Examining The Link Between Oral Sex And Oral Cancer

Media spotlight on HPV

Actor Michael Douglas recently garnered a great deal of attention when he linked his 2010 oral cancer diagnosis with the Human Papilloma Virus (HPV), which he claims he contracted by performing cunnilingus:

Xan Brooks: “Do you feel, in hindsight, that you overloaded your system? Overloaded your system with drugs, smoking, drink?”

Michael Douglas: “No. No. Ah, without getting too specific, this particular cancer is caused by something called HPV, which actually comes about from cunnilingus.”

Although Salon.com and feminist lifestyle site Jezebel dismissed Douglas’ statement as an obnoxious boast about his sexual prowess, this kerfuffle has served to raise awareness that HPV puts men as well as women at risk for certain types of cancer. Douglas’ claim lends support to The Center for Disease Control and Prevention’s (CDC) 2011 recommendation that males, as well as females, should be vaccinated against cancerous strains of HPV.

Basic facts about HPV and Cancer

  • There are approximately 40 strains of HPV that affect the mouth and genitals, and about 15 strains are known to be linked to cancer. HPV strain 16 is most commonly associated with oropharyngeal (throat and neck) cancers. It is entirely possible that HPV contracted through oral sex was a contributing factor to Douglas’ cancer diagnosis.
  • HPV is present in about 90% of sexually active people by age 25, and almost all sexually active people will contract it at some point in their life. The virus can be spread through kissing, oral sex, and genital to genital contact.
  • The good news: 98% of HPV infections clear up within a few years of exposure in people with healthy immune systems. The remaining 2% of persistent infections are a risk factor for oropharyngeal, cervical, anal and other cancers. HPV-related cancers typically appear 20-40 years after initial exposure.
  • Head and neck cancers are very rare, affecting about 1 in 10,000 people. However, the prevalence of oral squamous cell carcinoma, a type of cancer potentially related to HPV exposure, has tripled in the past twenty years . Fortunately this type of oral cancer appears to be more responsive to treatment than others.
  • Men are about three times as likely to have an oral HPV infection than women, and also three times more likely to develop oropharyngeal cancers as a result. This gender-based disparity is not well understood.

Who is at risk for HPV-related oral cancer?

  • The presence of HPV in the mouth is less problematic than the persistence of HPV. In 98% of cases, the immune system will clear HPV within 1-2 years. It is when the body does not clear HPV that it becomes a risk factor for cancer. People with compromised immune systems are at greatest risk for cancer resulting from HPV.
  • Large numbers of sexual partners over a lifetime seems to increase the risk for HPV-related cancers. A 1991 study indicated that men with 30 or more oral sex partners over their lifetime were 2.4 times more likely to develop oral cancer than those with 4 or fewer partners.
  • Michael Douglas was incorrect when he stated that his history of smoking and other unhealthy lifestyle behaviors was unrelated to his oral cancer diagnosis. Even if smoking was not directly to blame for his specific diagnosis, the National Cancer Institute lists smoking as a major risk factor for developing HPV-related cancers.

Reducing the risks of HPV

  • Vaccination should be the first line of defense against HPV, if possible. The CDC states that HPV vaccines Cervarix and Gardisil are “licensed, safe, and effective,” for use for both females and males between the ages of 9 and 26. Both vaccines protect against cancer-related HPV strains 16 and 18. Gardisil also protects against strains 6 and 8, which can cause genital warts. Consider vaccinating your children against HPV, and receiving the vaccine yourself if you are age 26 or younger.
  • Ask your dentist about oral cancer screening. Women should also receive regular pap smears to screen for cervical cancer.
  • A healthy immune system is key for preventing persistent HPV infections. Cut out drinking and smoking and boost your immune system with regular exercise, sleep and a healthy diet.
  • Consider practicing monogamy. In a 2012 meta-analysis of research related to oral sex and cancer, Rosenquist states:

HPV infections occur commonly and are usually cleared within 18 months, thus HPV infection should not be a cause for concern among monogamous couples with a rich and varied sex life as long as the sexual system remains closed and other immune compromising factors are not present.

  • Individuals with multiple sexual partners should practice safer sex. Use condoms for all types of insertive intercourse, and dental dams or another barrier while performing cunnilingus. Avoid oral sex when you have cuts or sores on your mouth or genitals. Avoid flossing, brushing or using alcohol-based mouth wash directly prior or after oral sex.

Oral Pursuits: A Barrier Is A Good Thing