“Dental Care with a Difference”®, PC
Where “Knowledge brings Health”®

Articles featuring Dr. Comisi



 Issue date: November 2010

HPV FACTS
Health Risks of Oral Sex
Long known to cause cervical cancer, the pervasive but often silent human papillomavirus (HPV) has been finding its way into women's mouths
ALYSSA GIACOBBE

Lydia Miner definitely didn't fit the profile. She, too, ate well, worked out, and didn't smoke or drink much. But she had a strange sensation in the back of her throat that felt like a half-swallowed pill, stuck midway. Or maybe, she thought, it was a patch of skin irritated by one of the many times she'd hurriedly choked down lunch during her hectic job as an environmental consultant in Anchorage, Alaska. "For a while I thought I was just imagining it," says Lydia, now in her forties. But after two months, she knew better.

Like Mische, she got a scan, which showed something alarming. "The doctor stared at the results, then turned to me and said, 'I've got to tell you, I think you have oral cancer,' " she recalls. Her small malignant tumor, which was later surgically removed, tested positive for HPV. Lydia was incredulous. She hadn't thought about the virus in more than a decade.

In her twenties, she'd had a series of abnormal Pap smears; however, by her thirties, her Paps continuously came back normal, and she'd forgotten all about any irregularities. But HPV is nothing if not sneaky; it can lie dormant and undetectable in the body for years, making it incredibly difficult to know if you're infected and unknowingly passing it along to others. This can also make it nearly impossible to pinpoint the partner responsible for giving it to you. (Meaning, that one-night stand you had in your teens or even the guy you dated seriously in college can come back to haunt you well into your thirties and beyond.) Though between 40 and 60 percent of guys have HPV at any given time, less than 1 percent will have visible symptoms, and there are currently no FDA-approved HPV tests for men. What all this means is that oral sex—once considered a safer alternative to vaginal sex—might not be so harmless after all.

The most obvious HPV-related oral-cancer risk factors, as you might imagine, have to do with the kind of sex you have, how often you have it, and the number of partners you've tangled sheets with. According to a study in the New England Journal of Medicine, people who have had six or more sex partners are more than twice as likely to develop oral cancer. But those who've had six or more oral sex partners increase their chances by a whopping 340 percent. As such, says Masters, HPV-related oropharyngeal cancer should be considered a sexually communicable disease. "From cases I see, I get the sense that many younger people don't think oral sex counts as sex," he says. "But oral sex has risks too."

As is the case with most STDs, the best way to protect yourself from HPV-related oral cancer is abstinence, which isn't realistic for most people. Complete honesty about your sexual history and frequent HPV testing can help, and the HPV vaccine might work too, says Francis Worden, M.D., a clinical associate professor of medicine at the University of Michigan and a leading researcher of HPV-related oral cancers. (Though, Worden notes, the vaccine's efficacy is an assumption at this point: "There's no data just yet.") Using condoms for any sexual contact—yes, including oral sex and even with a committed partner—can also help thwart the genital-to-mouth spread of HPV, though Moore concedes it's naive to think couples will commit to a lifetime of wrapped-up oral sex. (For their part, men can get oral HPV by performing oral sex on a woman with vaginal HPV, with or without using a dental dam, says Worden. Michael Douglas reportedly tested positive for HPV, and while there's no concrete link between his particular cancer and the STD, cases of HPV-related oral cancer are also rising among men.)

If this advice sounds thin, that's because it is. The fact is, a lot of HPV research still needs to be done—if it can be done at all. For one thing, determining how sexually transmitted diseases spread depends in large part on the truthfulness of patients and test subjects. "It's particularly tough to get figures on sexual habits, because you're relying on people's memories and forthrightness," says Masters.

The good news you've been waiting for: If detected early, this type of cancer is highly treatable. Compared with other forms of mouth malignancies, HPV-related oropharyngeal cancers have significantly higher survival rates, especially among nonsmokers. "For reasons we're not entirely sure of, HPV-related cancers respond better to chemotherapy and radiation," says Masters. "The majority of patients are cured not only because they are generally younger and more tolerant of treatment but also because the cancer actually behaves differently." The key, of course, is to catch it early—in most cases, this means spotting a lesion or a change in mouth tissue color or texture. It also means seeing your dentist regularly.

Tests using rinses, dyes, and different types of light are being developed to allow dentists to administer comprehensive oral-cancer screenings, but many dentists are already actively peering into patients' mouths, on red alert for cancerous signs. (While all dentists are educated in cancer screenings, not all perform them, so it's crucial to ask.) John Comisi, D.D.S., a dentist in Ithaca, New York, says he has caught dozens of lesions on female patients, many in their thirties. "Some don't turn out to be much of anything," he says. "Others turn out to be abnormal cells that over time would surely become cancerous."

"Women are really good about going for their annual Pap smears, but I don't know one gynecologist who will look in your mouth," adds Gigi Meinecke, D.M.D., a dentist in Potomac, Maryland, who performs a thorough oral exam on all of her patients. "The only place you're going to get that is at your dental office."

A good oral-cancer screening, says Meinecke, includes a comprehensive head, neck, and lower-jaw examination, as well as superficial checks of the lymph nodes, the front of the ears (where tumors can also develop), and the back of the neck. And your tongue should be thoroughly examined from every angle. "Basically, what we're looking for are subtle changes in coloration," she says.

Dental screenings aren't 100 percent fail-safe. "The biggest problem with these types of cancers is that people typically don't have a lot of symptoms, and if you can't see it or feel it, your dentist might not either," says Moore. But enlisting an extra set of trained eyes is still a worthwhile protective measure. "In my opinion, any oral abnormality should be investigated," says Comisi. "You just can't be too sure."


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