Oral sex - a risk factor for oral cancer, say researchers

Hold your horses! Oral Sex can be a risk factor for acquiring throat cancer, researchers at Tata Memorial Hospital (TMH) in Mumbai say. The research paper was formulated after reviewing medical literature across the globe. 

Hollywood actor Michael Douglas, a few years ago, had admitted that the cancerous tumor lodged at the base of his tongue was apparently linked to oral sex. Human papilloma virus (HPV) which is lodged in cervix of women and causes cervical cancer, also has a role to play in head and neck cancers. 

The paper says, sexual behaviours like having unprotected oral sex, practicing oro-anal sex, early age of sexual debut or having multiple sexual partners pre-dispose those who practice it to cancer of the throat. “These play an important role in HPV transmission and infection that may result in HPV-associated head & neck cancers, which are an emerging epidemic. These patients are more likely to be younger, well -educated males from higher socio-economic backgrounds,” said Dr Pankaj Chaturvedi, Oncosurgeon at TMH. 

Head neck cancers are a significant cause of illness and death across the world causing 5.5 lakh infections and 3 lakh deaths. Just like tobacco and alcohol, Human papilloma virus (HPV) infection is now recognized to play a role. While the global incidence of head and neck cancers is declining, but the incidence of HPV related head and neck cancers is rapidly increasing over the last few decades, the paper goes on to say. 

“Due to social stigma, health professionals hesitate to inquire about and document sexual practices and are also reluctant to counsel patients regarding oro-genital contact and HPV transmission,” it states. 

The case in point is the treatment of a 30-year-old man at LH Hiranandani Hospital in Powai, few years back. “The patient had a squamous carcinoma tumour in his tonsils which we suspected to be related to infection through HPV 16. The patient didn’t smoke, drink or chew tobacco. Hence, we suspected that oral sex might have led to his acquiring the cancer in his throat. However, as the mode of treatment for all oral cancers is the same, we did not investigate further,” said Dr Wasim Phoplunkar, radiation oncologist at the hospital.

The paper says that sexual liberation is more commonly seen in Western countries and less so on the Indian subcontinent due to sexual convention. However, Indian statistics are alarming as well.  “HPV prevalence in oropharyngeal cancer was 22.8% in a north Indian population,” Dr Chaturvedi said. 

However it warns that oral sex is likely to increase in popularity as other sexual practices

are avoided for fear of acquiring HIV infection. “A study of younger age groups reported that 36%–49% of adolescents aged 15–19 were engaging in oral sex,” it states. 

The paper says that the odds of acquiring HPV infection and eventually cancer increase with the rise in sexual partners. Those patients who had HPV-positive oropharyngeal carcinoma had over twelve oral sex partners as compared to six in HPV-negative patients. It cites a case of a patient who had a history of having upto as many as fifteen oral sex partners. 

It goes on to say that a sexual behaviour study reported that young and middle-aged men and women have over 45% more oral sex than older people. It also says that males have more infection than the females. It further states that HPV-positive group of head and neck cancer patients are in younger age-groups, and are non-smokers and non-drinkers. And a ray of shining hope for such patients is that their five-year survival rate is 60% to 90%. 

“HPV 16 once lodged in the oral cavity is difficult to eliminate. The tumour manifests over several years and is only diagnosed in the third or fourth stage. Also, kissing may spread the virus to a woman’s oral cavity. Further, HPV 16 can be lodged in a man’s penis and a woman may acquire it if she is giving a man oral sex,” says Dr Mehul Bhanushali, surgical oncologist at Jaslok Hospital.  “However, the occurrence of such tumours is extremely rare; they may be one in a population of one lakh.”