Michael Douglas, HPV, oral sex, and cancer of the oropharynx

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The Guardian newspaper recently published an interview saying that the actor Michael Douglas attributed his head and neck cancer to HPV (human papilloma virus) from oral sex. Douglas reportedly offered “without wanting to get too specific, this particular cancer is caused by HPV, which actually comes from cunnilingus.” Douglas’ spokesman later clarified the statement, offering that Douglas never said that was the cause of his cancer, but was discussing what causes oral cancer during the interview.

Epidemiology: HPV is the most commonly diagnosed sexually transmitted infection in the USA. It is associated with warts, as well as pre-cancers and cancers of the cervix, vagina, vulva, penis, and anus. Two vaccines are available to prevent infection with several types of HPV known to cause cervix cancer.

How: HPV is a virus that is spread by skin-to-skin contact, including sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (for example, hand to genital contact). Condoms do not appear to provide complete protection, as the do not cover all exposed genital skin. You can’t get it, though, from the toilet seat.

To vaccinate, or not to vaccinate: In the USA, HPV vaccination with either vaccine is recommended for all girls/women between 9 and 26 years old. Gardasil vaccine is recommended for boys/men between 9 and 21, and can be given up to 26 years of age. We do not know how long the vaccine works, but it appears to work at least 5 years.

Does HPV vaccine prevent other diseases from sex? No.

So, what’s the scoop on HPV and cancer of the head and neck region? Recent studies have shown a remarkable increase in the incidence of cancer related to a common virus, HPV. In fact, it is estimated that 60% to 70% of newly diagnosed cancers in one part of the head and neck (the oropharynx) are due to this virus. The specific culprit is a particular strain of the virus, HPV type 16. And yes, it

Clinical reports indicate that patients with HPV-associated cancers have improved response to treatment and survival, as compared to HPV-negative tumors. My read is that smoking and alcohol tumors have a worse prognosis, HPV-related tumors the best, and someone who smokes and is HPV positive intermediate between the two. We do not have enough data to tell us that we can de-intensify treatment for the HPV-associated tumor, however.

I’m Dr. Michael Hunter.

The fine print: This communication should not be construed as medical advice for an individual. Check with a valued health care provider for informations specific to you.

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