Let’s talk about oral sex
HPV is the cause of around 70 percent of oropharyngeal cancers, which occur in the tonsils and base of the tongue, and is most commonly transmitted through oral sex. This month, the College spoke out about the need to break down the stigma surrounding oral sex during its annual International Pathology Day event.
During the event, which focused on HPV-related head and neck cancer, Julie McCrossin AM, TV presenter and media personality, shared her personal experience with the disease. In mid 2013, she was diagnosed with stage 4 oropharyngeal cancer. She had cancer in her tonsils, the back of her tongue and the side of her throat. She was successfully treated with 30 sessions of radiation and four sessions of chemotherapy. During her presentation Julie was vocal about the need to break down the stigma surrounding oral health, encouraging people to talk openly about normal sexual behaviour.
“There is a new epidemic of HPV-related oropharyngeal cancer in the throat, tonsils and back of tongue and we need to raise more awareness about this under-recognised disease. In 2013 I was successfully treated for what was classified as stage four throat cancer at the time, which was caused by the HPV virus. I had not smoked or drunk alcohol at all for over 30 years. About 80% of Australians have HPV at some time in their life, however, in most cases their immune system destroys it. Unfortunately, for a small number of people it causes cancer.
“The HPV vaccine for boys and girls will protect future generations, but most people over 30 missed out on the vaccine. In terms of oropharyngeal cancer, the virus is commonly transmitted through oral sex, we need to be able to talk openly about this, so that people understand the link to throat cancer. We also need to publicise the symptoms of throat cancer: a persistent sore throat, earache, voice changes and lumps on the neck. Early treatment saves lives. It saved mine,” said Julie McCrossin.
Last year, it was estimated 700 Australians would be diagnosed with an oropharyngeal cancer, and around 490 of those cases will have been caused by HPV. It is estimated that at any given time 10% of men and 4% of women have oral HPV infection, although most of these are with low-risk types of HPV that do not cause cancer.
Also speaking at the event, Associate Professor Ruta Gupta, staff specialist in the Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, said,
“We are seeing an epidemic of oropharyngeal cancer caused by HPV. Our hopes are that the HPV vaccine will have a preventive effect and will protect against oropharyngeal cancer in the future, and therefore strongly recommend the vaccination. In the meantime, however, it is important that the public, as well as the medical community, are aware of HPV-associated oropharynx cancer. This particular cancer often develops nearly 20-30 years after HPV infection, which means that most patients are 40-60 years old. The most common symptom is a swelling in the neck that persists beyond 2-3 weeks but, unlike Julie, some patients may not have any symptoms related to their throat or tonsils.
“The medical community should be alert about investigating persistent neck lumps in adults with fine needle aspiration cytology/biopsy to exclude metastases from oropharynx cancer. The doctors performing the biopsies should ensure that there is adequate sample to allow HPV-related testing as this is very important to establish the diagnosis of HPV associated oropharynx cancer.”
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This article appeared in the November 2019 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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