Yahoo Lifestyle If you've ever had oral sex, you have to read this
Photography: Mark Andrew and Jonathan Kantor.
Most of us would look at oral sex as a bit of very pleasurable but ultimately harmless fun.
But new research has put a scary spin on the whole thing: a link between oral cancer and human papillomavirus (HPV), the sexually transmitted infection notoriously linked to cervical cancer. What the? A mere decade ago oropharyngeal cancer - a deadly disease often found in the base of the tongue and the tonsils - among women was practically unheard of. Patients were nearly always male and over 50, heavy smokers or drinkers, or both. (When actor Michael Douglas, 66, was diagnosed with the illness last year, the media pointed to his longtime half-a-pack-a-day habit.)
But according to the Journal of Clinical Oncology, there has been a major upswing in HPV-related oral cancers. In fact, up to 20 per cent of all oral cancers are now HPV-related according to the World Health Organisation (WHO), and about 25 per cent of these cases occur in women, says oncologist Dr Gregory Masters.
Take Mische Eddins, 37, who woke up one day with what appeared to be a head cold. Postnasal drip. Sore throat. Swollen lymph nodes. No biggie, seeing as a bug was going around. "I'd just been bragging to my friends about how I'd managed to avoid getting sick," she says. "But I was healthy, so it passed quickly." Everything, that is, except a swollen node on the left side of her neck, which, months later, hadn't gone.
The new year rolled round, and the little bump was still there. Eddins bounced from doctor to doctor, and finally, six months after that seemingly innocuous head cold, she had a PET/CT scan. The results were a total shock: Eddins had stage III oral cancer, and the disease had spread from her tonsil to her lymph nodes. Within hours, her doctors had scheduled a tonsillectomy and were talking about chemo and radiation. Someone suggested she prepare a will.
"I was floored," she says. "A will?" A professional singer, Eddins exercised almost every day, ate a mostly organic diet, didn't booze heavily and had never smoked as an adult. Even her doctors were stymied.
Searching for answers, one doc tested Eddins' cancer cells for HPV. Eddins was taken aback; shed spent the past 16 years in two monogamous relationships and was fastidious about getting annual pap smears, which had never been abnormal. Why were they testing her mouth? Her doctors explained the new link between oral cancer and HPV, which can be transmitted to the mouth via oral sex. And indeed, she tested positive. Her oral cancer was HPV-related.
a numbers game
But how could HPV, a sexually transmitted infection associated with the genitals, be causing so many mouth problems? Its something doctors and public health experts have long feared, thanks to the rampant spread of the virus. You've probably heard the stats: at least 75 per cent of sexually active people (males and females) will be infected with at least one type of HPV virus which can have zero symptoms or bloom into warts at some point in their lives, according to the Cancer Council Australia.
In the vast majority of cases, the body's immune system will clear HPV on its own within two years (there is some debate over whether the same HPV infection can return to cause cervical lesions later, but research is still in early stages). But a small percentage of infected women won't clear HPV, and may develop cervical cancer. This prompted WHO to recommend all girls be vaccinated for HPV by age 12.
To date, safe-sex campaigns have typically blamed the spread of HPV on unprotected vaginal intercourse. But its now clear that the disease can be contracted orally too. And thats where things got dangerous for Eddins and thousands of other women. Their mouths were infected with HPV-16, the particular type that most doctors believe is responsible for the majority of cases of HPV-related oral cancer.
The signs of HPV to look for in your mouth
Painful sores Any sore or lesion inside the mouth that lasts longer than two weeks should be checked out by a doctor, says Dr Eduardo Mendez, a head and neck surgeon.
Long-term hoarseness or an unexplained persistent cough.
A persistent sore throat “Don’t ignore a sore throat that goes on longer than two weeks or any lump in your neck that’s present for more than a few days,” says otolaryngologist Dr Eric Moore.
Pain or swelling in the lymph nodes or neck that lasts longer than two weeks.
Changes in your voice or ability to swallow.
Just how long HPV-16 lingers in the mouth before turning into cancer is uncertain. But what is evident is that more than 14 per cent of cases arent caught until very late stages, possibly because some physicians are slow to consider the cancer in young female patients. Usually, the patient is quite healthy, exercises regularly and eats right. She doesn't fit the old oral cancer profile.
Lydia Miner definitely didn't fit the profile. She too ate well, worked out and didn't smoke or drink heavily. But she had a strange sensation in the back of her throat that felt like a half-swallowed pill, stuck midway. Or maybe, she thought, it was a patch of skin irritated by one of the many times shed hurriedly choked down lunch during her hectic job. "For a while I thought I was just imagining it," says Miner, now in her 40s. But after two months, she knew better.
Like Eddins, Miner got a scan, which showed something alarming. "The doctor stared at the results, then turned to me and said, 'I think you have oral cancer'," she recalls. Her small malignant tumor, which was later surgically removed, tested positive for HPV. Lydia was incredulous. She hadn't thought about the virus in more than a decade. In her 20s, she'd had a series of abnormal pap smears; but by her 30s, her tests continuously came back normal and she'd forgotten about any irregularities.
