Oropharyngeal cancer is horrible. Just ask Michael Douglas. He had stage 4 disease at the base of the tongue, and cautioned in an interview that had newswires buzzing last week that the culprit was oral sex, transmitting a cervical cancer-causing HPV virus. What’s the message for you? Obviously, not engaging in it is the only sure way, and if so, make sure your partner is a virgin to avoid any risk of exposure. From a population health standpoint, though, the reality is that we know 80% of women will have at least one HPV infection in her lifetime, and for young adults, the chances of anyone you see walking down the street, or meet for dinner being infected with one or another HPV type is roughly 1/3. Of course not all of those are type 16, the one found most frequently in mouth and throat cancers, but it is obviously a high stakes medical version of Russian roulette.
There’s some preliminary research suggesting the partners of people with oropharyneal cancers are orally infected no more often than the general population, suggesting most infections are cleared. Only rarely do they persist and live on to wreak havoc in the unfortunate few. Not air tight yet, but at least a bit reassuring. Even more, this parallels the situation with cervical cancer. It’s probably a genetic susceptibility that, along with modulating factors like smoking and immune competence, differentiates who will clear the virus and who won’t, and a test not available at present.
But the news is good, especially for those who have teens and pre-teens who statistically are likely to become sexually active before marriage. Even if THEY are virgins at marriage, they are from a practical perspective unlikely to marry a sexually naïve mate. Aren’t they vulnerable to HPV infection then? That good news is the HPV vaccine. Now approved for pre-teens (starting at age 9) through age 26, Gardasil is a 3 dose vaccine that covers the 2 HPV types most likely to cause genital warts and 2 most prevalent in cervical cancers…..and found frequently in oropharyngeal cancer. Soooo…..just as a hepatitis vaccine won’t help after you’ve gotten a tainted transfusion, it’s important to be protected against HPV (at least the Big Four) before exposure. Yes, it can prevent some cancers, by preventing against infection with the virus causing these genital and oral cancers. To be perfectly precise, the vaccine is not approved for the prevention of mouth and throat cancers, but it likely will follow the pattern for cervical cancer reduction. While all this is great, make note that not ALL high risk HPV types are covered by the vaccine, only the 16 and 18 types….the ones that account for 70% of cervical cancers. So the vaccines will prevent cancer all right , but only the ones ignited by these types.
This vaccine is very safe, irrespective of what you may read, and the outcomes are tragic when people get a cancer that may have been averted. Ask your kids’ doctor if Gardasil…a 3 shot series over 6 months, is a good idea. My suggestion? Don’t tell the kids that the vaccine “prevents cancer” or “prevents genital warts”, because it doesn’t prevent them all. So it reduces the risk, but doesn’t put an impenetrable shield around them. Only mutual monogamy, from the start, can. Period. Entiendes? Let me know your thoughts.