Blog Post

The Safe Sex Message and Rising Oral Cancer Rates

Sex education programs that encourage youth to engage in "safer sex" or to use oral sex to avoid pregnancy may be putting young people at risk for cancers of the head and mouth.

The Washington Times is reporting on a first-of-its-kind study released late last week which estimates that about one in every 14 Americans carries in their mouths and throats a sexually transmitted virus that can cause a virulent form of cancer.

According to the study, which was published in the Journal of the American Medical Association, found that head and neck cancers, which claim the lives of 50,000 people a year, are increasingly being caused by the human papillomavirus (HPV). The culprit is HPV-16, a prevalent strain that is particularly likely to cause these cancers.

Dr. Maura L. Gillison, who is associated with the Ohio State University Comprehensive Cancer Center, and her colleagues said an estimated 2.13 million Americans have an oral HPV-16 infection with men being almost three times as likely as women to test positive for the infection (10.1% vs. 3.6%).

There was a time when tobacco use was most often the cause of head and neck cancers, but the sexually transmitted HPV-16 is becoming increasingly associated with these deadly forms of cancer. The study found that HPV-caused oropharyngeal cancers have jumped 225 percent, from 0.8 cases per 100,000 to 2.6 cases per 100,000, in recent years.

"I've been involved in the care of head/neck cancer patients for 25 years, and it is only in the last five to seven years that we are realizing that HPV is associated with a substantial proportion" of these cancers, said Dr. Paul Harari, department chairman of human oncology at the University of Wisconsin School of Medicine and Public Health.

Head and neck cancers involve the mouth, lips, tongue, throat and voice box, and have about a 50 percent mortality rate. Oropharynx cancer, which pertains to cancers in the back part of the mouth, the tonsils and skin down to the middle part of the throat, is fatal for about 8,000 people a year.

The study was based on oral-fluid samples collected from 5,000 people ages 14 to 69 and found that infections were associated with being a smoker, a heavy drinker, and current or past marijuana use. Prevalence also rose with the number of lifetime and recent sex partners.

An ongoing study may help clarify how oral HPV is transmitted, such as through "deep kissing" and oral sex.

One of the solutions being discussed is the prospect of using HPV vaccines already on the market that target HPV-16 and other stains that cause herpes and cervical cancer.

According to Dr. Gillison, the impact of this vaccine on oral HPV infections is currently unknown, "and therefore vaccination cannot currently be recommended for the primary prevention of oropharyngeal cancer."

However, because oropharyngeal cancers are expected to surpass cervical cancer rates by 2020, "perhaps such vaccine trials are warranted," they added.

Experts are also advising young people who engage in oral sex to use barrier protection of some kind.

This study should be concerning to sex educators whose comprehensive programs lack a compelling abstinence message and instead promote ways to engage in sexual activity while minimizing the risks of pregnancy or disease. Promotion of sexual activity at young ages inevitably leads to a higher number of sexual partners which has been associated with increased risk of head and neck cancers.

These programs also recommend that teens resort to practices such as oral sex as an alternative to intercourse and as a way to avoid the risk of pregnancy. Apparently, young people are taking this advice. A 2008 study published in the Journal of Adolescent Health found that 55 percent of youth engage in oral sex during their teens.

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