Rise in Some Head and Neck Cancers Tied to Oral Sex: Study

Changes in sexual activity linked to increased HPV-related tongue, tonsil malignancies

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By Amanda Gardner
HealthDay Reporter

TUESDAY, Jan. 25 (HealthDay News) -- There's a worrisome uptick in the incidence of certain head and neck cancers among middle-aged and even younger Americans, and some experts link the trend to a rise in the popularity of oral sex over the past few decades.

That's because the human papillomavirus (HPV) is a major trigger for these cancers, and HPV can be transmitted through this type of sexual activity.

"It seems like a pretty good link that more sexual activity, particularly oral sex, is associated with increased HPV infection," said Dr. Greg Hartig, professor of otolaryngology--head and neck surgery at the University of Wisconsin School of Medicine and Public Health in Madison.

According to Dr. William Lydiatt, professor and chief of head and neck surgical oncology at the University of Nebraska Medical Center in Omaha, the overall incidence of head and neck cancers is going down, largely because fewer people are smoking (tobacco and drinking are the major traditional risk factors).

But the incidence of cancers of the tonsil and base of the tongue have been going up over the past decades, he said. And those are the ones that are more likely to test positive for HPV.

"It's gotten to the point now where 60 to 70 percent of all tonsil cancers in the U.S. are HPV-related," Lydiatt said.

Although the link between HPV and these types of cancers is indisputable, the association with oral sex is strong but a little more speculative, experts say.

A 2007 study in the New England Journal of Medicine found that younger people with head and neck cancers who tested positive for oral HPV infection were more likely to have had multiple vaginal and oral sex partners in their lifetime.

In the study, having six or more oral sex partners over a lifetime was associated with a 3.4 times higher risk for oropharyngeal cancer -- cancers of the base of the tongue, back of the throat or tonsils. Having 26 or more vaginal-sex partners tripled the risk.

And the association increased as the number of partners -- in either category -- increased.

The researchers also reported that cancers of the tonsil and base of the tongue have been increasing every year since 1973, and wrote that "widespread oral sex practices among adolescents may be a contributing factor in this increase."

The researchers concluded that in their study, oral sex was "strongly associated" with oropharyngeal cancer, but noted that they could not "rule out transmission through direct mouth-to-mouth contact" such as French kissing.

In 90 percent of cases of HPV infection in the body, the immune system clears HPV naturally within two years, according to federal health agencies, but in some cases, certain types of HPV can lead to cervical cancer or less common malignancies, such as oropharyngeal cancer. A 2010 Swedish study, in fact, suggested that the rise in oropharyngeal squamous cell cancer in a number of countries "is caused by a slow epidemic of HPV infection-induced [cancers]."

HPV tends to be site specific, explained Dr. Amesh A. Adalja, an adjunct instructor in the division of infectious diseases at the University of Pittsburgh Medical Center. In other words, it tends to stay wherever it first enters the body, be it the vagina (which in some cases could lead to cervical cancer), or the mouth and throat.

So does the increase in incidence mean that recent generations are having more sex than their grandparents?

"The general consensus on the street is that because people's [sexual] practices have changed over time, we're seeing an increase in these cancers," said Hartig. "I don't know why they're having more oral sex [but] the concept of having oral sex is something that seems less obscure to you than it did to your parents or grandparents."

"The thought would be that the Baby Boomers -- the 60s and early 70s generation -- probably had more freedom in sexual relationships in general, including oral sex," added Dr. Bert W. O'Malley, Jr., chair of otorhinolaryngology--head and neck surgery at the University of Pennsylvania.