Although the rate of most head and neck cancers has been declining over the past 30 years because more people have stopped smoking, the rate of certain cancers in the throat and mouth hasn't dropped, according to research published in the August 27 online issue of Cancer.
"Smoking prevalence has dropped dramatically, and, likewise, most head and neck cancers have declined in incidence. Cancers at the base of the tongue and tonsil are increasing or have remained stagnant. We're not seeing the reduction in incidence that we would have expected," said study author Dr Erich Sturgis, an associate professor of head and neck surgery and epidemiology at the University of Texas MD Anderson Cancer Centre.
The study authors suspect the reason may be orally transmitted HPV infections.
Oral sex not safe
"Just as cervical cancer is the outcome of a sexually transmitted disease, as are most anal and penile cancers, people need to be aware that they can get throat or tongue cancer as the consequence of a sexually transmitted disease," said Sturgis. "Oral sex can't be considered safe sex."
Head and neck cancers aren't common; they account for about 3% of all cancer cases in the US, according to the study. Each year, there are about 45 000 new cases of head and neck cancers. Cigarette smoking and excessive alcohol consumption have long been considered the most significant risk factors in the development of these cancers, said Sturgis. Between 80% and 90% of head and neck cancers can be attributed to tobacco or alcohol use.
In 2005, about 21% of Americans were smokers, down from 42.5% in 1965. The decline in smoking prevalence began in the 1970s, and about 10 to 15 years later, the incidence rates of most head and neck cancers began to decline, according to the study.
Certain cancers on the increase But the rate of some of these cancers didn't go down as quickly as others, and, in the case of cancers of the tongue, the rate has gone up. In 1995, there were fewer than 6 000 cases of tongue cancer. By 2005, that number was more than 8 000, according to the study.
Previous research has found that up to 50% of nonsmokers with throat and mouth cancers were infected with HPV, according to the study.
How people get infected hasn't been proven, but experts suspect oral sex may be the cause.
If that's the case, then the introduction of the cervical cancer vaccine for girls and women, which covers the common strains of HPV, may also help reduce the incidence of some head and neck cancers.
"We encourage the rapid study of the efficacy and safety of these vaccines in males and, if successful, the recommendation of vaccination in young adult and adolescent males," the study authors wrote.
Oral sex probable mode of transmission
"This gives us a good explanation of what we're seeing clinically," said Dr Jay Brooks, chairman of haematology/oncology at Ochsner Health System in Baton Rouge. "Engaging in oral sex probably is the mode of transmission."
Both Brooks and Sturgis said that quitting smoking and drinking alcohol in moderation are still good ways to prevent head and neck cancers but that cutting down on those two risk factors may not be enough.
"We always thought, to prevent these cancers, all we had to do was get people to stop smoking and drinking excess alcohol, and stop chewing tobacco, and that we'd eliminate most head and neck cancers," said Sturgis. But, he added, future prevention efforts will likely focus on the HPV vaccine and on safe sex practices. For now, he said, women who've had an abnormal pap smear and their partners probably shouldn't engage in oral sex. - (HealthDay News)