Michael Douglas, cancer and the growing popularity of oral sex

http://www.guardian.co.uk/film/2013/jun/03/michael-douglas-cancer-oral-sex
by Lisa Pryor

The film star's revelation highlighted the growing complexity of STDs. Should everyone avoid cunnilingus?

Michael Douglas has shared, perhaps over-shared, with readers of the Guardian, the news that oral sex caused the throat cancer he was diagnosed with three years ago. “Without wanting to get too specific,” he said, “this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus.” Could he be right?

The world of sexually transmitted infections is being turned upside down by the growing popularity of oral sex. All kinds of infections usually considered in terms of genitals are increasingly colonising the mouth. Herpes, gonorrhoea, chlamydia, and, yes, the human papillomavirus – which is implicated in cervical cancer and can cause genital warts – can be transmitted through oral sex.

Evidence of the link between HPV and oral cancer has been building for several decades. While head and neck cancers have been declining since the 1970s along with smoking rates, scientists have noticed an increase in a particular type of oral cancer. Known as “oral squamous cell carcinoma”, it is linked to the same strains of HPV known to cause cervical cancer.

Prof Andrew Grulich, who heads the HIV epidemiology and prevention program run by the Kirby Institute at the University of New South Wales, says that the majority of cancers in the back of the throat, the oropharynx in technical terms, are now caused by this virus. “Twenty years ago it was thought to be about 20% and now, depending on where you are, it seems to be 60-70%,” he says. This type of cancer is associated with having a larger number of sexual partners, and more oral sex, he says. “In terms of increased oral sex there’s solid data that an increasing proportion of people report oral sex than 20 to 30 years ago, especially for younger people.”

Older people who have oral sex are not immune. In 2010 a Taiwanese study noted the cases of two middle-aged couples, oral sex veterans with a history of more than 20 years of oral sex, where the wife was diagnosed with cervical cancer and the husband was diagnosed with oral cancer within a short period of time.

But it is not a simple case of “catching” cancer from cunnilingus. The human papilloma virus is so ubiquitous it has been found in the mouths of newborn babies. And while many sexually active adults carry the virus, very few will develop cancer.

Last year a review was published in the Journal of Sexual Medicine asking Is Oral Sex Really a Dangerous Carcinogen? Let's Take a Closer Look. Psychologist Sara E Rosenquist noted the complexity of the research, including a Finnish study of married couples which found that husbands and wives often carried different strains of the virus in their genitals and mouths, and indeed had different strains of the virus from each other, and there was no clear link with oral sex.

She concluded that: “HPV should not be a cause for concern among monogamous couples with a rich and varied sex life, as long as the sexual system remains closed and other immune compromising factors are not present. HPV becomes a concern in the context of immune system compromise and infection persistence.”

So what are oral enthusiasts to make of all this? Is it time to raid the women’s rooms of universities for all those boxes of dental dams which have been gathering dust since the 90s? Or is it time to swear off cunnilingus for good?

Nice try. The UK’s official guidelines on safer sex advice note that when it comes to spreading infections cunnilingus is less risky than fellatio, and neither is as risky as vaginal or anal sex. The guidelines admit that “while routinely advocating condom use for oral sex is unrealistic, oral sex should not be promoted as risk-free”. Ways to make oral sex safer include abstaining when you have cuts or sores on your mouth, and not brushing your teeth or flossing before oral sex.

Grulich says the good news is that cancers caused by this virus are more treatable and survivable than other oral cancers. The best news of all is that the Gardasil vaccine, which targets the virus with the aim of preventing cervical cancer, is also likely to prevent the infections which lead to these oral cancers.

As for Michael Douglas, Grulich says “good on him for going public about it and raising awareness”.

Vinegar Test Accurately And Cheaply Screens For Cervical Cancer

http://www.redorbit.com/news/health/1112863506/vinegar-test-cervical-cancer-screening-060313/

Brett Smith for redOrbit.com – Your Universe Online

In more affluent countries, Pap smear tests have been credited with an 80 percent reduction in deaths fromcervical cancer. However, costs and cultural norms have prevented India from conducting widespread testing, resulting in cervical cancer being the leading cancer-related cause of death among the country’s women.

In a new study, a test using simple vinegar was found to have a rate of accuracy comparable to that of Pap smears, providing a cheap and easily accessible screening mechanism. Researchers reported the cervical cancer mortality rate was cut by 31 percent among the 150,000 Indian women who were involved in the study, and they speculate that it could save 22,000 lives in India and 72,600 worldwide each year.

“That’s amazing. That’s remarkable. It’s a very exciting result,” Dr. Ted Trimble study-sponsor of the National Cancer Institute told the Washington Post.

To perform the test, a trained health care worker swabs the female patient’s cervix with vinegar, causing any pre-cancerous tumor cells to turn white. The worker then visually inspects the cervix using a bright light.

Researchers admitted to having difficulty recruiting volunteers in the deeply conservative country where women must often ask permission from husbands, fathers or other family members before making even routine decisions.

“Many women refused to get screened. Some of them died of cancer later,” study participant Usha Devi told the Post. “Now I feel everyone should get tested. I got my life back because of these tests.”

Beginning in 1998, the research team enrolled over 75,000 women to be screened every two years using the vinegar test. A control group of 76,000 women received cancer education at the start of the study and vouchers for a free Pap smear test. Any participants who had cancer were offered free treatment at their local hospital.

Health worker Urmila Hadkar told the Post that many women resisted the procedure.

“There was a sense of shame about taking their clothes off. A lot of them had their babies at home and had never been to a doctor,” she said. “Sometimes just the idea of getting tested for cancer scared them. They would start crying even before being tested.”

When they were performed, the vinegar-based tests proved to be an overwhelming success. The study was slated to last 16 years, but results were so positive after the first 12 that independent monitors recommended offering it to the women in the control group.

In fact, the vinegar test was so successful that the US Office for Human Research Protections initially said researchers did not adequately inform participants in the control group about Pap tests for screening. However, officials later accepted how study leaders had handled the comparison group.

Officials in India have said they are already making plans to expand the vinegar testing to a wider population.

“It’s just not possible to provide Pap smear screening in developing countries,” said Dr. Surendra Shastri of Tata Memorial Hospital in Mumbai. “We don’t have that kind of money.”

In May, two companies announced that they will drastically lower prices on HPV vaccines for underdeveloped countries, with pilot projects beginning in Asia and Africa.

HPV: the facts in the UK

http://www.guardian.co.uk/film/2013/jun/02/michael-douglas-oral-sex-cancer

• There are more than 100 variants of HPV (human papillomavirus). They appear in different parts of the body and manifest themselves in different ways – some cause warts, but most are symptomless.
• Some are spread by skin-to-skin contact, while others are typically spread during sex. When HPV is found in the mouth, it probably got there as a result of oral sex.
• HPV is common – if you're a sexually active adult, you've probably had it. By the age of 25, 90% of sexually active people will have been exposed to some form of genital HPV.
• Around 15 types of HPV are linked to increased cancer risk, but it can't be explicitly said to cause any particular cancers. It's a long-term risk factor: over years and decades the risk is increased, rather than overnight.
• It is calculated that between 25% and 35% of oral cancers are HPV-related – meaning that it seems to be involved in 1,500-2,000 diagnoses a year.
• Overall, HPV-related oral cancers are most common in heterosexual men in their 40s and 50s.
• Teenage girls in the UK and elsewhere are now vaccinated against HPV, which should in time both protect them from cervical cancers and – it's believed – future partners from HPV-related oral cancers.