernster’s research is the latest in a growing body of studies that have established a connection between the HPV virus and oropharyngeal (throat) cancer. A study published online in August and in print this month in the journal Cancer similarly suggests that a rise in throat cancer among men younger than 45 can be attributed to the HPV virus.

Why cases among young men are increasing is unclear, but Ernster and others believe oral sex generally has become a more prevalent practice than in years past. Surveys have shown that attitudes toward oral sex are more casual than toward intercourse, and many people consider it an alternative to contraception or perceive it as safer. It does not, however, eliminate the risk of common sexually transmitted diseases.

A 2005 Centers for Disease Control and Prevention survey of thousands of people ages 15-44 found oral sex was a common practice among teenagers, with 28 percent of boys ages 15-17 performing oral sex on girls for data collected in 2002. Ninety percent of men ages 25-44 reported having oral sex with women, compared with 97 percent who reported having intercourse with them.

The oropharyngeal cancer attacks the tonsils or the base of the tongue. People who have had their tonsils removed can suffer from the cancer in surrounding tissues.

Ernster and another area doctor, Cosimo Sciotto, found that annual incidences of the cancer among men rose by 40 percent in Colorado and 11 percent nationally from the 1980s to the ’90s. They do not know why Colorado has so many more cases than other states.

The increase in throat cancer was not found in women, and other kinds of head and neck cancers decreased for both genders, which Ernster and Sciotto say is probably from a decrease in smoking.

The doctors also analyzed stored tissue samples from 72 male and female throat-cancer patients in El Paso County spanning 25 years. They found that samples testing positive for the HPV virus increased substantially over time for males, correlating with the rise in overall throat cancer cases.

“From this it is likely that the virus is causing this spike in oropharyngeal cancers,” Ernster wrote in a summary of his findings.

The research raises questions about whether boys and men should receive a vaccine given to some girls and women to prevent HPV, which is a primary cause of cervical cancer.

Researchers who published a similar study in Cancer, Erich M. Sturgis and Paul Cinciripini of The University of Texas MD Anderson Cancer Center in Houston, concluded that the vaccine could have a strong impact on reducing the number of throat-cancer cases in men. They called for more studies on the vaccine’s use in men and boys.

The new vaccine is approved by the Food and Drug Administration for use only on girls and women ages 9-26, said Dr. Bernadette Albanese, medical director for the El Paso County Department of Health and Environment.

At least 24 states are pushing legislation to require the vaccine for young girls, but such mandates have been met with resistance because of the vaccine’s cost, questions about its effectiveness and the political debate over vaccinating children against an STD.

An effort by Colorado Sen. Suzanne Williams, D-Aurora, to require the vaccine in Colorado died in committee. Williams said at the time the main objections were the newness of the vaccine and whether it was appropriate to give to young girls.

Although there are numerous studies on HPV, the virus is not a reportable condition tracked by the health department like many other STDs are, such as AIDS, syphilis or gonorrhea, Albanese said.

The CDC estimates about 20 million people are infected with HPV and says at least 50 percent of sexually active men and women acquire genital HPV infection during their lives. There are multiple strains of the virus and only certain ones seem to be linked to cancer.

By age 50, at least 80 percent of women will have acquired genital HPV infection, and about 6.2 million Americans get a new genital HPV infection each year, the CDC reports.

The local study found one bright spot amid the rising cancer rates and new ways to contract the disease: Survivability appears much higher for people who have throat cancer that contains the HPV virus than in throat-cancer cases in which the HPV virus is not present.

HPV-positive throat cancer is linked in the study to men ages 35 to 55 years old, and Ernster said the cancer could develop decades after engaging in oral sex.

In light of his findings, Ernster asks male patients with such cancers about their sexual history.

Men who have long been married with families are surprised to learn that sexual activity from their college or high school days may be the cause of their cancer, he said.

The findings serve as a warning for men to pay attention to the signs: a lump on the neck or a sore throat that doesn’t go away.

For doctors, the new information could mean the difference in recognizing cancer early in someone who doesn’t fit the traditional profile of drinking and smoking.

Despite the rising numbers, oropharyngeal cancer is uncommon compared with many cancers. It affects about five of every 100,000 people, compared with about 130 of every 100,000 for breast cancer.

Still, it’s a cancer that can cause difficulty with basic functions such as talking, swallowing and tasting, and treatment can alter physical appearance.

The study was funded by the Penrose-St. Francis Foundation.