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How can you get HPV?

Consumer Reports magazine: February 2012

A few months ago, after a friend learned he had late-stage cancer of the base of the tongue and another friend died from the same disease, I knew it had to be more than a sad coincidence. Neither man was a smoker or regular alcohol drinker, two risk factors associated with squamous-cell carcinoma of the mouth and throat. That left one other likely, albeit less discussed, cause: infection with human papillomavirus, or HPV.

Researchers are discovering that this virus, widely linked to cervical cancer and genital warts, also seems to greatly increase the risk of oropharyngeal cancers—malignancies of the tonsils, soft palate, throat, and base of the tongue. They’re more than twice as likely to occur in men as in women, and the number of cases is growing to the point that medical experts have begun referring to the problem as an epidemic.

Ballooning risk

The presence of HPV in mouth and throat tumors was around 16 percent in the 1980s, then it mushroomed to roughly 73 percent in the 2000s, according to an extensive review of data from three cancer registries in the Nov. 10, 2011, issue of the Journal of Clinical Oncology. The authors of the study predict that by 2020, the number of HPV-related mouth and throat cancers will surpass those of cervical cancer, currently the focus of HPV vaccination. Middle-aged men appear to be at particular risk;  the striking growth in oral cancer cases in the U.S. in recent years has been mainly in white men in their 50s and younger.

It’s pretty well known that HPV spreads through genital contact, increasing the risk of genital warts and several cancers, including those of the cervix, penis, and anus. What some people might not realize is that the virus can also be transmitted through oral sex, the type of transmission that’s linked to oral cancers. When you consider how alarmingly common HPV infection is—at least 50 percent of sexually active men and women get it at some point in their lives, and about 20 million Americans are currently infected—it’s not hard to understand why health-care professionals have started throwing around the word “epidemic” in relation to the virus.

Those sobering statistics are one reason I decided a few months ago to have my two teenage sons vaccinated with the HPV4 vaccine, Gardasil. Approved in 2006 for girls and women ages 9 to 26, it was later approved for boys in the same age group.

In October 2011, an advisory committee with the Centers for Disease Control and Prevention took the bold step of recommending that 11- and 12-year-old boys receive Gardasil as a routine vaccine. The link between the vaccine and the prevention of oropharyngeal cancers is still under study, but the hope is that vaccinating boys will safeguard them against these cancers and other HPV-related conditions and, by reducing the transmission of the virus, also provide indirect protection to women.

The idea of vaccinating children against something transmitted through sexual contact is controversial, but it’s the best weapon we have at this time against HPV-related cancers. And clinical trials have found that the vaccine is generally well tolerated and at least as safe as other routinely recommended vaccines. Based on the scientific evidence, many of my physician friends are vaccinating their children, too.

What you can do

If you’re older than 26, Gardasil isn’t an option because it’s approved only for children and young adults. But there are other precautions you can take to reduce your chances of HPV infection and oral cancers—or to catch such cancers early, when they have a greater chance of being successfully treated.

  • Stay in a monogamous relationship; otherwise, use condoms for any sexual activity, including oral sex. They’re not foolproof, but they may reduce the risk of HPV.
  • Be sure that your regular dental visit includes an oral soft-tissue exam. Because the base of the tongue lacks pain fibers, tumors in this area often cause no symptoms until they’ve grown significantly.
  • Go to a doctor if you see or feel any suspicious, persistent lumps in your neck or if you experience difficulty swallowing, an unexplained weight loss, or pain in your mouth or ear.
  • Be on the lookout for signs of genital HPV infection: warts, blisters, sores, ulcers, white patches, or other abnormalities. Even if they don’t cause pain, you should see your doctor immediately.

Orly Avitzur, M.D.

Medical Adviser

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