How to reduce the risk of oral cancer

The fact that cunnilingus increases a man’s risk of developing oral cancer has been all over the Internet recently with Michael Douglas’ disclosure that he had an HPV-positive tumor.

To recap: some strains of human papilloma virus (HPV) are oncogenic, meaning they induce changes in a cell’s DNA that can lead to cancer. The same strains of HPV that are oncogenic in the genital tract for women, causing both cervical cancer and anal cancer, can also wreak havoc on cells in the oral cavity. As an aside, HPV can also cause anal cancer for men.

The association between cervical cancer and HPV has been known for a while, in fact the Nobel prize in 2008 was given to the scientist who proved the link. However, even before we knew about HPV women were getting Pap smears to diagnose pre-cancers, dramatically reducing the risk of death from cervical cancer. Now that we know about HPV and have tests that can detect it, cervical cancer screening has become very refined and if every woman had access to health care HPV-related cervical cancer could become a disease that we “used to see.”

Keep in mind that Pap smears and HPV testing for women are after-the-exposure surveillance. These methods prevent cancer by catching the infection before it causes cancer, they don’t prevent acquiring the cancer causing HPV virus in the first place. So, cervical cancer prevention for women also includes HPV vaccination and safe sex practices. Condoms reduce the risk of HPV transmission, but they are far from 100% effective as HPV infection is not limited to the vagina or penis (HPV infection causes what is known as a field effect, meaning the virus is often multiple places in the reproductive tract, penis and scrotum for men and cervix, vagina, and vulva for women). Safe sex practices also include limiting partners. The more partners you have, the greater your risk of exposure.

So what about preventing HPV-related oral cancer? Well, here are some strategies.

1. Don’t smoke. It doubles the risk of head and neck cancer.

2. Think of oral sex as sex. Because it is. Many people think they are being safer if they “just” have oral sex, but the reality is oral sex is an effective way to transmit sexually transmitted infections. Also, many people who use condoms for penetrative sex don’t for oral sex, so in many ways it has become and even riskier behavior. Six heterosexual oral sex partners increases a mans risk of oral cancer 8 fold.

3. Consider using a dental dam for oral sex if you are not in a long-term relationship. If you would use a condom with that partner for disease protection, then you should be considering what you can catch from other orifices as well. Although keep in mind no one knows how well a dental dam actually works in reducing exposures.

4. Go to a dentist regularly. Studies show this reduces the risk of invasive cancer as your dentist can often identify a lesion when it is small and hopefully pre-cancerous. There is no oral Pap yet or HPV test, but I wouldn’t be surprised if we started seeing some kind of screening test down the road.

5. Maintain good oral health. In one study bad dentition was an additional risk factor (distinct from dental visits). This could be that chronic inflammation from gum disease or missing teeth may increase the risk of catching the virus if exposed.

6. If you are in the right age group, get the HPV vaccine. While there are no studies that show it reduces oral cancer for men (we won’t know that for 10-20 more years at least), it does reduce the burden of HPV related genital tract diseases. The vaccine could possibly help men in two ways: reduce their risk of exposure if their partners have been vaccinated (a vaccinated woman is less likely to shed the virus) and reduce the risk of a man catching the HPV virus if exposed through oral contact.

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

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