[Question #1811] Oral hpv cancer clarification

78 months ago
Hi doctors. I've been struggling with oral cancer fear due to decisions made 20 years ago in my life. I've read some of your answers and realize that the fears are most likely unfounded but I struggle w putting it behind me. I find it very interesting that you state that someone w a very conservative sexual raising might be more likely to have these issues. I definitely fall into that category. 
My questions are 
1) the CDC website used to say that annually there was around 14k cases of oral cancer due to hpv but recently it is saying 9k. Could you explain please
2) I recently read in your posts that only hpv 16 can cause oral cancer. My wife had hpv about 13 years ago and was treated w a freezing process. It cleared the infection and has been gone since. I'm sure I gave it to her. She was not tested for the type of hpv. With that info could you make an educated guess on the probability of it being hpv16?
3) when a tumor does form would it most likely be visible by looking in ones own mouth or would it take a professional?
4) I'm 41. I don't smoke or drink. Is this something I should put completely out of my mind or something I should monitor due to the fact I had oral sex w 5 people 20 years ago?
Thank you. I apologize for the length. I will try to keep the follow ups to a minimum. 
H. Hunter Handsfield, MD
78 months ago
Welcome to the forum. Thanks for your reasoned and thoughtful question.

Perhaps you have noted the coincidence that the question immediately before yours (1810) also was about cancers caused by HPV, including oral cancer. Please read my reply there, which you should find reassuring.

One clarification:  Although media reports often refer generallly to "oral cancer" and HPV, there are several types of oral cancer and only one of them -- squamous cell cancer of the pharynx (throat) -- is regularly caused by HPV. And as you already seem to know, these almost always involved HPV16. Millions of people acqure HPV16 every year, mostly genital -- but many are oral infections. While I can't quote exact numbers, millions of people probably acquire oral HPV16 somewhere along the line. The vast majority of them never develop pharyngeal or any other oral cancer.

To your specific questions:

1) Estimating cancer rates is not a precise science. Most likely improved data became available. Or perhaps one report used a particular analytic method, or a different database than the other. Read the fine print. But the main take-home message is that either 9,000 or 14,000 means a rare cancer when you consider a population of over 300 million.

2) HPV16 is just about the most common of all genital and sexually transmitted HPV types, so there may be a pretty good chance she had it. I'm guessing maybe a 25% chance? But I stress that's just an educated guess; it could be signifiantly higher or lower. Either way, it's not something to lose sleep about. Even among HPV16 infections, the vast majority are cleared entirely by the immune system and do not cause later cancer.

3) Most HPV related throat cancers probably are suspected by dentists during routine exams. Self examination probably isn't helpful. Research is underway on whether some sort of HPV testing should be routine, e.g. after age 40 or 50. (Few oral cancers occur earlier than that.) So perhaps someday we'll all gargle for a specimen for oral HPV testing. But at this point, it isn't recommended, even though technically feasible. There is no treatment and no proof that earlier detection of asymptomatic HPV would have any benefit in preventing cancer or earlier diagnosis of it.

4) That's a pretty low number of oral sex partners -- nothing unusual at all. Even if you'd said hundreds, I would advise you to try exactly what you say yourself:  put it out of your mind. As a 40 year old male, there's probably a 50% chance that the illness that carries you off 40-50 years from now will be some kind of cancer. (Just a rough guess -- you could look this up, e.g. via the American Cancer Association.) If that happens, however, it is far more likely to be cancer of the colon, prostate stomach, pancreas, and all the other common ones than it is pharyngeal or any other cancer due to HPV.

Don't owrry about follow-ups. Don't be spooked by the assertive words we sometimes use for hyper-anxious users asking the same question the third time! Two follow-ups for clarity, and replies, are included with each new question. So fire away if something isn't clear.

Best wishes--  HHH, MD

78 months ago
Thank you for the quick response. 
My follow ups will be
1) the CDC states that sometimes there are no symptoms when one has throat cancer.  Is that something that happens very often w this particular cancer?
2) since it is so rare do I need to ask my dentist to specifically look for this problem or would he most likely find it on his own?
Thank you again. I will read the previous post 
78 months ago
Sorry. Guess I should have read the previous post first. I'm sure u get tired of repeating yourself 
78 months ago
Wow! I've been reading many of your old posts. If I need to resubmit this as a new question I will be happy to. 
You explain genitally focused anxiety and in a kind way suggest that many problems could actually be psychological. 
I am trying to put 2 and 2 together and not sure I'm correct but when I read the earlier posts and also the posts that talk about the history of how one was raised it leads me to believe that perceived problems may be guilt and anxiety issues. Am I correct in thinking that a person could think they are feeling a lump or odd sensation in their throats and it is actually just the mental aspect getting out of control?
Again I believe I've surpassed the question limit and will be glad to resubmit if necessary. 

H. Hunter Handsfield, MD
78 months ago
Well, I'm not a psychologist. I would not have considered your question as being especially anxiety driven -- at least I see no evidence of would seem to be pathologic anxiety. That said, clearly various sexual hang-ups tend to be more common in people brought up with especially conservative perspectives on life, love, and sex. Similarly, it's no accident that STD rates and unwanted pregnancy are more common in "red" states than "blue". As for whether your own symptoms are primarily the result of guilt or anxiety, two comments:  First, symptoms like those you mention certainly can be largely anxiety driven. Second, whenever someone suspects his or her own symptoms have a psychological origin, usually s/he is correct. But this isn't a medical care delivery site, and I'm not making any sort of diagnosis or judging whether all this applies to you. Anyway, you're in a much better position than I am to make this judgment about yourself.