Human papillomavirus and the risk of oropharyngeal cancer

Cancers of the tongue and throat, all categorized as oropharyngeal cancers, are appearing at an epidemic rate.

The old paradigm is that such cancers most often occur in older men who drink and smoke. But this is no longer true. Now the most common cause of cancer of the tonsil and tongue is human papillomavirus (HPV). That’s right, the sexually transmitted disease. And it is occurring in ever younger people of all socioeconomic classes.

The increased rate of this cancer directly parallels the evolution in sexual practices that have occurred on our society over the past 40 years. The risk factor most strongly associated with this cancer is a history of performing oral sex, or oral-anal contact. That’s because the tonsils in the back of the throat are fertile ground for this virus. What’s truly frightening is that confidential surveys confirm that oral sex is now a popular activity amongst even kids as young as early teens.

Genital HPV is the most common sexually transmitted infection (STI) in the United States. About 20 million Americans ages 15 to 49 currently have HPV. And at least half of all sexually active men and women get genital HPV at some time in their lives. Yet many young people mistakenly think oral sex  is a “safe” sexual practice. That likely explains why this cancer is at epidemic levels.

Human papillomavirus exists in multiple forms, called types. The most virulent is type 16 (HPV16) which also causes the majority of cervical cancers. What once was a cancer of the pelvis and parts below the belt have now become an epidemic of the mouth and throat.

The only good news: the human papillomavirus vaccine includes protection from HPV16. The results of studies of populations of vaccinated young people show a remarkable degree of protection from cervical cancer and genital warts. By extension experts project that the vaccine will also prevent many oral cancers as well.

Nonetheless conversations with parents regarding administering this vaccine to their kids can be awkward. Nobody expects their kids to ever be involved with this kind of activity, so “they shouldn’t need it” the argument goes. But what about potential future sexual partners, or future spouses with a secret past?  There is also mounting worrisome evidence that this infection can also be spread by open mouth kissing. Think your kid will never do that?

The HPV vaccine has recently been recommended by the FDA for both males and females starting around the 10th birthday. Most insurers who have covered this vaccine in the past only for females will now likely cover it for males as well.

As a parent I understand there are moral, ethical, and even political arguments for and against giving your kids this vaccine. But let’s remember this vaccine is not about sex, it’s about cancer, a bad, disfiguring, painful, potentially deadly cancer.

Here’s what I and my wife have told our four kids already: sex is a special bonding relationship that should be reserved for your lifelong spouse. That is the safest way to keep such horrible things like cancer of the cervix or throat out of your future. We have also taught them that mistakes happen, and we are all capable of making bad choices.

We have chosen to vaccinate all of our kids.

“Dr. Frederick” is a physician who blogs at Dr. Fredericks Second Opinion

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