But HPV is nothing if not sneaky; it can lie dormant and undetectable in the body for years, making it incredibly difficult to know if you're infected and unknowingly passing it along to others. This can also make it nearly impossible to pinpoint the partner responsible for giving it to you.
Though between 40 and 60 per cent of men have HPV at any given time, less than one per cent of them will have visible symptoms, and there is currently no approved test available to detect HPV infection in men. What all this means is that oral sex once considered a "safer" alternative to vaginal sex might not be quite so harmless after all.
who's doing what
The most obvious HPV-related oral-cancer risk factors, as you might imagine, have to do with the kind of sex you have, how often you have it, and the number of partners you've tangled sheets with. According to a study in the New England Journal of Medicine, people who have had six or more sex partners are more than twice as likely to develop oral cancer. But those who've had six or more oral sex partners increase their chances by a whopping 340 per cent.
As such, says Dr Masters, HPV-related oropharyngeal cancer should be considered a sexually communicable disease. "From cases I see, I get the sense that many younger people don't think oral sex counts as sex," he says. But oral sex has risks too.
As is the case with most STIs, the best way to protect yourself from HPV-related oral cancer is abstinence, which really isn't realistic for most people. Complete honesty about your sexual history and frequent HPV testing can help (there is an HPV test available for certain strands of HPV, but it's only subsidised by Medicare in a small number of cases), and the HPV vaccine might work too.
A 2011 Australian study from the Victorian Cytology Service found the first solid evidence to suggest vaccination against HPV can help prevent cancer since the advent of the national HPV immunisation program in 2006, girls younger than 18 have presented with 38 per cent fewer serious cervical lesions (precursers to cervical cancer).
Using condoms for any sexual contact - yes, including oral sex and even with a committed partner - can also help thwart the genital-to-mouth spread of HPV, though its naive to think couples will commit to a lifetime of wrapped-up oral sex. (For their part, men can get oral HPV by performing oral sex on a woman with vaginal HPV, with or without using a dental dam, says Dr Worden. Michael Douglas reportedly tested positive for HPV, and while there is no concrete link between his cancer and the STI, cases of HPV-related oral cancer are also rising among men.)
"Oral cancer can show up as tumours, cracks or lesions on your throat, voice box, tonsils or tongue. Around 2000 Australians are diagnosed each year and nearly 500 die from the disease. Because the cancer is so tricky to catch, it’s important to pay close attention to any changes in your mouth and throat."
If this advice sounds thin, that's because it is. The fact is, a lot of HPV research still needs to be done if it can be done at all. For one thing, determining how sexually transmitted diseases spread depends in large part on the truthfulness of patients and test subjects. "It's particularly tough to get figures on sexual habits, because you're relying on peoples memories and forthrightness," says Dr Masters.
early warning
But there is good news: if detected early, this type of cancer is highly treatable. Compared with other forms of mouth malignancies, HPV-related oropharyngeal cancers have significantly higher survival rates, especially among non-smokers. "For reasons were not entirely sure of, HPV-related cancers respond better to chemotherapy and radiation," says Dr Masters. "The majority of patients are cured not only because they are generally younger and more tolerant of treatment but also because the cancer actually behaves differently."
The key, of course, is to catch it early in most cases, this means spotting a lesion or a change in mouth tissue colour or texture. It also means seeing your dentist regularly (sorry). Tests using rinses, dyes and different types of light are being developed to allow dentists to administer comprehensive oral-cancer screenings, but many dentists are already actively peering into patients mouths, on red alert for cancerous signs. (While all dentists are educated in cancer screenings, not all perform them, so its crucial to ask.)
Professor Basil Donovan, head of the Sexual Health Program at the Kirby Institute at the University of NSW, says the incidences of oral cancers shoot up in people in their 50s, and the statistics in Australia show it's fairly rare in younger people though he believes there could be a lot more young women in the very early stages. "That's because HPV-related cancers take on average 30 years to develop, from the time of infection to the time a person presents with a cancer. It's not often diagnosed until the symptoms become very obvious."
Your dentist will be looking out for symptoms of mouth cancer, so its important to get your mouth checked regularly too. "Women are really good about going for their annual pap smears, but I don't know one gynaecologist who will look in your mouth," says Dr Gigi Meinecke, a dentist who performs a thorough oral exam on all of her patients. "The only place you're going to get that is at your dentist's office."
A good oral cancer screening, says Dr Meinecke, should include a thorough head, neck and lower-jaw exam, as well as checks of lymph nodes, front of ears (where tumours can also develop) and back of neck. And your tongue should be examined from every angle. Basically, what were looking for are subtle changes in colouration, she says.
Dental screenings aren't 100 per cent fail-safe. The biggest problem with these types of cancers is that people typically don't have a lot of symptoms, and if you can't see it or feel it, your dentist might not either. But enlisting an extra set of trained eyes is still worthwhile, especially if there's any kind of oral abnormality. Really, you just can't be too sure.
