Why Oral Sex Has Become the Primary Risk Factor for Throat Cancer

HPV spreads through sex. Having many sexual partners, especially with oral sex, increases the risk of oropharyngeal cancer. People who have six or more oral-sex partners in their lifetime are 8.5 times more likely to get oropharyngeal cancer compared to those who don’t engage in oral sex.

The incidence of oropharyngeal cancer, which targets the tonsils and the rear part of the throat, has been increasing significantly in the last twenty years.

According to the Centers for Disease Control and Prevention (CDC), around 70 percent of cases of this particular throat cancer are linked to the human papillomavirus (HPV), a virus also responsible for cervical and anal cancers.

Despite the tendency to attribute the rise to greater acceptance of oral sex in recent decades, some experts caution that there may be additional factors at play.

“One of the biggest misconceptions is that HPV-associated throat cancer is all related to oral sex,” says Neil Gross, MD, director of clinical research in the department of head and neck surgery at MD Anderson in Houston, and a specialist in HPV-associated cancers of the head and neck.

Dr. Gross explains that HPV can be transmitted through any close interaction, such as deep kissing, though a simple peck on the lips is not sufficient for transmission.

“You will find active oral HPV asymptomatic [without symptoms] in as much as 8 percent of the population,” he says, noting that only a fraction of the more than 150 strains of HPV have the ability to cause cancer.

Individuals might employ protective measures like condoms while engaging in vaginal or anal intercourse, yet they may not use such precautions during oral sex.

“I think there is just a lag in both understanding of the fact that unprotected oral sex is a risk factor for getting oropharyngeal cancer and people are likely more knowledgeable of using condoms for other types of sex,” Dr. Timbang says.

Once more, HPV can be spread through kissing and not solely through sexual intercourse. Previous studies indicated that the likelihood of HPV infection rises with the number of sexual partners, but this is primarily attributed to an increased potential for exposure, which could be reduced through the adoption of safe sex practices.

“We don’t have great data on it because clinics aren’t great at asking questions about sexual habits, but some of the data we have suggest that plenty of patients who get HPV-related throat cancer have never had oral sex,” Gross says.

The CDC reports that approximately 10% of men and 3.6% of women carry oral HPV, and the likelihood of infection increases with age due to higher exposure opportunities.

Although the extent of the vaccination’s effectiveness in individuals already exposed to various HPV strains remains uncertain, Gross emphasizes the vaccine’s proven safety, emphasizing its continued importance.

“By the time people get past puberty and through their twenties, they’ve likely already been exposed to many different types of HPV. That’s why the vaccine is recommended before puberty for girls and boys,” says Gross.

Gross talks about HPV and other viruses like the ones causing shingles and chickenpox. These viruses can stay inactive in the body for many years after someone gets exposed to them. Even though the body gets rid of the virus, its impact on your cells can last for a long time.

“It used to be, everybody got chickenpox and then a certain portion of people will develop shingles later in life. We don’t know why, but it likely has something to do with a chink in the armor of the immune systems,” Gross says. HPV likely works in a similar way. While many people can pass the virus without ever developing health issues, some will develop cancer related to the infection.

If adults who haven’t been vaccinated against HPV and were exposed to it when they were younger get vaccinated in their thirties or forties, it could boost their protection against future exposures, especially if their natural immunity is decreasing.

“I don’t really see a downside to getting it, particularly if you think you may be at higher risk,” Gross says — for example if you anticipate having new sexual partners in the future.

Throat cancer linked to HPV usually happens to people in their fifties or sixties because the cancer appears many years after getting the virus. However, due to population changes, it’s now happening more frequently in even older individuals.

“Unlike cervical cancer, where the pap smear has greatly reduced the incidence of cervical cancer, we don’t have that for the throat,” Gross explains. “So there is nothing to do but be aware of the early symptoms, live a healthy lifestyle, and avoid risky behaviors.”

The CDC says that using tobacco, whether by smoking or chewing, can lead to a type of cancer in the throat.

If you notice a painless lump in your neck or a lymph node that’s as big as a plump grape or larger and doesn’t go away, or if there’s a growth on your tonsil causing ear pain, it’s important to see a healthcare provider.