[Question #8502] Risks of Oropharyngeal Cancer caused by HPV

43 months ago

Hello,

I have been under a lot of distress about the possibility of oropharyngeal cancer caused by HPV. For the past month, I have been ruminating about this topic, but I don’t know if I should be.

I am a 34 year-old straight male. I started becoming sexually active when I was 28.

I performed unprotected oral sex on 5 different women. On 4 of these women, I performed unprotected oral sex only once. On 1 woman, I did so several times. I have deep-kissed about 20 different women.

Does deep-kissing with tongues involved cause oral HPV? Or is oral HPV in men caused primarily by performing oral sex?

Upon learning about the risks of getting cancer from oral HPV, I have become extremely worried. Is my risk of getting oropharyngeal cancer high?

H. Hunter Handsfield, MD

43 months ago

Welcome to the forum. Thank you for your confidence in our services.

Oropharyngeal cancer is a relatively uncommon cancer -- last I heard, around 16,000 cases per year in the US (population >300 million) -- much less common than prostate, colon, lung, pancreatic, breast, and other cancers. (You could check latest data at the American Cancer Society website, www.cancer.org.) Although the risk probably is elevated in persons with frequent oral sex exposures (but not kissing), even in those with hundreds of oral sex partners, the chance of cancer remains quite low. And many cases occur in people who never perform oral sex at all: just having genital HPV16, the main type that causes oropharyngeal cancer, raises the risk, probably because some oral infections likely occur from auto-inoculation.

This isn't to say your risk of oropharyngeal cancer is zero. But it is very low. Having apparently had a fairly conservative sex life, you could consider HPV immunization, if you haven't yet been vaccinated. There's a good chance you've been exposed to some of the 9 HPV types prevented by vaccination, but not all of them; and if you have not yet had HPV16, vaccination will be 100% protective against future infection. And since that's virtually the only HPV type that causes oropharyngeal cancer, you would be nearly 100% protected against it. Something to discuss with your primary care physician. But I would also stress that even without vaccination, your risk of pharyngeal cancer is minuscule. I really wouldn't be worried about it.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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43 months ago

I understand that most oral HPV-16 infections are cleared by the body relatively quickly and do not lead to cancer. Even if oral HPV-16 is not cleared and persists for many years, would there be a high risk of getting pharyngeal cancer?

H. Hunter Handsfield, MD

43 months ago

HPV16 is no different than other high-risk (cancer causing) HPV types: typically cleared by the immune system over 1-2 years, at least to a point at which DNA testing doesn't detect it. However, that doesn't necessarily mean the virus is gone entirely: some experts believe that HPV DNA always persists for life, whether or not in detectable amounts with current technology. To my knowledge, there are no data to answer your second question. Regardless of detectable persistence of the virus, your risk of pharyngeal cancer is very low, even if you have (or have had) HPV16. This is one of the reasons testing for oral HPV isn't recommended: whether positive or negative, for HPV16 or any other type, isn't know to be predictive: no higher risk of cancer in those with HPV16 or lower risk in those with negative testing.

But please do trust me on this: you have had a minuscule number of potential oral HPV exposures compared to many people. Your personal risk of having oral HPV16 or future oropharyngeal cancer probably is a lot lower than average. I really don't think you should be at all worried about it.

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43 months ago

Thank you, I feel more reassured.

Regarding my sex life and my possible exposure to HPV, in my first question, I emphasized only my history of performing oral sex. Overall, I have had vaginal sex with 13 women and performed oral sex on 4 of these women. On 1 other woman, I performed oral sex once in an experience with no vaginal sex. Would the HPV vaccine still provide effective protection for someone with my history?

I was a little bit unclear when you said that genital HPV raises the risk of oral cancer in men, because I thought that it is mainly oral HPV that causes pharyngeal cancer in men. It did not occur to me that genital HPV is as risky for men as oral HPV is.

H. Hunter Handsfield, MD

43 months ago

This is not an unusual or especially risky sexual history -- but it does assure you have been exposed to and undoubtedly infected with several HPV types, likely including HPV16 (since it is one of the most common of all HPV types). But the vast majority of people with HPV16 and other high risk HPV types never develop cancer as a result. (Think of it like smoking and lung cancer: smoking elevates the risk, but the large majority of smokers never get lung cancer.)

Correct that only oral HPV16, not genital, causes pharyngeal cancer. But some people who never perform oral sex test positive for HPV16 orally. The exact mechanism isn't known, but probably it occurs by auto-inoculation, i.e. transmitting the virus to the oral area after contact with genitals.

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43 months ago

So, essentially, I should not worry too much about pharyngeal cancer from HPV? My overall risk of getting it is low? Upon learning how some famous people had pharyngeal cancer caused by HPV, this topic really spooked me over a period of several weeks.

H. Hunter Handsfield, MD

43 months ago

"So, essentially, I should not worry too much about pharyngeal cancer from HPV? My overall risk of getting it is low?" Exactly the points I tried to make in all my comments above. I'm glad you (finally!) get it.

"Upon learning how some famous people had pharyngeal cancer caused by HPV, this topic really spooked me over a period of several weeks." The media are continually filled with stories of famous or infamous personalities dying of any number of cancers and other disorders, common and uncommon. The number of stories about people who had (or died of) pharyngeal cancer due to HPV has been quite low, it seems to me.

That concludes this thread. I'm glad the discussion apparently has been helpful. Best wishes and stay safe.

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