Oro-pharyngeal cancer is the sixth most common cancer in the world and in some countries in south-east Asia, it’s the leading cancer. It’s traditionally caused by smoking and drinking alcohol. But in recent years, a link has been made between oral sex and the cancer. This suggests that oro-pharyngeal cancer is also a sexually transmitted disease. Researchers say by practicing oral sex, one is likely to come into contact with the human papilloma virus (HPV), which is responsible for the development of cervical cancer in women.
‘How this came to light was that we started seeing, worldwide, that there was suddenly an increase in oro-pharyngeal cancer, which was contrary to the anti-smoking campaigns ‘ lowering tobacco use, and so on. This was an anomaly. People started saying: ‘Why is this increasing and why are we starting to see it in younger people ‘ 20 to 40 years of age versus the normal oro-pharyngeal cancer figures that you see over 45?’ These were the two factors that actually brought attention to this area. It was proven then, a few years ago, that HPV virus, and specifically the number 16, can actually incorporate itself into the mucosa in the oro-pharyngeal area and cause cancer. And this virus is spread through sexual contact and, specifically, oral sex’, according to Professor Andre van Zyl of the University of Pretoria’s School of Dentistry.
Professor van Zyl says young people have become particularly at risk of the cancer.
‘In the 80s when HIV became so very big and people were so scared of getting HIV, oral sex was regarded as a dangerous pastime. And then, towards the end of the 80s, people started saying oral cancer is not a dangerous pastime for the spread of HIV. Now this meant that people turned towards oral sex more because it was regarded as a safe type of sexual behaviour within an HIV-dominated world. So, teenagers perceive it as very safe and, so, 50 % of adolescents have oral sex before they have their first coital sex’.
He recommends that young people should be taught at an early age about the risks of oral sex.
‘If you look at the studies done in South Africa, it shows that up to about 30 % of people would use condoms for their first coital sex versus 4 % for oral sex. People are not using protection for oral sex because it’s not regarded as a dangerous behaviour. And we are now saying, it should be looked at again. In fact, we actually propose that it should be taken up into Life Orientation, which is a compulsory subject at school. Children should be taught that it can be dangerous to their health’, he says.
The use of condoms for oral sex as well as partner reduction could also help protect one against oro-pharyngeal cancer. Making a point that boys and men are also at great risk, Professor van Zyl says young males should get vaccinated against the human papilloma virus (HPV).
‘If you have six or more lifetime partners in oral sex, it increases your risk dramatically. Secondly, there must be protection – condoms must be used. Young boys should also be vaccinated against HPV.
The same as young girls should be vaccinated against HPV for cervical cancer, the Centres for Disease Control and Prevention in the United States now recommends that boys also be vaccinated’.
Vaccination is crucial to prevent the spread of this growing form of cancer.
‘We know that probably about 30% of oro-pharyngeal cancers are caused by HPV, but much higher in certain instances, especially if you have the HPV 16. Once you get this virus, it will take more than 10 years before you can actually get the cancer. It’s a guesstimate by most researchers at the moment. We still expect to see the rise’, says Professor van Zyl.
He says symptoms of oro-pharyngeal cancer appear in the hidden parts of the mouth as lesions or ulcers on the soft palate of the mouth, the very back part of the tongue and the tonsilla area.
‘The cancer itself will kill’, he says. ‘And the cancer kills in not too a pleasant way because it is in an area that you use every day for speech, for swallowing. So, the quality of life is lowered dramatically once you have a cancer there that has grown too big to excise surgically or to treat with chemo-radiation. But the earlier it’s detected, the less trouble we have treating it. Many people experience a severe difficulty in breathing and, of course, swallowing is also affected very early in this cancer.
Dentists are in the best position to identify oro-pharyngeal cancer as they are specifically trained in oral care. In the next 12 months, the South African Dental Association (SADA) will run an awareness campaign to educate its more than 3000 members in the private and public health sectors about risky practices that can predispose one to oro-pharyngeal and oral cancer.
‘Specifically, we’re going to look at hubbly-bubbly, where we know that a one-hour hooka session has got 100 ‘ 200 times the volume of smoke, compared to a single cigarette. We look at alcohol and the role of ethanol in alcoholic beverages, which holds the same risk for causing oral cancer as nicotine and tobacco. We are going to look at warning signs of oral cancer to educate patients about danger signs, early detection, thereof, and how they, themselves, and their dentists could play a role in earlier diagnosis’, says SADA’s Chief Executive Officer, Maretha Smit.