As If We Don’t Have Enough to Think About

My work recently took me to the Multidisciplinary Symposium on Head and Neck Cancer.  Among the proceedings was a discussion of the epidemiology of oropharyngeal cancer—cancer of the throat.  Historically, this tumor typically occurred in people with long histories of smoking and drinking.  Treatment brings the prospect of disfiguring surgery, although the surgeons do great work these days, and/or a 6-7 week slog of radiation treatment, often with chemotherapy as well, and the risk of lifelong dry mouth and aspiration pneumonia, among other things.

But lately, throat cancer has a different cause—human papilloma virus, or HPV, the virus associated with cervical cancer in women, and other, less-common cancers.  HPV-related throat cancer is a sexually transmitted disease.  I don’t want to be indelicate here, but the mode of transmission is—ahem—oral sex.  And as one might expect, men (especially white men) are at greater risk, and the risk goes up directly with the number of (principally female) partners.  There are a number of things not yet fully understood, and HPV-related throat cancer has a better prognosis than smoking-related disease and may not need quite as aggressive treatment, but one still does not want to get it.  And the incidence is increasing sharply.  It’s sort of an epidemic in the U.S. and elsewhere.  Onset of the disease in one’s 40’s or 50’s, sometimes earlier or later.

Of course, one can control and greatly limit, if not eliminate, this risk by choice—specifically, chastity before marriage and monogamy afterward.  And so would and did we, like many fellow religious conservatives, raise our sons, with that council.  Or, there are vaccines, like Gardasil, initially introduced with reducing girls’ risk of cervical cancer in mind.  The Centers for Disease Control and Prevention recommend vaccination at age 11 or 12.

Now, I do not intend to re-litigate here issues over vaccination like government pressure, safety (my impression is that the HPV vaccines don’t have great risks), and the like.  And, frankly, I’m more inclined do urge vaccination for infections for which exposure can’t be so reliably controlled, with potentially devastating consequences (meningococcal disease, whooping cough).

But the public health people look at behaviors across populations, not of individuals, and given that I have heard tell that some religiously-raised kids think of oral sex as “Christian sex,” reflecting on the increasing incidence of HPV-related throat cancer leads me to think that more parents than otherwise would might want to give vaccinating their sons more than a passing thought.

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Trevor Stammers
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Trevor Stammers

Even as a medic, I struggle to understand why the number of principally female partners is put in parentheses above. It is not intuitively apparent why this should lead to throat cancer. How does a man having sex with multiple women in itself lead to this increased risk? Or am I the only one puzzled by this? Surely it is women having oral sex with multiple men who are intuitively more likely to have an increased risk or men having oral sex with male partners? I understand this is the case with the latter but not the former so yet… Read more »

Jon Holmlund
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Jon Holmlund

All I can say is that I wrote my understanding of the data as presented. I gather that it is believed that women may clear viral infections in the oropharynx more efficiently than men (for reasons not fully understood) or that viral load may differ in important ways.

Or the data may just not be complete, notably regarding risks of same sex vs opposite sex encounters.

But the gender difference in cancer incidence is real.