On oral sex, oral cancer, early detection

This week, a patient seemed worried when he asked me if what he read in the papers is true that oral sex could lead to oral cancer. The newspaper reports were based on a joint symposium of the Philippine Medical Association (PMA) and Philippine Dental Association (PDA) as part of this year’s celebration of National Cancer Consciousness Week.

Under PMA president Dr. Oscar Tinio’s term, and with Dr. Ramon Abarquez Jr. chairing PMA’s continuing medical education (CME) committee, the association has been active in organizing informative symposiums like this to draw awareness to noncommunicable diseases (NCDs) which are now plaguing the country and the global community, too. NCDs include cancers and cardiovascular diseases.

I didn’t pry into my patient’s reason for such a concern, but I seemed to have increased his anxiety when I told him that there’s good scientific evidence to believe that indeed, performing frequently oral sex on women with genital warts caused by human papilloma virus (HPV) could increase one’s risk to develop cancers of the oral cavity—specifically the base of the tongue and tonsils—later on.

Reported in 2007

We reported this in H&L (Health & Lifestyle) magazine sometime in 2007, months after the study was published in the New England Journal of Medicine. H&L summarizes recently published researches in major international journals and present them in a simple easy-to-understand format.

For obvious reasons, the increased risk was noted more in men than in women, but in both genders, it showed that those who reported having six or more oral-sex partners during their lifetime had a nearly ninefold, repeat, nine-fold increased risk of developing cancer of the tonsils or at the base of the tongue. Subjects enrolled in the study who were infected with HPV also had 32 times higher risk to develop this type of oral cancer than those who did not have the virus.

Previously, it was well established that smoking (three-fold increase) and drinking alcohol (2.5 times) increased the risk for oral cancer, but even if you combine them, the risk is no match compared to that seen in those who frequently engage in oral sex. So, HPV infection is not only a plague to women who could develop cervical cancer with it, but to men as well.  Just as we’re overconcerned with HIV, we should also be extra wary of HPV infection.

Alarm sounded

In the United States, they’ve literally sounded the alarm that relatively young men and women in their 30s and 40s are developing oral cancer. Experts attribute this to a “change in sexual behavior over the last decade.”

We don’t have statistics on the prevalence of oral cancer in young Filipinos, but there’s good reason to start worrying about it. In the same PMA-PDA symposium, Dr. Tinio and the other speakers reported a University of the Philippines Population Institute study showing that more than four million teens and young Filipinos are already engaged in sexual practices.

Citing findings from the third Young Adult Fertility Survey, a total of 4.32 million Filipinos aged 15 to 24 are already sexually active. Another finding is that oral sex has become a common practice “among most sexually adventurous teens.”

Doing simple math, if the expected prevalence of oral cancer in the general population is 1.5 percent, and with a nine-fold increase in risk, that means that we have approximately 583,000 young Filipinos aged 15-24 who are likely candidates to develop oral cancer.

So, how do we tackle a problem like oral sex leading to oral cancer? Tough question! It should be a combined approach of public education to generate increased awareness particularly in high-risk individuals, strengthening of values and morals, especially in the youth, preventive strategies including vaccination against HPV in women and immediate check-up of the oral cavity if any lesion is detected.

Not all oral lesions are cancerous, so one should not panic when a lesion is noted, but it’s good to be checked by an expert. Many of these cancers—if caught early enough—could be curable. There’s a precancerous stage which has a very good chance of absolute cure. It’s truly bad to be found to have oral cancer, but it’s not so bad when you catch it early and undergo the necessary treatment that can remove it permanently.

Incidentally, my patient who asked me the question requested to be referred to a throat specialist.