One of the biggest questions anybody who ends up sick asks is, “how could I have prevented this?” Anyone who carries extra pounds, drinks alcohol, smokes, eats non-organic food, takes a vaccine, has sex, lives near high-power wires, talks on their cell phone, or has a donut with coffee wonders whether that decision will ultimately lead them to getting cancer, having a heart attack, becoming diabetic, becoming autistic, or being hurt in a car accident.
This was a big week for news about the spread of HPV, one of the most common STDs in the U.S., believed to be found in over 90% of sexually active people. The research, performed at Ohio State, examines the rate of HPV in the mouth and found that 6.9 percent of people between 14 to 69 years who participated in the study had oral HPV.
More interesting—and if you don’t like reading about sex, this is the place to stop—the research questioned the assumption that increased rates of oral HPV (and HPV-related oral cancer) was caused by an increase in oral sex. Here’s the analysis:
Although risk of HPV-positive OSCC has previously been associated with oral sexual behaviors,2,19,20 the colinearity of sexual behaviors precluded associating infection with any particular behavior. Oral HPV infection was more common among sexually experienced individuals who did not report performing oral sex than among sexually inexperienced individuals, consistent with transmission by other sexually associated contact (eg, deep kissing).
In other words, although having oral sex may increase risks it is not the only risk in getting oral HPV and that even “deep kissing” could be a cause. The other related finding was that men who performed oral sex on women were at higher risk than women who performed oral sex on men. While the research did not break down the evidence for gays and lesbians, it would be interesting to see what the rates were for those subgroups who would help challenge the hypothesis of the oral sex link.
The other thing that is fascinating, to me, is that HPV appears to peak in men at ages 55 to 64 years. A similar age-peak was found with HPV-related cervical cancer.
The second peak in oral HPV prevalence we observed was not entirely explained by participants’ sexual behaviors or other factors and could have arisen from a combination of increased incidence, reactivation of latent infections due to age-related loss of immunity,23differences in sexual behaviors across birth cohorts,7 or increased persistence among older individuals.24 The bimodal age pattern was evident primarily for high-risk but not low-risk infections, suggesting an association of age with oralHPV persistence (given higher rates of persistence for high-risk infections). Prior studies, however, demonstrate that incident cervical HPV infections have similar persistence rates regardless of age.25
The research calls to mind a comment my oncologist, John Deeken, made to The Atlantic in discussing the rise of oral cancer
“The epidemiology is perplexing,” he says. “The assumption, when we noticed the trend eight or nine years ago, was that this was a sexually transmitted disease due to more oral sex,” he says. “But at least at Georgetown, we have patients in their 80s with this kind of cancer,” he notes. “That raises questions about the sexual habits of Americans who are older, or about HPV.”:
Deeken’s comments come in response to the release of data by the American Cancer Society about the increase in oral cancer, with HPV-related cancer increasing while cancer connected just to smoking is decreasing.
The ACS estimates there will be 13,500 new cases of oropharyngeal cancer in the U.S. this year. This includes both HPV positive and negative cases; nearly 11,000 men and over 2,500 women will be affected; some 2,300 will succumb to this condition. Between 1999 and 2008, the rate of HPV positive oropharyngeal cancers by rose 4.4 percent per year in white men and by 1.9 percent per year in white women. Changes among other racial and ethnic groups were not significant, according to the report. The biggest rise emerged in men between the ages of 55 and 64 years.
So what does this all mean? Well, we have a lot more to learn. There needs to be more research looking at what causes the virus—and how to prevent it—and why most people with the virus will never end up with cancer. The other big question, as everyone points out, is determining whether vaccines like Gardasil can prevent oral HPV. Despite the numbers and the increase in cancer rates, there is still no research to determine whether it will prevent oral HPV. And, of course, Gardasil is often not covered by insurance companies for boys despite evidence that men (and specifically white men) appear to be the likeliest group to have oral HPV.
![alexorue:
Gardasil May Protect Against Anal Cancer
Joe.My.God. reports:
In a small study involving HIV-negative gay men, the HPV vaccine Gardasil was shown to reduce the risk of anal cancer.
The vaccine reduced the risk of lesion recurrence by approximately 50% in the first two years after immunisation. There was some evidence that the protective effects of the vaccine waned after this point. “This is the first study to demonstrate an association between Gardasil after primary disease and decreased risk of recurrent HGAIN [high-grade intraepithelial neoplasia],” comment the investigators, who believe the vaccine may be “an effective post-treatment adjuvant to prevent recurrent HGAIN.” High-risk strains of human papilloma virus are the main cause of anal and cervical cancer. The quadrivalent human papilloma virus vaccine (Gardasil) is highly effective at preventing infection with these strains. Rates of anal cancer are elevated in gay and other men who have sex with men.
As I overshared on Facebook at the time, last month my new doctor surprised me with an anal pap smear, something his practice does routinely for all gay men over 40. My result was thankfully negative, but I mention it here to reinforce how simple and brief the procedure is. Ask for it, regardless of your age.](http://25.media.tumblr.com/tumblr_lyzdnpO6it1qcb881o1_500.jpg)
