The topic becomes considerably more relevant, however, when coupled with
a new study linking the human papillomavirus (HPV) to an increased risk
of a kind of oral cancer more often seen in men.
The study, which appears in this week's New England Journal of Medicine (NEJM), shows that men and women who reported having six or more oral-sex partners during their lifetime had a nearly ninefold increased risk of developing cancer of the tonsils or at the base of the tongue. Of the 300 study participants, those infected with HPV were also 32 times more likely to develop this type of oral cancer than those who did not have the virus. These findings dwarf the increased risk of developing this so-called oropharyngeal cancer associated with the two major risk factors: smoking (3 times greater) or drinking (2.5 times greater). HPV infection drives cancerous growth, as it is widely understood to do in the cervix. But unlike cervical cancer, this type of oral cancer is more prevalent in men.
The study's findings bring to light a part of the debate over HPV vaccination and treatment that is often overlooked: the elevated risks of cancer that being HPV-positive has for men. According to Johns Hopkins' researcher Dr. Maura Gillison, who worked on the study: "When you look at the cancers associated with HPV in men — including penile cancer, anal squamous cell carcinoma, oral cancers — it's very close to the number of cases of cervical cancer that occur in the U.S. in women every year. We need to adjust the public's perception... that only women are at risk."
In his practice, Haddad has seen an increase in the number of younger people developing this cancer, people in their 30s and 40s. He attributes it in part to a "change in sexual behavior over the last decade." He says: "The idea that oral sex is risk-free is not correct. It comes with significant risks, and developing cancer is one of them."
The study, which appears in this week's New England Journal of Medicine (NEJM), shows that men and women who reported having six or more oral-sex partners during their lifetime had a nearly ninefold increased risk of developing cancer of the tonsils or at the base of the tongue. Of the 300 study participants, those infected with HPV were also 32 times more likely to develop this type of oral cancer than those who did not have the virus. These findings dwarf the increased risk of developing this so-called oropharyngeal cancer associated with the two major risk factors: smoking (3 times greater) or drinking (2.5 times greater). HPV infection drives cancerous growth, as it is widely understood to do in the cervix. But unlike cervical cancer, this type of oral cancer is more prevalent in men.
The study's findings bring to light a part of the debate over HPV vaccination and treatment that is often overlooked: the elevated risks of cancer that being HPV-positive has for men. According to Johns Hopkins' researcher Dr. Maura Gillison, who worked on the study: "When you look at the cancers associated with HPV in men — including penile cancer, anal squamous cell carcinoma, oral cancers — it's very close to the number of cases of cervical cancer that occur in the U.S. in women every year. We need to adjust the public's perception... that only women are at risk."
In his practice, Haddad has seen an increase in the number of younger people developing this cancer, people in their 30s and 40s. He attributes it in part to a "change in sexual behavior over the last decade." He says: "The idea that oral sex is risk-free is not correct. It comes with significant risks, and developing cancer is one of them."
Human Papillomavirus HPV & Oral Cancer
Human
Papillomavirus (HPV) is the most common STD in the United
States. There are 6.2 million new infections each
year. Most HPV infections spontaneously clear on
their own, 70% within one year and 90% within two years.
Over 40 different types of HPV infect the
mucosal areas of the body.
...
The skin can also become infected, for example plantar warts are caused a variety of the HPV virus. In this case, only skin to skin contact or walking on an unclear surface can result in an infection.
Substantial evidence is mounting that the Human Papillomavirus or HPV is playing an increasing important role in oral cancer. On the rise are cancers of the tonsils and base of tongue. Infections with HPV-6 and HPV-11 are known causes of genital warts and cervical cancer(1) . It has been shown that 70% of cervical cancers are caused by HPV-16 and HPV-18. Frisch and Biggar (2) reported that patients with anogenital squamous cell carcinoma had a 4.5 increased risk of developing tonsillar cancer.
..
D'Souza (4) demonstrated that HPV is by far the major risk factor for developing oropharyngeal carcinoma. He demonstrated HPV-16 in 72% of 100 pathology specimens studied. He found that patients who developed HPV had an odds ratio of developing oropharyngeal cancer of 32.2, as heavy alcohol use had an odds ratio of 2.5, and heavy smoking (greater than 20 pack year) had an odds ratio of 2.8. The interaction between HPV, tobacco and alcohol is unclear.
Chemock et. al (5) found Human Papilloma Virus in 63.5% of oropharyngeal squamous cell carcinoma tumors in Whites and 11.5% of tumors in African Americans.
...
The skin can also become infected, for example plantar warts are caused a variety of the HPV virus. In this case, only skin to skin contact or walking on an unclear surface can result in an infection.
Substantial evidence is mounting that the Human Papillomavirus or HPV is playing an increasing important role in oral cancer. On the rise are cancers of the tonsils and base of tongue. Infections with HPV-6 and HPV-11 are known causes of genital warts and cervical cancer(1) . It has been shown that 70% of cervical cancers are caused by HPV-16 and HPV-18. Frisch and Biggar (2) reported that patients with anogenital squamous cell carcinoma had a 4.5 increased risk of developing tonsillar cancer.
..
Of the 29,627 cases of oral cancer in
2003, up to 12% were caused by HPV. The incidence is
approximately, one-third of the 11.820 cases of vaginal
cancer caused by HPV in the same year.
Sexual transmission is associated with infection of the upper
respiratory tract. D'Souza, et. al. (4) found that HPV
associated oral pharyngeal cancer was associated with greater than
25 life-time vaginal-sex partners and greater than 6 life-time oral
sex partners. However, they could not rule out transmission by
direct mouth to mouth contact.
D'Souza (4) demonstrated that HPV is by far the major risk factor for developing oropharyngeal carcinoma. He demonstrated HPV-16 in 72% of 100 pathology specimens studied. He found that patients who developed HPV had an odds ratio of developing oropharyngeal cancer of 32.2, as heavy alcohol use had an odds ratio of 2.5, and heavy smoking (greater than 20 pack year) had an odds ratio of 2.8. The interaction between HPV, tobacco and alcohol is unclear.
Chemock et. al (5) found Human Papilloma Virus in 63.5% of oropharyngeal squamous cell carcinoma tumors in Whites and 11.5% of tumors in African Americans.
Haddad (6) reports that HPV
associated oral carcinoma occurs in a higher proportion of men, at a
younger age and at a more advanced stage than non-HPV associated
oral carcinoma. He also states that HPV oral carcinomas are
believed to have a better prognosis.
A new vaccine, Gardasil, protects against four of the most common HPV viruses which causes genital warts and cervical cancer. Since the cancer risk for men for oropharyngeal cancer, anorectal cancer and penile cancer is about the same incidence as for cervical cancer, some doctors are now considering giving the vaccine to men (6).
A new vaccine, Gardasil, protects against four of the most common HPV viruses which causes genital warts and cervical cancer. Since the cancer risk for men for oropharyngeal cancer, anorectal cancer and penile cancer is about the same incidence as for cervical cancer, some doctors are now considering giving the vaccine to men (6).
If a patient has a papilloma on his tonsil should he have his tonsils removed?
Although tonsillar cancer is the most common cancer caused by HPV, removal of the tonsils in patients with papilloma is probably not indicated. The type of HPV viruses which causes papillomas are HPV-6 and HPV-11 but tumors are associated with HPV-16 and HPV-18. In addition, a tonsillectomy is not a risk free surgery and should not be undertaken lightly. If the patient still wishes to be considered for a tonsillectomy, removal of the papilloma and serotyping the virus is indicated.
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